Building a robust healthcare system
NEWS In the wake of the COVID19 pandemic, there have been vociferous demands to strengthen the country’s public health system so that we are better prepared to handle such emergencies in the future.
HOW CAN PUBLIC HEALTH SYSTEM CAN BE JUDGED?
The efficacy of the public health system varies widely across the country since it is a State subject. A good public health system can easily be judged just by looking at certain health parameters such as Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate for which annual surveys are conducted through the Sample Registration System.
- With the numbers given in the chart, it is doubtful whether India will be able to achieve Goal 3 (good health and well being) of the Sustainable Development Goals (SDGs) set by the United Nations General Assembly in 2015.
- We have already failed to achieve the earlier Millennium Development Goals because of the poor performance of the northern States.
PERFORMANCE OF NORTHERN Vs SOUTHERN STATES
- The Northern States are performing very poorly in these vital health parameters.
- In Madhya Pradesh, the number of infant deaths for every 1,000 live births is as high as 48 compared to seven in Kerala. In U.P. the Maternal Mortality Ratio is 197 compared to Kerala’s 42 and Tamil Nadu’s 63.
- The percentage of deliveries by untrained personnel is very high in Bihar, 190 times that of Kerala.
- Another vital parameter that has an impact on poverty, Total Fertility Rate, is very high in Bihar (3.2) against the stabilisation rate of 2.1.
- Tamil Nadu and Kerala have done so well that their population will decline over the years. This has been made possible due to effective Maternal and Child Health and Family Welfare services provided by these States.
- Some of these States are performing so poorly that they are comparable to the poorest countries in the world, pulling down the average for India.
WHAT NEEDS TO BE DONE?
- Unless all the States perform well, there will be no dramatic improvement in the health system .
- Funds allocation by the Finance Commissions should be done based on performance unlike the present method in use.
- Clear focus and better governance are required to address the situation.
- Taking examples from the southern states, the Government of India needs to focus on public and preventive health by holding the district health administrations accountable to the SDGs.
- Ensuring better primary and preventive health care services.
TAKING EXAMPLE FROM TAMIL NADU
- The Southern States made these significant strides in healthcare because of the will of the political leadership which was interested in the health and well being of the people.
- The district administration was spearheading these health initiatives because of the government’s focus and drive.
- The government encouraged a healthy competition among the districts by giving prizes to the well performing ones.
- By the 1990s, family planning drives were no longer necessary, and all that was needed was some finetuning of the Maternal and Child Health programme.
- The result is that the Total Fertility Rate of Tamil Nadu is among the lowest in the country (1.6) comparable to that of Germany (1.57) and Japan (1.43). In addition to it, good administrative structure helped to deliver the demands of the political executive, benefiting the people of the State.
Unless we invest in human capital, FDI will not help. It will only increase the wealth of the already wealthy and accentuate income disparity. Thus, investing in health and education is the primary responsibility of any government. It is time the governments — both at the Centre and States — gave health its due importance. Improving health of such a large population requires concerted efforts over years.