In the recent year, the health and economic growth linkage has become an important rationale and rallying point for countries to work towards advancing Universal Health Coverage (UHC) by focusing on improving services provisions and developing mechanisms for financial protection. India has also committed to achieve UHC as part of the country’s National Health Policy 2017 (NHP-2017) .

Improving Health Services:

• There have been initiatives by both Union and State governments in India to improve health outcomes.
• First, the National Rural Health Mission (NRHM) and then National Urban Health Mission have created foundation for strengthening provision of health services in India.
• Ayushman Bharat Program (ABP) has components to strengthen primary health care and health insurance for 40 per cent of the poorest families in India.
• Better health of people is intrinsically linked to and contributes to economic growth and overall development of a nation. Health is a social contract between people and government.
• The global discourse on advancing universal health coverage is an opportunity for the governments at all levels to increase government spending on health, improve overall health services provision; make provision of public health services; and to develop mechanisms for providing financial protection.

Broad Ranging of Health Services:

• Improving health outcomes requires provision of a broad range (promotive, preventive, curative, diagnostic, and rehabilitative) of health services available to all citizens. India has a mixed health care system, where private sector provides majority (75 per cent of out-patients and 65 per cent of in patient) if health services (NSSO, 2014). One of the challenges in private sector dominant mix health systems is that the private sector incentives are very differently aligned from population health needs. The private sector mostly focuses on care for sick people and provision on curative and diagnostic services and risk the system becoming curative focused. Therefore, the onus lies on the government to intervene to ensure sufficient supply of all types of health services with special focus on preventive, promotive and other public health services. Considering that the government is, in most settings the only provider of such services, there is need for rapid increase in spending in public health services in India, as recognized in NHP 2017 as well. In addition, there is need for setting up public health management cadre by all states of India.

Increasing Government Spending

Globally, the average government spending on health as a proportion of GDP stands at around 5 per cent and in terms of proportion of government budget at 10 per cent. The level of government expenditure on health in India, is around 1.15 per cent of GDP and nearly 4 per cent of government budget.

The NHP 2017 proposed (a) to increase government funding to 2.5 per cent of GDP by year 2025 and (b) that states should spend 8 per cent of their budget on health by 2020. The current level of spending on health by states is variable and most spend around 5 per cent of state budget on health. Considering that Union to State government share in health expenditure is nearly 1:2, there is need to increase budgetary allocation by both Union and States to achieve NHP 2017 target in India.

Interim Budget

‘Healthy India’ has been identified as one of the 10 dimensions under Vision for India by 2030.

Way Forward

• Put Primary Health care (PHC) first: The government spending on PHC makes health services efficient; reduces the cost and helps in delivery of preventive and promotive health services, The PHC system can tackle up to 80 per cent of health needs and can reduce the need for specialized health services. Indian states have an elaborate network of primary healthcare facilities. There is need for boosting and rapid strengthening of the PHC system in India
• Focus on Financial Protection and not ‘National Coverage’ only: India needs to learn from experiences in other countries and design and implement mechanisms where coverage from health insurance schemes will reduce both catastrophic expenditure and out of pocket expenditure (OOPE) and would contribute to improved health outcomes.
• Indian States to Take Lead and Innovate: Health is a state subject as per Indian constitution. The experience from National Health Mission (NHM) has pointed that Union Government led initiatives can only be guiding and catalytical. The impact of Union Government led health initiatives is dependent upon leadership and additional measures by the state government. There is need for stronger engagement and ownership at state level, to transform health outcomes in India.

Conclusion

In a federal system such as India, the build upon existing/ongoing initiatives with recent focus and attention on improving health outcomes and financial protection in India, it is another opportunity to pave the path to better health outcomes as well as sustained rapid economic growth in India.

TID-BITS:

e-AUSHADHI portal for online Licensing System of AYUSH Medicine

• The e-AUSHADHI portal is for online licensing of Ayurveda, Siddha, Unani and Homoeopathy drugs and related matters.
• This e-portal is an acronym for Ayurveda, Unani Siddha and Homeopathy Automated Drug Help Initiative and will not only aid the licensing authority, manufactures and consumers, as it will provided real time information of the licensed manufactures and their products, cancelled and spurious drugs, details of the concerned authority for specific grievances.