CONTEXT

• Recent reshuffle in the cabinet has given India a new Union Health Minister.
• The editorial emphasis on what does the new Health Minister need to learn from previous experience, and what unfinished tasks need to be taken forward. 

TWO STATES AND COMPARISON

• The availability of functional public health systems, for any population is of most importance.
  • This is evident by comparing two States which currently have the highest number of COVID-19 cases in India — Maharashtra and Kerala.
• The per capita gross State domestic product (GSDP) of both the states, reflect similar economic situations in each State.
  • However, their COVID-19 case fatality rates are hugely different —such that a COVID-19 patient in Maharashtra has been over four times more likely to die when compared to one in Kerala.
• A major reason for such critical divergence is likely to be the huge differences in the effectiveness of public health systems.
  • Kerala has per capita two and a half times more government doctors, and an equally higher proportion of government hospital beds when compared to Maharashtra,
  • Also Kerala allocates over one and half times higher funds on public health every year.
• Hence, despite Maharashtra having a large private health-care sector, its weak public health system has proved to be a critical deficiency.
  • In contrast, robust government health-care services in Kerala have translated into: a more effective outreach, timely testing, early case detection and more rational treatment for COVID patients, which all together reduce fatality rates.

WHERE SHOULD BE THE FOCUS?

Immediate attention to National Health Mission:

• A larger programme which requires the immediate attention of the Health Minister is the National Health Mission (NHM) as:
  • Since 2017-18, Union government allocations for the NHM have declined.
  • Thus, resulting in inadequate support to States for core activities such as immunisation, while systemic gaps affect the delivery of COVID-19 vaccination.

Doubling of the present central health Budget:

• The condition of the National Urban Health Mission (NUHM) remains pathetic.
  • This year’s Central allocation for the NUHM is ₹1,000 crore, which is less than ₹2 per month per urban Indian.
• As recommended by the Parliamentary Standing Committee, the Government must allocate ₹1.6-lakh crore for public health during the current year for reaching National Health Policy targets.
• Thus doubling of the present central health Budget, could enable major strengthening of health services in rural and urban areas across the country.

Private sector regulation:

• The COVID-19 pandemic has highlighted the  need of regulating rates and standards of care in the private sector.
• The massive hospital bills by this sector have caused untold distress among the poor and middle class.
• The ‘Remdesivir panic’ was caused due to major overuse of this medicine by unregulated private hospitals, despite the drug lacking efficacy to reduce COVID-19 mortality.
• Although various determinants have contributed to the Mucormycosis outbreak, irrational use of steroids in COVID-19 patients, especially diabetics, appears to be an important factor.

Ineffective implementation of the Clinical Establishments (Registration and Regulation) Act (CEA):

• Despite accumulating evidence on the need for comprehensive regulation of private hospitals, the central government is yet to take necessary steps to promote the implementation of the Clinical Establishments (Registration and Regulation) Act (CEA).
  • This Act is not yet effectively implemented due to a major delay in notification of central minimum standards, and failure to develop the central framework for regulation of rates.
• Learning from stark market failures during the COVID-19 pandemic, comprehensive regulation of private health care in public interest must be a critical agenda for the new Health Minister.

Curb further privatisation of health care:

• NITI Aayog has recently published the document, ‘Investment Opportunities in India’s Healthcare Sector’. This document promotes further privatisation of health care.
• The report fails to acknowledge the negative aspects of unregulated private health care; neither is there any mention of the need for regulation of private hospitals.
• Therefore, such recommendations can prove to be detrimental in the current situation considering the fact that India already has one of the most privatised health systems in the world.
• The Health Minister must assert his authority to stop further privatisation, which might benefit healthcare corporations and be damaging for ordinary people.

CONCLUSION

• • Existing evidence from the COVID-19 pandemic provides a clear message- a neglect of public health systems can mean large-scale, avoidable losses of lives.
    • Hence, public health services must be upgraded rapidly and massively as a topmost priority.
  • Building people’s trust in public health systems is critical.
    • This would help in overcoming vaccination hesitancy while strengthening the promotion of healthy behaviours necessary to deal with the current wave of COVID-19 and prevent a third wave.
  • This would be done best if the new Health Minister acts on three core health system lessons of the COVID-19 pandemic —

• a need for strengthening public health systems;

• regulating private health care,

• preventing further privatisation of the health sector.

Reference:

1. https://www.thehindu.com/opinion/lead/india-needs-a-renewed-health-care-system/article35372730.ece