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It is always good to learn lessons from the present and be well prepared and ready for the future. The ongoing Corona crisis in the country is something that could be a ‘turning point’ in India’s journey towards inclusive, advanced and accessible healthcare for all. However, this could happen only if we begin with a holistic set of ‘health care reforms’ in a more systematic manner, as we look forward to reaching the goal of universal health security. The constitutional guarantee for ‘right to life’ under article 21 does incorporate in itself ‘right to health’ as an obligation on the Indian state for its citizens.
In a recent book collectively written by three leading medical professionals of India titled “Till We Win: India’s Fight Against the Covid-19 Pandemic’ Penguin, 2021, all these questions have been discussed in detail. Based on my reading, I wish to make a point on why India needs to call for a ‘New Health Revolution’ for the country. And this must involve all three major stakeholders who have been working together and driving our fight against Corona pandemic. The battle against this pandemic is going to be a long one, and hence this new health revolution must involve our policymakers; health professionals and wider participation from our civil society at large. It has to be a well-coordinated, collectively collaborated and cooperative effort at various levels to achieve this long-term goal.
In these distressed times, we need to convert every challenge into an opportunity towards better health security. The new health revolution must be built on a five factor strategy including widely spread and effective primary health infrastructure, better health financing, availability of medicines and logistics supply, well trained paramedical staffs and advanced healthcare research and information systems. We need to understand that health is about a broad range of services, which includes all these factors to make for a better and safer future. An effective governance and leadership can lead to this change.
Firstly, beginning with the report of the first Planning Commission (1952) to the National Health Policy (NHP) report (2017) and recently released five-year strategic plan (2018-22) by NITI Aayog, all have placed importance on expanding primary health infrastructure in India. The pandemic has exposed the weakness of our healthcare system, which suffers from shortage of health workforce, lack of curative and limited preventive services, suboptimal functioning of the primary healthcare system and weak disease surveillance systems. This is more prominent in rural areas creating much pressure on urban health infrastructure. It is a proven fact that a well-functioning primary healthcare system can tackle up to 80 per cent of health needs and can reduce the need for specialized health services. The goal of Ayushman Bharat Scheme (2018), to upgrade 150,000 existing primary healthcare facilities into Health and Wellness Centers (HWC) needs to be fastened up.
Given the lessons learned from this pandemic, there is an urgent need to expand our primary health infrastructure for preventive, promotive and public health services, especially in rural areas. We can take examples from Thailand and Vietnam, which have performed well, given their better primary health care systems.
Secondly, our health care system hugely suffers from lack of public spending and financing. The NHP 2017 proposed increasing government spending on health to 2.5 percent of the Gross Domestic Product (GDP) by year 2025. No health revolution can take place without investments in public health services and health care institutions. More investment will not just expand health infrastructure but shall also expand the network of medical colleges, research and training, labs and diagnostics centers while allowing better pharmaceutical support. The concept of multi-dimensional poverty acknowledges the relation between poverty and rising health costs. A report by the Public Health Foundation of India (PHFI) noted in 2018 how 55 million Indians slipped into poverty due to rising health costs. Better public spending on health can surely cut down these figures in India and help out our people.
Thirdly, the severity of the Corona pandemic has exposed, at least in its initial stages, the supply side crises in our healthcare system like PPE kits, availability of medicines, supply of medical oxygen, lack of hospitals beds and diagnostics kits etc. In addition, a stricter legal framework needs to be set up to discourage duplicity, over pricing and black marketing of medical supplies.
Given our population numbers, we need to involve both the public and private sector to expand our essential health supplies and services to face up any emergency situation. We must strengthen the network of testing and diagnostic services, which is a key to modern healthcare and disease identification. The new health revolution must aim for assured medicinal supplies and diagnostic services in the long run.
Fourthly, the pandemic also emphasized the role and importance of our paramedical and frontline workers to deliver in any health emergency. In rural areas, the role of Accredited Social Health Activists (ASHA’s), Anganwadi Workers (AWW) and Auxiliary Nurse Midwifes (ANMs) is critical to early health care. In urban centres much of the health services run on nurses, pharmacists, lab technicians, spot boys etc.
Guided by doctors, these frontline workers are the backbone of our healthcare services. Thus, we need to impart better training, facilities and incentives so that the expansion of health care is well equipped with professional paramedical staff. These people are performing a range of health utility services during the pandemic. We must prioritize the expansion of both medical and paramedical staff, which is critical to effective healthcare services.
And lastly, no goal of ‘universal health security’ can be fulfilled without investing in healthcare research. There is a vast scope for epidemiological, operational and scientific research in advancing health security. New research empowers us to fight against emerging diseases and pandemics and allows us to develop new drugs and vaccines. Countries must come forward to invest in health research, and must cooperate and allow free access to ‘new scientific knowledge’ in medical science. New entrepreneurship and startups must also drive this process backed by the government.
To sum it up, the Corona pandemic had a devastating effect on our country. Fighting on urgent health fronts is necessary, but we also have to learn lessons and must devise ‘new strategies’ to improve India’s health system in the long run. If we can do so then possibly we would be able to offer the most valuable tributes to the lives lost in this pandemic.