Electoral season and restructuring the health system
Source: The Hindu
For Prelims: Infant Mortality rate, Maternal Mortality rate
For Mains: General Studies II: Resilient integrated primary healthcare
Highlights of the Article
Medical Council of India (MCI)
National Medical Commission (NMC)
Infant Mortality rate (IMR)
Maternal Mortality rate (MMR)
Universal Health Coverage
Context:
With the electoral season on, it is going to be raining manifestos. Manifestos are useful documents as they reflect the thinking and priorities of the political parties, besides enabling people to hold the elected party accountable. Given the high stakes and the trend towards current competitive welfarism, the manifestos for 2024 are expected to contain wild promises. It will be interesting to see what space will be accorded to health, education and jobs in the current discourse blinded with temples and distributing consumer goods.
UPSC EXAM NOTES ANALYSIS
1. Health Outlook between 2014 to 2019
- The health sections in the 2014 and 2019 manifestos of the Bharatiya Janata Party (BJP) and the Indian National Congress exhibited both similarities and differences. Both emphasized the need to overhaul the primary health system, ensure universal healthcare, enhance human resources, and increase the utilization of technology.
- However, a distinction emerged, with the Congress framing health as a public good, asserting citizens' entitlement to it as a right, and emphasizing the States' obligation to provide. In contrast, the BJP viewed health as a commodity, to be delivered through public-private partnerships with market-based pricing moderated by social health insurance.
- Following a period of stagnation, both the United Progressive Alliance (UPA) and the National Democratic Alliance (NDA) made advancements. The UPA, through the National Rural Health Mission, significantly increased funding with the aim of strengthening healthcare delivery in rural India.
- This initiative deployed five thousand technical personnel and a million community health workers, introducing a large-scale pay-for-performance system and implementing the first social health insurance program, covering 80% of the population in Andhra Pradesh and expanding to 13 other states.
- The NDA maintained policy continuity by replacing the Medical Council of India (MCI) with the National Medical Commission (NMC), reinforced rural health infrastructure with capital investment, expanded social health insurance, and established the National Health Authority for strategic purchasing of services from both the public and private sectors.
- Additionally, the NDA established 317 new medical colleges, doubling the number of medical seats to 1,09,948. Although budget allocations increased in gross amounts, the proportion to GDP remained around an average of 1.2% under both the UPA and NDA.
- Despite these commendable efforts, the measures taken were incremental and failed to address the fundamental issues plaguing the health system's architecture, which had become distorted and dysfunctional over the years.
- Comparatively, other countries with similar economic strength achieved significant outcomes in half the time. For instance, Thailand introduced Universal Health Coverage in 2000, substantially reducing financial burdens, disease incidence, maternal and infant mortality, and strengthening the dominance of the public delivery system. Similarly, Turkey implemented its Health Transformation Program in 2003, banning dual practice, expanding public health infrastructure, and restricting private sector presence.
- India, facing a maternal mortality rate three times higher than the global average, confronts substantial challenges.
- The primary and secondary health infrastructure is weakened by severe shortages of human resources, with states like Bihar having one doctor for every 20,000 people. Despite this, there is a noticeable shift in policy focus towards tertiary medical care, even though 95% of ailments and disease reduction could be addressed at the primary and secondary levels
2.Primary Health Care
- Strengthening the foundation is crucial, as this is where community surveillance, demographic data, and the disease profile of designated populations converge, facilitating the planning of the appropriate skill mix needed to address current and future health requirements. The mapping and accreditation of reputable health facilities contribute to expanding access points.
- Clearly defining the package of services and raising awareness among communities about their entitlements fosters accountability. Executing these actions in a coordinated and well-sequenced manner necessitates robust local capacity to regulate patient flows and ensure the continuity of patient care.
- Successful instances of such reform processes demonstrate a purposeful intent executed according to a plan. Thailand's introduction of Universal Health Coverage in 2000 marked the culmination of a strategic plan.
