Perspective - Boosting for Health Infra

• 29 Jan 2022

For Prelims: Indian Polity and Governance, Economic and Social Development, Social Sector Initiatives, Fit India Movement, Eat Right Campaign, Non-Communicable Diseases (NCDs), PLI scheme for domestic manufacturing of Active Pharmaceutical Ingredients (APIs), Ayushman Bharat Health Infrastructure Mission.

For Mains: Government Policies & Interventions in the Health Sector, Analysis of Ayushman Bharat Scheme, Challenges to the Health Infrastructure of India.

Why in News

As the Covid-19 pandemic continues to wage on, people have started prioritizing their health over most things. This pandemic, especially during the Delta wave, exposed several gaps in the healthcare system and infrastructure of India.

India and Healthcare

• Preventive and Promotive Concept of Healthcare: India is one of the very few countries that have put in place a mechanism for preventive and promotive health care.
  • The integrated concept of Fit India Movement, Eat Right Campaign and then Non-Communicable Disease (NCD) screening in the health and wellness center for five diseases - Diabetes, Hypertension, and the three cancers, oral, cervical and breast cancer, is also there.
• Increase Public-Private Cooperation: The Covid-19 pandemic has resulted in a tremendous improvement in public-private cooperation in the healthcare sector.
  • During the second wave, several state governments partnered with private hospitals to overcome the capacity constraints in the government hospitals.
• Government Initiatives for Health Infrastructure: In the Union Budget for the financial year 2021-22, an amount of Rs. 2,23,846 crores was allocated for expenditure on ‘Health and Wellness Sector’. This came to about 6.43% of total Budget provision.
  • The National Health Policy, 2017 also envisages raising Government health expenditure to 2.5% of GDP in a time-bound manner.
  • The healthcare industry is expecting a rise in the Center’s budgetary allocation towards the sector and more public-private partnerships to strengthen indigenous manufacturing of essential equipment and a focus on the rural health infrastructure as well.
  • In view of various challenges, the Government announced the PLI scheme for domestic manufacturing of Active Pharmaceutical Ingredients (APIs) and the National Digital Health Mission.
• Ayushman Bharat Health Infrastructure Mission: Recently the PM of India launched the Ayushman Bharat Health Infrastructure Mission in addition to the National Health Mission.
  • It aims to provide support to 17,788 rural Health and Wellness Centers in 10 ‘high focus’ states and establish 11,024 urban Health and Wellness Centers across the country.
  • Under the scheme, a national institution for one health, four new national institutes for virology, a regional research platform for WHO (World Health Organization) South East Asia Region, nine biosafety level-III laboratories, and five new regional national centres for disease control will be set up.
  • It sets the stage for comprehensive healthcare interventions in terms of increased investment in public health, world-class infrastructure to prepare India for future pandemics, making all districts self-reliant for surveillance diagnostics and treatment and comprehensive capacity building.

Issues Associated

• Issues of Healthcare Insurance: In a recently released report by NITI Aayog, at least 30% of the population, or 40 crore individuals (referred as the missing middle in this report) are devoid of any financial protection for health.
  • Additionally, the high 18% GST on insurance premiums further discourages people from opting for health insurance.
• Lack of Private Sector Involvement: The primary healthcare sector is not one that will result in profits but provides more of basic level healthcare which is why the burden across the world for primary health care largely lies on the governments; it is more in the public domain rather than in the private domain.
• Lack of Original Molecular Development: India is the pharmacy to the world because the drug manufacturing in India is quite robust. However, due to lack of financing, there is no or very little original molecular development which is required as inputs into drug manufacturing.
  • This area requires impetus from the government so that India’s production can be updated along frontier medicines too rather than only on generic medicines.

Way Forward

• Working on Brownfield Infrastructure: Working on the brownfield projects is a better choice as the greenfield infrastructure building will take three to four years to come into mid-stream and the current situation with the pandemic does not offer time to do so.
  • There are two types health infrastructure and facilities in India that are available to the public and require improvements:
    • The first one is the infrastructure that is on the ground already and needs to be made efficient enough for utilization.
    • Second one is the one that is antiquated and should be upgraded.
• Increasing Efficiency in Disease Detection and Diagnosis: When the world is suffering from a dual burden of communicable and non-communicable diseases, the first priority should be to have early detection processes of diseases and decrease the disease burden.
  • In this field, the establishment of 1,50,000 Ayushman Bharat Wellness Centers will have a major role to play once they become operational.
  • What is needed in the immediate future is enough budgeting for health infrastructure and proper execution of government policies.
• Universalization of Financing Mechanisms: About 350 to 400 million Indians are there who have no financing, so the urgent need is to ensure the universalization of financing mechanisms, be it the health insurance or the government-sponsored programs to make sure that people are able to access the strengthened infrastructure.
  • Universalization of financing mechanisms can be ensured by making health insurance more affordable - the 18% gst on health insurance leads to out-of-pocket spending and creates a fairly big anomaly in terms of being able to make affordable health insurance available in general and specifically for outpatients.
• Recognising India’s Potential in Healthcare Sector: As the dictum goes “better to predict and prevent rather than repair and repent”, India shall follow it in its healthcare system and concentrate on all these four aspects.
  • India has the best brains and the best skills, the Indians are providing 30% of the doctors to the National Health Service (NHS) in the UK and 17% of super specialists in the US. So, with the highly skilled human capital available, India has the potential to do more in this field.
• Creating Awareness and Incentives: Awareness needs to go up dramatically in terms of the facilities provided to the people via various government policies and interventions, especially the Ayushmaan Bharat Scheme.
  • The other important factor can be the nudges and incentives in terms of tax benefits.
  • The behavioral economics does suggest that such incentives can help in terms of encouraging people to make the choices for opting health insurance.