Dr Devender Sharma
“The health of people is the foundation upon which all their happiness and all their powers as a state depend” – Benjamin Disraeli, British Prime Minister.
Ever since COVID-19 has gripped the world, the emphasis on health has triumphed to unprecedented levels. In a country with a population as large and diverse as that of India, which creates large scale health inequalities, the existence of a robust system for healthcare is absolutely crucial. The causes of widespread health inequalities lie in the social, economic and political mechanisms that lead to social stratification according to income, education, occupation, gender and race or ethnicity. Lack of adequate progress on these underlying social determinants of health has been acknowledged as a glaring failure of public health. However, the role of government is crucial for addressing these challenges and achieving health equity.
Important issues that the health systems must confront are lack of financial and material resources, health workforce issues and the stewardship challenge of implementing pro-equity health policies in a pluralistic environment. In this changing world, with unique challenges that threaten the health and well-being of the population, it is imperative that the government and community collectively rise to the occasion and face these challenges simultaneously, inclusively and sustainably. Social determinants of health and economic issues must be dealt with a consensus on ethical principles – universalism, justice, dignity, security and human rights. This approach will be of valuable service to humanity in realizing the dream of Right to Health. The ultimate yardstick for success would be if every Indian, from a remote hamlet in Himachal Pradesh to the city of New Delhi, experiences the change.
National Health Mission
To achieve the health equity in the country, the National Health Mission (NHM) came into force in 2006, launched by the Government of India. Main objective of the National Health Mission was to tackle India’s malnutrition crisis. However, the overall objective of the National Health Mission is to ensure that everyone gets easy access to affordable health care of great quality and also to be able to tackle communicable as well as non-communicable diseases.
The following two missions come under the National Health Mission:
National Rural Health Mission
and National Urban Health Mission.
The idea behind this program is to have an independent, robust health care system that is decentralised and essentially community-owned. At the National level, the NHM has a Mission Steering Group (MSG) headed by the Union Minister for Health & Family Welfare and an Empowered Programme Committee (EPC) headed by the Union Secretary for Health & Family Welfare. At the State level, the Mission functions under the overall guidance of the State Health Mission headed by the Chief Minister of the State.
How is the Mission funded?
India's expenditure on healthcare is covered both privately (by individuals) and publicly (by the state). India's annual Union Budget makes an allocation for healthcare to the Ministry of Health and Family Welfare. For years, public health professionals in India have spoken about the need to increase funding for public health and this sentiment was reinforced by the COVID-19 pandemic. COVID-19 has brought new challenges and expenses in healthcare to the fore. One such challenge is the COVID-19 vaccination drive, which aims to cover 1 billion people this year; however ICMR has criticized the government for poor planning of the home-grown vaccine production due to which India doesn’t have enough vaccine to go ground.
The allocation for NHM in 2021-22 (Rs 36,576 crore) is 4% higher than the revised estimates of 2020-21. Under the NHM, the rural component i.e. the National Rural Health Mission has been allocated Rs 30,100 crore, (0.2% annual increase over 2019-20). The allocation for National Urban Health Mission is Rs 1,000 crore in 2021-22 (8% annual increase over 2019-20). The Centre's expenditure on healthcare is 1.2% of its gross domestic product (GDP), according to the most recent data from the National Health Accounts (2016-17), which is cumin in camel’s mouth. This number has stayed between 1.2% and 1.6% of GDP, between 2014 and 2020, according to the Economic Survey.
On the contrary, over the last few years there has been a lot of attention on the Ayushman Bharat scheme which focused on both health insurance and the creation of health and wellness centres. This gives the impression of a deliberate intention to gradually weaken the public health system and move towards an insurance-based model of healthcare. Certainly such a move at the expense of the public health system will lead to disastrous results for a country like India, where a large section of population is poor and is critically dependent on public provisioning of healthcare.
It is true that a lot has been achieved in the past. It was a glorious past, but the future of a healthy India lies in mainstreaming the public health agenda in the framework of sustainable development. The need of the hour is to revert attention to the NHM, which emphasised strengthening the public health systems for providing comprehensive care. There is also a requirement for higher levels of investment and human resources in this endeavor.