RESURGENT INDIA: Transforming Indian Health Systems

• The Nation Health Policy (NHP) 2017 has provided a concrete shape giving direction to health sector and has universal health coverage as its central goal.
• The Period of 2017-20 is also a time when India is completing ‘Conventionally Accepted’ 15 year ‘policy to implementation cycle’.
• In 2002 India Published second National Health Policy (NHP) and National Rural Health Mission in 2005.
• National rural Health Mission is often referred to as the first major health system reforms in India since report of Sir Joseph Bhore committee in 1946.
• The initiatives under NRHM in the decade to follow resulted in India eliminating polio Yaws and maternal and neonatal tetanus.
• India is very close to achieve Millennium development goals 4 and 5.
• In 2017 that 15 years cycle seems to have been completed with new epidemiological realities i.e non-communicable diseases being the major burden of disease and other health challenges.
• Healthcare outcomes in India are yet to catch up with the countries with similar economic status understandably the new and the third in the National Health policy was released in 2017 followed by a Ayushman Bharat program in 2018 as an implementation component.
• In 2019 Union budget one of the ten components of vision for India in the decade ahead is “Healthy India: Ayushman Bharat, well nourished women and children.
• This vision can serve as the third step to sustaining the health policy implementation and ensuring that the country achieves his religious sustainable development goals by 2030.
• Inside the period of 2017 to 20 has the potential to become the second Beautiful system reforms in India. He policy initiative started are scaled up and implemented with and in sustained for the next few years a strengthening of PhD would be the key in the process this article papers a few action steps to ensure that the country is on track of Better Health outcomes for the people of India.
• Despite various efforts, health outcomes in India are yet to catch up with countries. Few action-steps to ensure that the country is on track for better health outcomes can be:

Put Primary Health Care (PHC) First

• Indian states have an elaborate network of nearly 200,000 Government Primary Health Care Facilities (GPHCFs), which deliver around 10% of total out-patient services (excluding Mother and child health services). The NHP 2017 has proposed to increase overall utilization of government health services from 30% to 50%.
• Thailand started on strengthening PHC in 1971, nearly 30 years before starting on famed universal coverage scheme in 2001.
• This concept has been reiterated time and again since Alma Ata in 1978 and more recently in Astana in 2018. India needs to consider adopting similar approach to deliver comprehensive primary healthcare.

Stronger Health System through Stronger PHC System

• Re- design PHC system based upon available local evidence : The functioning of best performing PHC in 4 states of India (Kerala, Tamil Nadu, Maharasthra and Meghalaya) should be studied. The proposed Health and Wellness Centres have been derived from these learnings.
• Correct ‘the inverted pyramid’ of health services provision and utilization: A large proportion of health services in India are delivered and used at secondary and tertiary level. Ideally, these services should be available at PHC level facilities.
• Start focussed initiatives to tackle social determinants of health (SDH): A lot of determinants for better health- improved drinking water supply and sanitation; better nutritional outcomes ,health and education for women and girls; improved air quality and safer roads-are outside the purview of Health Ministry. These issues are increasingly being recognized with emerging challenges such as Anti-microbial resistance (AMR), air pollution and non-communicable diseases (NCDs). There is need for multi-sector planning and ‘Health in all policies’ approach. An approach could be that initiatives to tackle SDH is added as third component under ABP, in addition to existing HWCs and Pradhan Mantri Jan Arogya Yojana (PMJAY).
• Strengthen urban health governance for multi-sectoral collaboration: the PHC system in urban areas need faster and effective interventions, if inverted pyramid of service delivery need to be tackled.
• Use of Behavioral Economics for Better Health Outcomes: The Economic Survey of India 2018- 19 has underscored the importance of behavioral economics. This is needed to ensure that people seek early care at appropriate level, which will reduce burden from higher level of facilities.
• Focus on public health cadre: Public awareness and education is an integral part of health service delivery. Many countries have dedicated cadres and workforce to deliver public health services. Tamil Nadu, West Bengal and Maharastra have a dedicated cadre. Thailand has a vast cadre of health workers delivering services.
• India has across the health policy formulation stage and in embarking on implementation. There is focus on strengthening overall health system in revitalizing of Primary Health Care system, which can address up to 80% of Health needs of the population.
• In this process, it will be important that
• Available local evidence are used to reform PHC system

     a) Inverted pyramid of Health Service delivery is corrected

     b) New initiatives for tackling social determinants of Health are started sub-district based health system is designed and developed.

     c) Urban Health governments is strengthed and

     d) behavioral economics to address demand side aspect of your service utilization used Public Health Care is established .

• Clearly, India is at a juncture, where it can build on past initiatives to transform health outcomes so as to have a healthy and prosperous nation, with minimal inequities. This would ensure that India achieves Universal Health Coverage as envisaged in the National Health Policy 2017 as well as achieves health-related Sustainable Development Goals well before the proposed timeline of 2030.