Shahid Akhter, editor, ETHealthworld, spoke to Lov Verma, former health secretary, GOI, to get his opinion on various healthcare policies, initiatives, and infrastructure.
National Health Policy
I think the National Health Policy is a very welcome step. It was formulated in 2017. But I feel that it must be made enforceable because we’ve been talking about these things a lot, but until it is made enforceable, it will remain on paper. And a lot of talk goes on. For instance, the policy says that we will spend 2.5% of our GDP on healthcare by the year 2025. But I don’t see that happening. In fact, the health budget has been cut. So, we really need to put our money where the mouth is or we really need to walk the talk, as they say. And so it is important that whatever is committed by the government be enforced. So it should be made legally enforceable.
Health norms for infrastructure
Regarding the health norms for infrastructure, I think that they are laid out centrally, which is not the correct thing to do because each state is different. And within the state, there are so many differences. So it will be very important, and then also, health is a state subject. So it is very important for each state to work out for itself how many PHCs they should have, how many subcenters, how many CHCs, and so on. So I would like the infrastructure norms to be very broadly defined, and it would be up to the states to do this kind of micromanagement on them and decide where to place which infrastructure.
Healthcare: Collaboration between states
I think there’s a great need for collaboration between the states, because some of the southern states, for instance, have done very well in healthcare. Some of their interventions, like having hospital cooperation do all the procurement, have been picked up by other states like Rajasthan, but we really need to take the best practises of each state and have them showcased at a national level. Maybe the Niti Aayog or some other national body could do this. And then that would be a win-win situation and a learning curve for all the states post-COVID.
Health care: Post COVID-19
There’s been a lot of introspection and also thinking about how the whole system collapsed during COVID. because the infrastructure was just not able to take care of the enormous load. So, I think it will get states thinking about how to beef up the infrastructure. Plus, I think it will give a massive boost to telemedicine. Because we saw even in places like Delhi, people were contacting doctors over the phone, making payments over the phone, and receiving treatment and diagnosis over the phone itself, and how to tackle COVID was being done majorly on the phone. So, I think that is the way to go for the future.
I think Ayushman Bharat has definitely been a game changer in the sense that it brought health insurance into the limelight and gave health insurance to the poorest of the poor. And the second aspect of it was the wellness centers. But I think the monitoring has not been as precise as it should be, because of the sheer scale of the project. There are more than 1.5 lakh centers, subcenters, and PHCs that are due to become health and wellness centers. There needs to be a very precise kind of program phase wise, and monitoring the grassroots to see how it’s being done because it’s very, very ambitious, I find that is still lacking. And of course, community participation has to be there. A lot of NGOs have also entered the fray, and they’re doing good work. But overall, I feel that the monitoring aspect needs to be beefed up.
Primary health care has really been neglected by all the states, with the result that about 70% of our population is actually going to the private sector. If you look at the overall picture, which is a very sad commentary on the state of affairs. This will only improve once the states, as well as the center, commit themselves to that 2.5% of GDP. We are vastly underfunded unless the funding improves. I don’t see primary health in Primary Health Care getting the importance it deserves.
NGOs in healthcare
I feel that NGOs in health care have a very big role to play because community participation is something we’ve been trying since the beginning of our planning programs and not really succeeding that much. So, NGOs can really step in where the health systems are weak. For instance, I saw a health centre that is being run by WISH, where telemedicine is combined with a medicine vending machine called the Swasth ATM, in one of the remote areas of Rajasthan. They linked up with the Jaipur Medical College. So they were able to show the patients directly through telemedicine to these doctors who are sitting in Jaipur. And as soon as the medicine was prescribed, if it was available, it was made available to those patients that very day. So that was a marvellous demonstration of how NGOs can beef up our infrastructure, which is really lacking.
Association with WISH
My association with WISH, which is the Wadhwani Initiative for Sustainable Healthcare, goes back a few years, when Mr. Sunil Wadhwani first approached me. He is like a mini-Bill Gates. He made his money in IT in the US. And he is investing it back, totally selflessly, for the health of Indians all over the country, with a massive ambition to touch more than a million lives. So, he struck me as somebody who was really committed and genuine, and we find very few people like him these days. And I feel that WISH is doing a great job. I really feel that WISH has a great future, and I wish it all the best.
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