The new government has begun well on health, listing it as a major priority and signalling its intent to tackle the varied determinants of population and health, alongside improved provision of healthcare. It was propitious that the first 10 days of the government included the World No Tobacco Day (May 31) and the World Environment Day (June 5), providing an opportunity for the country to hear clear policy articulation on these health concerns from the prime minister and Union health minister.
Traditionally, health ministers have been reluctant to engage with other sectors to ensure that their policies and programmes enable, not erode, the health of the population. They have usually seen provision of health services for illnesses as their remit. Water, sanitation, nutrition, air quality, road safety and physical activity in urban environments are all critical to health. Fortunately, we have in Harsh Vardhan, a Union health minister, who combines a public health perspective with the political will needed to tackle these difficult but necessary engagements with other ministries.
From ‘greening’ of hospitals to scaling up of trauma services, and from free provision of essential drugs to financial protection against healthcare related impoverishment, the minister has laid out an ambitious but achievable agenda of action. He has wisely acknowledged the need to consultatively engage the states for accelerating concerted action to advance the implementation of the National Health Mission.
The announcement that public health education will be promoted through new schools of public health is welcome. Such education must, however, be inter-disciplinary and health system connected, features which most medical colleges have failed to build into their programmes. To be effective, public health education and research must integrate knowledge from life sciences, quantitative sciences (epidemiology, biostatistics, and demography), social and behavioural sciences, economics and management sciences, with linkages to law, engineering, agriculture and information technology. The minister has to ensure that such a template emerges in the proposed new institutions. He also has to speed up the process for creation of public health cadres, as proposed in the 12th Five-Year Plan.
The decision to craft a new national health policy (NHP) will help set the principles, priorities and course coordinates for actions needed to improve India’s aggregate health indicators and bridge the health inequities that exist among different population groups. This will not only help to revamp and integrate the many national health programmes but will also unify the central and state governments on a comprehensive strategy that addresses the social determinants of health along with universal health coverage.
The new NHP must be guided by the need to provide all countrymen with comprehensive primary health services, with adequate linkages to advanced care.
The minister has correctly described the Rashtriya Swasthya Bima Yojana (RSBY) as useful but not sufficient, for providing essential healthcare to all people with assured financial protection. The challenge is not only to expand the ambit of the RSBY but, more importantly, to unify all Centre-and state-funded health assurance schemes into a single-payer system that is nationally portable. Without such a framework, the health mission will be incomplete, fragmented and unable to overcome the pitfalls of the traditional health insurance programmes.
For all of this to happen, the prime minister and Union finance minister have to ensure greater public funding for health, beginning with the coming budget. No doubt, there are fiscal constraints. However, the past experiences of South East Asian nations and Mexico clearly demonstrate that when nations increasingly invest in the health and education of the people even when the economy is experiencing a slump, it will help the economy to quickly rebound and surge on the strength of the country’s human resources.
K Srinath Reddy is president, Public Health Foundation of India
The views expressed by the author are personal