K V Venkatasubramanian
India has made remarkable progress in healthcare; the nation is much healthier today. Several diseases including polio, smallpox and guinea worm have been eradicated successfully. Besides, there is a sharp reduction in IMR (infant mortality rate), MMR (maternal mortality ratio), low mortality due to TB and malaria and significant decrease in HIV infections and AIDS-related deaths.
Healthcare, one of the largest sectors, is growing at a brisk pace due to its strengthening of coverage, services and increasing expenditure by public and private players. Alongside, social trends and growing urbanisation are leading to rapid spread of non-communicable diseases such as heart ailment, diabetes and cancer. With the population ageing, the elderly will account for nearly 11 percent of the citizenry in 2025. Consequently, there is a demand for greater access to quality care. But expensive treatment costs are making it difficult for uninsured citizens to afford care.
To reduce health inequities and improve healthcare infrastructure, the government recently launched the National Health Policy 2017. It aims at achieving universal health coverage and delivering quality health care to all at affordable cost. It intends to expand access to medical facilities, make it affordable by reducing treatment costs and improve quality. In a major departure from the past, the policy strongly recognises the role of the private sector in expanding healthcare.
The policy will provide a comprehensive primary healthcare package which includes major non-communicable diseases, mental health, geriatrics and also palliative and rehabilitative care. Primary healthcare will get two-thirds of resources. Public spend on health would be raised to 2.5 per cent of GDP by 2025 (up from about 1.15 per cent, currently). It also addresses the challenges such as burden of diseases and availability of human resource.
The policy considers major changes, in terms of disease profile and epidemiology, which have taken place over the past 15 years. For the first time, the policy has set specific targets for elimination of certain diseases kala azar in 2017, leprosy by 2018 and the “very ambitious” target of eliminating TB by 2025. The government also plans to end indigenous transmission of malaria by 2030.
India’s Universal Immunisation Programme (UIP), Mission Indradhanush, is one of the world’s largest drives in terms of number of beneficiaries reached, quantity of vaccine used, number of immunisation sessions organised, geographical spread and diversity of areas covered. Launched in December 2014, it ensures that no child is left without the protection of full immunization, particularly in hard-to-reach districts.
Begun with six vaccines, the programme now protects children against 11 deadly diseases–with new vaccines against rotavirus diarrhoea, Haemophilus influenzae type b (Hib) pneumonia and rubella being added in the last few years. A new vaccine against pneumonia and meningitis, the pneumococcal conjugate vaccine (PCV), is being launched in May.
Since its launch, more than 2.14 crore children and around 0.56 million pregnant women have been immunised, with routine immunisation coverage increasing by 5-7 percent over two years, compared to an average of 1 percent during the past decade.
Several government interventions to reach and improve the quality of care of women, newborns and young children, under the National Health Mission (NHM), have led to a sharp 40.2 per cent rise in institutional births in ten years.
These include the Janani Suraksha Yojana (JSY), a direct cash transfer scheme, Janani Shishu Suraksha Karyakaram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan, a programme that provides ante-natal services. The JSSK entitles every woman delivering at a public health institution to free and cashless health services. The NHM also lays emphasis on a continuum of care for the newborn.
The government is launching the Pradhan Mantri Bhartiya Janaushadhi Pariyojana for cheaper medicines in hospitals. To provide health security, it will soon bring in a legal framework under which doctors will have to prescribe generic medicines, which are cheaper than equivalent branded drugs.
As an initial measure, prices of 700 medicines have been capped to enable poor people to get medicines at reasonable rates when they face chronic diseases. Rules have been framed in such a way that medicines which were available in the market at Rs 1,200 have been reduced to Rs. 70 to Rs. 80. The government has also capped the prices of stents used in heart ailments.
The government has just launched the ‘Test and Treat Policy for HIV’ scheme under which anyone who is tested and found positive for HIV-AIDS will be provided with ART(Antiretroviral Therapy) irrespective of one’s CD count or clinical stage. This will improve longevity and quality of life of those infected and will save them from many opportunistic infections, especially TB.
India will soon develop a National Strategic Plan for HIV for next seven years which will be crucial for ending AIDS.
To facilitate reduction in stigma and discrimination, the government recently passed the HIV/AIDS Act–a historical step as very few countries have such a law to protect rights of people infected with HIV.
Preventive healthcare has been accorded importance; people adopting it may not have to visit hospitals. The cleanliness campaign (Swachchata Abhiyan) is aimed at preventive healthcare as it has been proved that many diseases are contracted if we live in an unclean environment.
Hygiene refers to conditions and practices that help maintain health and prevent spread of diseases. Of the 1.7 million people worldwide who die from unsafe water, sanitation, and hygiene each year, more than 600,000 are in India. India’s priority project Swachch Bharat has given a big push to combat one of the biggest causes of death–poor hygiene.
To accelerate efforts to achieve universal sanitation coverage and to put focus on sanitation, the government launched the Swachh Bharat Mission on October 2, 2014. It aims to make urban India free from open defecation by October 2019 and achieve 100 percent scientific management of municipal solid waste in 4,041 statutory towns. The mission intends to generate awareness about sanitation and its linkage with public health.