Introduction

Global experience shows that with the right public policies focusing on agriculture, improved sanitation, and women’s education, one can have much better health and well-being for its citizens, especially children. World Bank data shows a secular decline in poverty in India from 45.9 per cent to 13.4 per cent between 1993 and 2015.

India has been making progress in the first two SDG Goals in reducing poverty and hunger. The real challenge for India, however, is to achieve the third goal of good health and well-being by 2030. India’s performance in this regard, so far, has not been satisfactory.

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Current scenario in Health and well-being

• Nutrition: In 2015-16, almost 38.4 per cent of India’s children under the age of five years were stunted, 35.8 per cent were underweight and 21 per cent suffered from wasting (low weight for height), as per the NFHS-4.
• Women Health: Anemia is widespread in India-58.6% of children, 53.2% of non-pregnant women and 50.4% of pregnant women were found to be anaemic in 2016, as per the NFHS.
• Disease Burden: As per the ICMR’s “India: Health of the Nation’s States” report, contribution of Non-Communicable Diseases (NCDs) to total death in the Country was 61.8% in 2016, as compared to 37.9% in 1990.
• Health Expenditure: India’s expenditure on the health sector has risen meagrely from 1.2 per cent of the GDP in 2013-14 to 1.4 per cent in 2017-18. The National Health Policy 2017 had aimed for this to be 2.5% of GDP
  • According to the latest National Health Accounts (NHA) estimates released on Wednesday, patients bear a big chunk of health expenses, as high as 61 per cent of the total health expenditure, by themselves.

Key Factors to achieve Health and Well-being in India

A study by ICRIER made emphasis on four key areas

• Mother’s education: It is one of the most important factors that has a positive multiplier effect on child care and access to healthcare facilities. It also increases awareness about nutrient-rich diet, personal hygiene among others.
  • This can also help contain the family size in poor, malnourished families.
  • Thus, a high priority to female literacy, in a mission mode through liberal scholarships for the girl child, would go a long way towards tackling this problem.
• Sanitation and Drinking Water: Most morbid diseases are connected to drinking water and sanitation, especially in rural areas and urban congested slums. Here, Swachh Bharat Abhiyan and Jal Jeevan Mission can have a huge impact on well-being by preventing diseases through oral-faecal route.
• Nutrition and Diet: There is a need to shift dietary patterns from cereal dominance to the consumption of nutritious foods such as livestock products, fruits and vegetables, pulses, etc.
  • But they are generally expensive and their consumption increases only by higher incomes and better education.
  • Diverting a part of the food subsidy on wheat and rice to more nutritious foods can help.
• Bio-fortification: India must adopt new agricultural technologies of bio-fortifying cereals, such as zinc-rich rice, wheat, iron-rich pearl millet, and so on.
  • The Indian Council of Agricultural Research (ICAR) has to work closely with the Harvest Plus programme of the Consultative Group of International Agricultural Research (CGIAR) to make it a win-win situation for curtailing malnutrition in Indian children at a much faster pace.

Steps to be taken

• The current approach requires re-emphasizing the missing priority on PHCs and CHCs for developing comprehensive primary care. Achieving comprehensive primary care requires a paradigm shift from disease-control vertical programmes to community-led, people-oriented primary care.
• Sharper focus in the resource-starved states should be on improving efficiency in spending without compromising equity, and this can be attained by designing programmes that would cover a large number of people and a wide range of diseases.
  • For example, POSHAN Abhiyan to be strictly rolled out in BIMARU
• Since the states have higher responsibility than the Centre in matters related to health, the blueprints of primary care can further be redefined in view of the local needs. This should be the policy agenda for the low-performing and resource-constrained states.
• It is relevant to develop low-cost primary care service delivery models involving nurses and allied health professionals which can lower the burden on the public health system marked by the stress of a low doctor-strength.
• India needs to design health services to meet local needs with the opposite referral mechanism to secondary- and tertiary-care, and this can produce better health outcomes with a considerable cost-advantage.
  • In this context, the role of public health professionals, those who can help design outreach and preventive programmes and implement the continuing health programme effectively, assumes paramount importance. Eg: Telemedicine
• India lacks the required number of public health professionals. The shortage is severe in many parts of the country, especially poorer states like Odisha, Jharkhand, Chhattisgarh and Rajasthan.
  • The focus should be to train a pool of social workers, psychiatrists, counsellors with public health orientation who could then transform the primary healthcare delivery system in the country.
  • Ayush doctors can prescribe Allopathy medicines after a bridge course.

Conclusion

Approximately, 51% of total government expenditure on health is spent on primary care. This needs to be stepped up to at least two-third of the government expenditure as suggested in the health policy document of India. Reorienting resources towards population-based preventive programmes will help set the allocation of scare resources for larger social benefits right.