Shahid Akhter, Editor-in-Chief, ETHealthworld, spoke with hunting vermaformer Health Secretary, GOI, for his views on various health policies, initiatives and infrastructure.
National health policy
I think the national health policy is a very welcome step. It was formulated in 2017. But I think it needs to be enforced because we’ve talked a lot about these things, but until it’s enforced it will remain on paper. And a lot of discussions are going on. For example, the policy says we will spend 2.5% of our GDP on health care by 2025. But I don’t see that happening. In fact, the health budget has been reduced. So we really have to put our money where the mouth is or we really have to follow the chops, as they say. It is therefore important that everything initiated by the government is applied. It must therefore be made legally enforceable.
Sanitary standards for infrastructures
As far as health standards for infrastructure go, I think they are set centrally, which is the wrong thing to do because every state is different. And within the state, there are so many differences. So it will be very important, and also, health is a matter of state. It is therefore very important that each State determines for itself the number of PHCs it should have, the number of sub-centres, the number of CHCs, etc. So, I would like infrastructure standards to be very broadly defined, and it would be up to the states to do that kind of micromanagement on those and decide where to put what infrastructure.Health: collaboration between States
I think there is a great need for collaboration between states, because some states in the south, for example, have been very successful in the area of health care. Some of their interventions like hospital cooperation for all purchases have been taken up by other states like Rajasthan, but we really need to take the best practices from each state and bring them to the national level. Maybe the Niti Aayog or some other national body could do that. And then that would be a win-win situation and a learning curve for all post-COVID states.
Healthcare: After COVID-19
There’s been a lot of soul-searching and also thinking about how the whole system fell apart during COVID. because the infrastructure was simply not able to support the huge load. So I think that will get states thinking about how to build infrastructure. Also, I think it will give a huge boost to telemedicine. Because we saw that even in places like Delhi people were contacting doctors over the phone, making payments over the phone and receiving treatment and diagnosis over the phone itself, and the way to fight COVID was mostly by telephone. So I think that’s the way to go for the future.
I think Ayushman Bharat was definitely a game changer in that he brought health insurance into the limelight and gave health insurance to the poorest of the poor. And the second aspect was the wellness centers. But I think the tracking was not as accurate as it should have been, due to the sheer scale of the project. There are more than 1.5 lakh centers, sub-centers and PHCs which are expected to become health and wellness centers. There must be a very precise type of program phase, and a follow-up from the base to see how it is done because it is very, very ambitious, I find that it is still lacking. And of course the community involvement has to be there. Many NGOs have also entered the fray, and they are doing good work. But overall, I think the control aspect needs to be strengthened.
Primary health care
Primary health care has really been neglected by all states, with the result that about 70% of our population actually goes into the private sector. If you look at the bigger picture, that’s a very sad commentary on the state of things. This will only improve when the States, as well as the centre, commit to reaching this 2.5% of GDP. We are grossly underfunded unless funding improves. I do not see primary health in primary health care having the importance it deserves.
NGO in the field of health
I think health NGOs have a very big role to play because community participation is something that we have been trying from the beginning of our planning programs and not really having much success. Thus, NGOs can really intervene where health systems are weak. For example, I saw a health center run by WISH, where telemedicine is combined with an automatic medicine dispenser called Swasth ATM, in one of the remote areas of Rajasthan. They partnered with Jaipur Medical College. So they were able to show the patients directly via telemedicine to these doctors who sit in Jaipur. And as soon as the drug was prescribed, if it was available, it was made available to those patients the same day. So it was a wonderful demonstration of how NGOs can strengthen our infrastructure, which is sorely lacking.
Association with WISH
My association with WISH, which is the Wadhwani Initiative for Sustainable Healthcare, dates back a few years when Mr. Sunil Wadhwani first approached me. He’s like a mini Bill Gates. He made his money in IT in the United States. And he reinvests it, selflessly, in the health of Indians across the country, with the colossal ambition of touching over a million lives. So he struck me as someone who was really committed and genuine, and we find very few people like him these days. And I think WISH is doing a great job.
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