Even as millions of Indians wish each other health, happiness and hope in the new year, they also await news on the new National Health Policy which will become the GPS in our journey towards better health. The draft policy, which was framed by the Union Health Ministry, was placed for public comment just over a year ago but is yet to be adopted as the definitive road map of declared government priorities. This may be because of unreconciled differences in the perspectives of the Health Ministry and NITI Aayog. The impasse has to be resolved over the next few weeks if health programmes are not to be left adrift in uncharted seas.
Budgetary allocation
K. Srinath Reddy These questions assume importance and urgency because of two key developments that took place in 2015.
First, the transfer of a higher share of Central tax revenues to States was tagged to the expectation that the State governments would bear a greater responsibility for the design and delivery of health services even as Central schemes are phased out. How this will play out in terms of health equity, across and within States, remains uncertain. Second, India signed up at the United Nations in September to the Sustainable Development Goals (SDG), which provide the road map, up to 2030, for global health. The Health Goal has nine targets, incorporating three core clusters: 1. Continued commitment to the carried-over agenda from the Millennium Development Goals on maternal and child health and major infectious diseases; 2. The new agenda of non-communicable diseases, mental health, road safety and pollution control; 3. A health system revamp to provide Universal Health Coverage (UHC) and ensure unimpeded access to reproductive and sexual health services.
Framework for coverage The year ahead should tell us how the Centre and States will harmonise the twin agendas of enabling State autonomy to drive health policies and programmes, and of developing a unifying national framework for UHC that carries all of us in India towards the SDG targets and promotes health equity across geographical, social and gender distinctions.
The Central government has to take the lead in developing a coherent framework that allows State-specific health policies to be accommodated in a nationally operational UHC programme. That will be a true vindication of consultative federalism.
These lofty goals cannot be achieved without developing a larger, multilayered health workforce that is well-skilled, socially committed and adequately remunerated. Technology-enabled frontline workers are especially needed to increase the outreach and effectiveness of primary health services. Allied health professionals of diverse categories, basic doctors, specialist clinicians and public health professionals too will be needed in large numbers.
Will 2016 see a strategic thrust towards planned human resource development, through coordinated Central and State initiatives that can cut through the regressive regulatory cobwebs of antiquated councils? A national commission on human resources in health, that provides trustworthy accreditation and promotes innovative education, needs to take shape in 2016.
UHC calls for financial protection, to reduce out-of-pocket spending, curb catastrophic health expenditure and prevent health-care-related impoverishment. While it will probably take some years for UHC to evolve to nearly complete levels of population coverage, service coverage and cost coverage, early relief can come through the free provision of essential drugs and diagnostics at strengthened public facilities. The various Central and State insurance schemes too need to be unified to provide an expanded package of services, with an emphasis on primary and secondary health care for all while allowing the poor unimpeded access to essential tertiary care.
Policy alignment Actions outside the health sector too need to gather speed in order to provide health benefits. Swachh Bharat needs to succeed. The public outcry against the appalling levels of air pollution in Delhi, as well as the spirit of global unity following the historic Paris agreement on climate change, should spur actions to reduce environmental degradation and protect people’s health. From an assurance of healthy nutrition across one’s life course, to an elimination of the tobacco threat, health calls for supportive policies in other sectors. Will such policy alignment get political support at the highest levels?
With a large and urgent ‘action agenda’ to address through a combination of political will and professional skill, 2016 can be the harbinger of great change in India’s health programme. Will it live up to that expectation?
(Prof. K. Srinath Reddy is president, Public Health Foundation of India. The views expressed are personal.)
