Health Sector - Issues in Governance

The challenges of Health can be seen in terms of Disease Burden (Communicable vs Lifestyle diseases), structural problems (National Health Policy, Primary-Secondary-Tertiary Healthcare centres, management vs prevention) and financial issues (Healthcare spend as part of GDP, Health Insurance).

The progress report in terms of managing Disease burden has been mixed. While communicable diseases like Filaria and Malaria have been controlled and admirable progress has been made by AIDS control; Dengue and Chikungunya still strain the health care facilities every season. Programs like NRHM, JSY, JSSK were implemented to improve the infant mortality and maternal mortality figures under the aegis of Millennium Development goals. But the growing challenge is the rise of Non communicable or Lifestyle diseases. Increase in income, changing food habits and greater urbanisation have led to a change in the disease profile of upwardly mobile India. People have to contend with heart diseases, lung disorders and growing incidences of Cancer. This puts a great pressure on the structural design of Health Governance in India as primary and secondary healthcare face both the shortage of trained personnel and medicines/facilities to manage Lifestyle diseases.

The structural problems of Indian Health Governance arise from the woefully inadequate National Health Policy and its haphazard implementation. The woes of implementation start from the unclear focus on Prevention of diseases vs Management of Diseases. While public health service announcements have tried to bridge the gap that should have been covered by education of healthy habits and sanitation, it still falls short of effecting a social change on ground. Case in point is the massive drive to end ‘Open Defecation’ that can help prevent many diseases. Programs like Institutional delivery of babies, preventing water from stagnating and proper sanitation facilities also fall into the domain of preventive healthcare. The overwhelming focus till now has been on management of diseases once they have occurred. And even in that space, management of communicable diseases is given overwhelming precedence which reflects that Primary and Secondary health care centres have yet to catch up with the changing disease burden profile of India. Another issue is the haphazard urbanisation leading to growth in slums and unauthorised colonies that are breeding grounds for diseases.

The third major challenge in Health Governance is Finance. The allocation for health care expenditure is slated to target 2.5% of GDP according to 12th Five year plan. This would still pale in comparison to what other Developing and Developed countries spend - in the range of 4-6 % of GDP. The devolution of this money happens from Centre to State and then to various centres, creating a convoluted structure of allocation which in theory subscribes to Federalism but in practice puts money meant for Healthcare to be appropriated under other heads as the State sees fit. The other major challenge for Government and citizen both, is Insurance. While Government has tried to lower the healthcare costs by curbing the prices of essential drugs, formulating insurance schemes but the coverage and penetration of these schemes is still limited. 90% of cost of healthcare is still borne out of pocket by consumers which poses a big problem for a low middle income country like India adversely affecting the objective of inclusion. Matters are not helped that the rising burden of NCDs is more expensive to treat. The inadequacy of Private Sector in Healthcare is both in Hospitals and Health Insurance.

The need of the hour is to recognise the changing Disease Burden Profile of India, work on correcting structural flaws in National Health Policy and improve the financial devolution and insurance penetration and coverage. A burgeoning demographic potential will come to nought if blighted by stuntedness, diseases and uncertain life expectancy.

By: Navdeep Jakhar