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| EDITORIAL |
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| Year : 2018 | Volume
: 23
| Issue : 2 | Page : 51-52 |
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Swasth Bharat, Samriddha Bharat
Omprakash Gupta
Department of Medicine, MGIMS, Wardha, Maharashtra, India
| Date of Web Publication | 11-Oct-2018 |
Correspondence Address:
Dr. Omprakash Gupta
Department of Medicine, MGIMS, Sewagram, Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmgims.jmgims_45_18
How to cite this article:
Gupta O. Swasth Bharat, Samriddha Bharat. J Mahatma Gandhi Inst Med Sci 2018;23:51-2 |
“The new and hopeful, high-tech solutions are important, but the older, high-touch approaches of human relationships also matter when it comes to improving overall health and healthcare.”[1] - Julie Kliger (Healthcare Realist and Cosultant)
Health and education are the fundamental pillars of human development. It has always been a challenge in India, a country with a large population (now ~1300 million), vast area, and limited resources to have a perfect comprehensive primary health care including community-based health promotion, disease prevention, and basic diagnostic and treatment services for communicable and noncommunicable diseases. Development is an ongoing process and after independence attempts are being made at various levels to improve public health services (though health care has not been considered as priority). Some success is achieved in controlling communicable diseases through concerted efforts and with the help of national and international agencies (for example India became polio-free by 2012). But, a lot remains to be done. The poverty (25% of the population or about 250 million are still below poverty line), lack of public infrastructure and skilled workforce, and poor budgetary allocations (As per the World Bank estimates, the per capita health-care expenditure in India is around USD 60, and this has been stagnant over the last decade or so) are some of the prevailing important factors.
India meets the global average in a number of physicians whereas there is a shortfall in a number of beds and nurses. Many of health professionals are concentrated in urban areas, leaving rural areas underserved. The private sector dominates the health-care delivery across the country. The majority of the population continues to rely on underfinanced and short-staffed public sector hospitals for its health-care need which remains unmet even after 70 years of the independence.
The World Health Day 2018 serves as a reminder to countries of the commitments they made when they adopted the Sustainable Development Goals (2015) and committed to taking concrete steps to advance the Health for All agenda, i.e., “Universal Health Coverage” (UHC) that means that all individuals and communities receive the health-care services they need without suffering financial hardship. “UHC is a fundamental human right,” said Dr. Mahjour, acting WHO Regional Director for the Eastern Mediterranean. He added that it also ensures access to essential quality care and financial protection. This will not only enhance people's health and their life expectancy but also protect countries from epidemics and reduces poverty and the risk of hunger, creates jobs, drives economic growth, and enhances gender equality.[2]
The National Health Policy (NHP) also envisioned a rise in public funding for health, increasing to 2.5% of the gross domestic product (GDP) by 2025 (as against the present 1.4% of the GDP) with more than two-thirds of resources going toward comprehensive primary health care through the “Health and Wellness centers.” It also proposed free diagnostics, free drugs, and free emergency and essential heath-care system in all public hospitals, so to reduce out-of-pocket expenditure of the people. It envisages the strategic purchasing pathway to procure and pay for secondary and tertiary care services from public and private health-care providers. This together has been brought under the ambit of “Ayushman Bharat Scheme.”[3]
The (NHP) builds its optimism on the perceived success of the National Rural Health Mission, which has strengthened the infrastructure and trained thousands of people.
Under the National Health Protection Scheme, the Rashtriya Swasthya Bima Yojana announced in 2016 provided coverage up to Rs 30,000/annum/family, now the scheme is geared up to provide a coverage of Rs 5 lakhs/family for secondary and tertiary care, hospitalization to 10 crore poor and vulnerable families, the world's largest health insurance program.[4] Although some of the states have expressed their inability to take up this program since they have almost a similar program already running in their states, for example, Mahatma Jyotiba Phule Jan Arogya Yojana, in Maharashtra and Remedinet Technology in Karnataka. The central and state governments offer universal health-care services and free treatment and essential drugs at government hospitals.
Rs 1200 crore is allocated for converting 150,000 subcenters into active delivery points. Another welcome initiative is the upgradation of 24 district hospitals to new medical colleges in states which have very few at present, as a measure of capacity building to deliver advanced care closer to home as well as increasing the number of medical graduates. It looks challenging since it requires skilled persons to look after the subcenters and similarly faculty for medical colleges because existing medical colleges are short of optimum required number of faculty.[4]
The indirect measures such as Swachh Bharat Abhiyan (toilet and cleanliness) and Ujjwala Scheme (cooking gas connections) are helping to improve sanitation and control the air pollution as long-term preventive measures to further boost the health-care services.[3] Similarly, efforts to reduce train and road accidents and action against gender-based violence, optimization of resources, and the Swasth Nagrik Abhiyan, a sort of social movement for health, will be of great help in that direction.[5]
In addition, several new computer- and mobile phone-based e-health and m-health initiatives were launched on the World Health Day 2016. These include the Swasth Bharat Mobile Application for information on diseases, symptoms, treatment, health alerts, and tips; ANMOL-ANM online tablet application for health workers, e-RaktKosh (a blood bank management information system), and India Fights Dengue.[5] Thus, in rural areas, mobile technology and improved data services are expected to play a critical role in improving health-care delivery. Although limited, some companies are also investing in innovative services and creating lucrative yet low-cost digital and device solutions. Information technology (IT) may also play a big role in applications of social sector schemes on a large scale. Hospitals impaneled under the government insurance scheme are IT enabled and connected to servers in districts. For accessing health services in any impaneled hospital, the beneficiaries can use a smart card.[6]
India spends just a little over 1% of its GDP on health care and this is leading the country into “a comprehensive healthcare crisis,” according to Bharat Ratna, Nobel laureate, and noted economist Amartya Sen, who has called for greater allocation on health care in India and highlighted what he calls “three general failures” in the country's health-care segment. The three failures are “the amazing neglect of primary healthcare compared with health interventions needed at later stages;” “India's hasty and premature reliance on private healthcare, which goes hand in hand with neglect of public healthcare;” and the deficiency of “informed public discussion on healthcare” in the country.[7] India has projected the scheme of health insurance for 50 crore people, but it is virtually nothing, said Dreze, who helped draft the first version of the Mahatma Gandhi National Rural Employment Guarantee Scheme.[8]
No doubt India has been facing a crisis in health-care system and fighting to come out of it. There is a comprehensive all-round effort to evolve a system, so to fill up the gaps and move on to meet the essential requirements through strategic planning. Even with some limitations, the health policy is forward looking because it does seek to strengthen the infrastructure, capacity, financing, and human resources and envisages a complete overhaul of primary care in a way that will expand its scope and scale to ensure continuity with higher levels of care.[6]
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