- Thailand had a robust human resources policy for years, dedicating three-quarters of its budget in the five years leading up to 2000 to build provincial-level health infrastructure capable of providing quality care. In contrast, India's strategy for Universal Health Coverage relies on purchasing services from a private sector operating on an inflationary fee-for-service model, amid severe supply shortages, particularly of specialists and nurses. Relying on the private sector for delivery, given extensive market failures exacerbated by governance issues, is not a prudent approach.
- Given our political economy, reforming and restructuring our health system is challenging. We not only require strong political leadership willing to move away from a focus on high-end hospitals, high-tech diagnostics, and digitization but also need the courage to undertake synchronized reforms from the grassroots level.
- Designing and implementing a system that is 'fit for purpose' involves changes in the medical curriculum to promote teamwork and rural service, as recommended in Mudaliar's 1959 report.
- Adopting more equitable admission and human resources policies, such as prohibiting dual practice, delegating functions, creating new cadres, and building teams with clearly defined functions, will ensure a community/patient outcome-based health system.
- Establishing IT and monitoring systems that assess performance based on outcome data linked to financing will improve efficiencies and optimize investments. This system relies on decentralization and operational flexibilities within a proactive, accountable framework that upholds values of equity, human dignity, and trust
3. Mortality
3.1.What is Mortality
Mortality refers to the state of being subject to death or the occurrence of death. It is a term commonly used in demography, epidemiology, and medical contexts to describe the number of deaths in a given population within a specific period. Mortality rates are often expressed as the number of deaths per unit of population, usually per 1,000 or 100,000 people, over a specified time frame, such as a year. Mortality can be analyzed in various ways, such as overall mortality rates or specific rates for certain age groups, causes of death, or demographic characteristics. Understanding mortality patterns is essential for assessing public health, healthcare systems, and societal well-being
3.2.Infant Mortality rate
The Infant Mortality Rate (IMR) is a vital statistic that represents the number of deaths of infants under one year of age per 1,000 live births in a given population and time period. It is a key indicator of the health and well-being of infants and is often used as a measure of the overall health of a population and the effectiveness of healthcare systems.
.png)
A lower IMR is generally considered an indicator of better healthcare and living conditions for infants. Factors influencing infant mortality include access to quality healthcare, maternal health, nutrition, sanitation, and socio-economic conditions. Monitoring changes in IMR over time and comparing it across different regions or countries provides valuable insights into the effectiveness of public health interventions and healthcare systems3.3. Maternal Mortality rate
The Maternal Mortality Rate (MMR) is a crucial health indicator that measures the number of maternal deaths per 100,000 live births within a specific period, often a year. Maternal mortality encompasses deaths related to pregnancy, childbirth, and the postpartum period, reflecting the health and safety of mothers during the reproductive process
.png)
Maternal mortality is influenced by various factors, including the availability and quality of healthcare services, access to prenatal and postnatal care, socio-economic conditions, and the overall health of women in reproductive age. A lower MMR is indicative of a healthcare system that effectively addresses maternal health needs and provides adequate support during pregnancy and childbirth.
Reducing maternal mortality is a global health priority, and monitoring MMR helps assess progress and identify areas for improvement in maternal healthcare. International organizations and health authorities use MMR as a key metric to evaluate the impact of interventions and policies aimed at enhancing maternal health and reducing the risks associated with pregnancy and childbirth
4. Conclusion
The challenge is to understand the current system of health care and have the imagination to design the process of reform while building the implementation capacity at the district level by training and upskilling existing staff. Simultaneously, there must be an infusion of new institutional and organisational capacities and resources. Building such a process will take time as every States has a different level of capability. Done well, it can reduce demand for hospitalisation by at least 30%, disease incidence ( by bringing in lifestyle changes in the diets we follow and exercises we do), and out-of-pocket expenditures that are likely to increase due to more than 20% of young Indians suffering from multimorbidities and an ageing population — together consuming more drugs and diagnostics
|
Practice Mains Questions 1.Discuss the significance of strengthening the primary health sector in a country's healthcare system. Highlight key strategies that can be employed to enhance primary healthcare delivery and its impact on overall health outcomes 2.Examine the role of healthcare policies in influencing mortality rates, with a specific focus on maternal and infant mortality. Assess the effectiveness of policy interventions in reducing mortality rates and improving health outcomes, and propose recommendations for future policy considerations |
