The unsatisfactory performance of an under-funded public health system (PHS) often creates the impression that India can do without it. By believing in such a thought process, we are not only justifying a larger role for the private sector in the PHS but also overlooking the rich and positive
experiences of China, Brazil, Thailand, Mexico, Cuba and Sri Lanka as well as the successes of the Kerala and Tamil Nadu models that have brought down mortality significantly in these states.
The Srinath Reddy Committee Report on Universal Health Coverage has recommended the strengthening of the PHS and has also laid out a framework for enlisting non-governmental health providers for achieving India’s public health goals. But recent reports suggest that the Planning Commission does not agree with the Reddy Committee Report. This is worrisome.
Health is not just about antibiotics and hospitals. It is also about clean water and public hygiene. To achieve the goals of a PHS, we need community and public education and access to primary healthcare.
The National Rural Health Mission (NRHM) is making this kind of holistic effort. Thanks to NRHM, there has been a faster rate of decline of the Infant Mortality Rate (IMR) between 2007 and 2011. In states like Bihar, from a meagre two-point decline in 2003-07, the 2007-11 period has seen a remarkable 14-point decline. Even a better performing state like Tamil Nadu has made good use of NRHM funds to improve its IMR record.
Yet, critics often fail to see the obvious link between a dip in IMR rates and the NRHM. But independent studies of key inputs from the NRHM — immunisation, institutional deliveries, ante natal care, post-natal care, early initiation of breast feeding — have led to good outcomes even in poor-performing states like Orissa, Rajasthan, Madhya Pradesh, Assam, Bihar, Jharkhand, Chhattisgarh, Uttar Pradesh and Uttarakhand. The NRHM is reviving the PHS. Take for example, the per month OPD figures for Block Primary Health Centres in Bihar. From 39 per month in February 2005, it is now over 8,500 per month in 2011.
Thanks to NRHM, doctors, nurses and managers have been inducted into the system; government facilities are now being subjected to accreditation; and protocols are being enforced. There is a thrust on generic drugs through a Tamil Nadu Medical Services Corporation-like arrangement in a few other states. Dengue, encephalitis, tuberculosis, malaria and all other public health challenges require community-led responses. Even surgical care in hospitals requires the countervailing presence of a functional PHS. The gate-keeping role of the PHS is required as unwanted hysterectomies/surgeries have been reported from many states. The message is clear: strengthen the PHS, fund adequately, innovate and improve accountability and provide service guarantees.
Amarjeet Sinha is a civil servant
The views expressed by the author are personal
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