A POLICY FRAMEWORK FOR REFORMS IN HEALTH CARE

5. A VISION FOR HEALTH IN INDIA

5.1 Health Imperatives

The state of health of citizens of a nation is important in two ways – it reflects the quality of life enjoyed by its people and impacts economic development.

India does not have a strong health infrastructure and has several infirmities in its health system. This state of affairs portends a major handicap for India in the information era where quality of human capital of a nation determines economic development and quality of life. Thus, an improvement in health systems and infrastructure is vital to assure India’s future.

India’s future health needs would be driven by three factors: population growth, economic growth aspirations and a transition from communicable to lifestyle diseases for a large segment of the population.

India’s population is currently around one billion and is still experiencing high growth rates as compared to most emerging nations. By the year 2015, India’s population will increase by a quarter to 1.24 billion. India’s ageing population will increase by 60% to 112 million by the year 2015, thus bringing a new dimension of health care to the aged.

With the spread of communications, aspirations for a better quality of life are increasing. There is already a groundswell for better education. It is only a matter of time before a similar demands arise for better quality health care.

The worst possible scenario is already beginning to unfold in India. One segment of society is making the transition and has begun to require costly hospital treatment for chronic illness. On the other hand, a very significant population remains mired in an earlier communicable disease profile. It is imperative that India avoids merely investing in health care that addresses diseases of development. India has to battle with life threatening diseases for a large component of its underprivileged while simultaneously caring for life style diseases for a large segment of relatively well-off people.

In the battle for better health standards, India can face loneliness. The western world is concerned primarily with lifestyle diseases. The World Health Organisation estimates that more than 56 billion US dollars are spent on health research but less than 10% of it is spent on diseases that afflict 90% of the world’s population. Between 1975 and 1997, 1,223 drug compounds were launched but only eleven of them were designed for tropical diseases. None of the top ten biotech drugs relate to health problems of poor countries. Research on vaccines, which are the most cost effective means of addressing public health, is under funded. India has to step up and orient research pursuits to address its epidemiological profile.

At the same time, India has the potential to be at the forefront of modern health care, given its strong base in quality health care professionals and cost effective world class drug research. India has the opportunity to harness these strengths to deliver quality health care not only for its people but to larger geographical regions as well.

5.2 Vision

In such a setting, the vision for India in the area of health would be:

To foster a healthy society through provision of quality health care services to all citizens.

5.3 Mission

To realise this vision, India has to focus on health development with the mission of ‘creating an affordable and efficient health care system, balancing preventive and curative measures and establishing an enduring public-private partnership.’

5.4 Strategic Objectives

The mission would translate into the following strategic objectives:

Increase overall Government expenditure on health care to improve equitable distribution between different segments of the population.

Ensure a health care safety net for the poor and indigent to ensure that every citizen of India has access to affordable, appropriate health care, regardless of their socioeconomic status.

Reduce the health and health care disparities between urban and rural areas and between the States.

Encourage an evolving range of health financing mechanisms that ensure financial viability of India’s health care system and supplement Government’s spending on health.

Ensure smarter spending of funds for health care, based on outputs and outcomes – to promote and reward efficiency and quality and maximise health gain.

Increase the role of the private sector, especially in secondary and tertiary care.

Bring primary care within the reach of every Indian.

Ensure high quality secondary health care services for every taluka in India.

Support the establishment of world class, tertiary, multi-disciplinary health care facilities at every district headquarters.

Encourage the creation of state-of-the art medical education, research and care institutions in all disciplines of medicine.

Encourage alternative systems of medicines such as ayurveda, unani, homeopathy etc. as active and efficient channels to be able to supplement the efforts of the allopathic systems.

Develop human capital in health care in a planned and relevant manner.

Legislate and enforce adequate regulations to ensure minimum levels of quality standards and accreditation for both public and private health care services.

Develop and utilize information and communication technology to plan, finance and deliver efficient health care services, and to monitor their quality, effectiveness and equity.

Create institutional linkages with other sectors of social development such as education, sanitation and civic amenities.

Develop and promote India as a destination for affordable and high quality medical services, to the global health care industry.

Become a leader amongst other developing nations on key health indicators in the next 7-8 years without disproportionate increase in per capita health expenditure.

5.5 Guiding Principles

India’s journey to achieve a world class health care system needs to be guided by the following principles:

Health care services should be affordable - by subsidy or other means - to all sections of Indian society.

Health care services and delivery should comprise a healthy mix of state supported health care systems and private sector initiatives.

Health care services should be equitably distributed between urban and rural India, and among the States.

Health care services should be aimed at maximising health gain.

5.6 Challenges

To achieve the above mission, a radical reform of the existing health system and infrastructure is called for. The major challenges in this mission lie in rallying the existing system to fully meet the health care needs of the indigent, funding the vast resources required for public health expenditure and encouraging the private sector to substantially invest in the health sector.