To safeguard our future

(The Indian Express)

 

Getting the healthcare sector ready for NHPS

(The Financial Express)

 

 

To safeguard our future

(The Indian Express)

Synoptic line: It throws light on the issue of the government aims to fully immunise children by year-end.

(GS paper III)

Overview

 

  • Over the past few years, the Indian government has taken tremendous strides in bringing health to the forefront. Part of this effort has been to ensure that every child receives vaccines to protect them from a range of infectious diseases.

 

  • For example- ‘Polio’, through a comprehensive campaign which enlisted celebrities, religious leaders, health workers and others, we were able to eliminate the disease from our country, an achievement recognised in 2014.

 

Immunisation

 

 

  • These days several other infectious threats to our children remain. In fact, diseases like pneumonia and diarrhoea account for the death of nearly 3 lakh children every year in India. Roughly speaking, this means a young life is lost every two minutes from these two diseases alone. What is most shocking is that most of these deaths are preventable through interventions, including immunisation.

 

 

  • Vaccines are tools that protect children from dangerous infections. They are globally recognised as one of the safest and most cost-effective medical interventions. In a country as vast as ours, with varying socio-economic realities, vaccines can ensure that all children receive protection from vaccine-preventable diseases, irrespective of where they are born.

 

 

  • The challenge, however, is building systems that reach the most remote rural areas or crowded city centres. Vaccines cannot help protect children if they don’t reach them. In the recent address Prime Minister and Health Minister announced that the immunisation coverage was increasing by almost 7 per cent each year, and currently stood at 80 per cent.

 

 

 

  • The government’s Intensified ‘Mission Indradhanush’ initiative aims to fully immunise 90 per cent of children by the end of the year. At the same time, the Government of India especially officials at the Ministry of Health and Family Welfare have been working to introduce a series of new vaccines, including two to prevent Pneumonia and Diarrhoea, and a combination vaccine against Measles and Rubella.

 

 

  • The Measles-Rubella vaccine was launched last year through a countrywide campaign, the largest of its kind in the world. As of February 2018, the campaign had immunised over 7 crore children. In order to repeat our success with polio elimination, this time aiming for the ambitious target of eliminating measles by 2020, we need sustained political action that prioritises the health and development of our children.

 

  • The 2018 budget outlined an initiative to alleviate a root of impoverishment for millions with the National Health Protection Scheme (NHPS), under Ayushman Bharat, the Modicare programme. By providing health insurance covers of Rs 5 lakh to over 10 crore vulnerable families, the programme is a move towards ensuring that no one goes bankrupt because they get sick.

 

Way forward

 

 

  • There is an urgent need to uphold the cause of child health in Parliament and raise it as a talking point in several public platforms.  There is no greater responsibility for a nation than to ensure the health of its children.

 

 

  • It is imperative that each and every citizen not just parents and teachers, but also policymakers, journalists, and civil society members come together to ensure that our children grow up in a healthier and safer India, free from preventable disease and death.

 

Question Vaccines are the best way we have to prevent infectious disease.  Analyse the government’s Mission Indradhanush’ programme and also explain that how a successful immunization program depends on the co-operation of every person.

 

Getting the healthcare sector ready for NHPS

(The Financial Express)

Synoptic line: It throws light on the issue of assessment of NHPS.

(GS paper III)

Overview

 

  • India with the announcement of the National Health Protection Scheme (NHPS) has embarked on the path of universal health coverage. The aim of the NHPS is to cover 10 crore families with medical insurance of Rs 5 lakh per household per year.

 

  • India, currently, has a highly inadequate social security structure, and the situation is especially dire in healthcare. The country’s average out-of-pocket expenditure on healthcare is one of the highest globally, at 68%, and this means that of every Rs 100 spent by the public on healthcare, Rs 68 comes from their pocket as the rest is reimbursed by insurance or is provided by the government.

 

Assessment of NHPS

 

  • In comparison, the out-of-pocket expenditure is much lower in China, at 34%, and in the US it is 11%. Due to this high out-of-pocket healthcare expenditure, 7% of the population in India is pushed below poverty threshold every year.

 

 

  • The government’s intent on moving towards universal health coverage is a welcome step; however, the effective implementation of the scheme will be a big challenge, given the scale involved. The NHPS will be one of the largest government-funded healthcare programmes globally.

 

 

 

  • It will be critical for the government to strengthen the overall healthcare system-including the infrastructure, availability of healthcare professionals and even the regulatory environment-for the effective implementation of the NHPS.

 

 

  • With the NHPS enabling financing of healthcare for a large chunk of the population, there will be a big jump in the demand for healthcare. The government needs to ensure that the availability of infrastructure and healthcare professionals is spruced up to meet this increased demand.

 

  • The supply of healthcare facilities is especially poor in rural areas, where 70% of India’s population resides. Many of the government hospitals in rural areas are defunct due to unavailability of doctors and other required facilities.

 

  • In fact, even private healthcare facilities are limited or non-existent in these areas. It is estimated that, in rural areas, the gap between staff in facilities and those required was 52% for midwives and nurses, 76% for doctors, 88% for specialists and 58% for pharmacists.

 

  • Increasing the supply of doctors and other healthcare professionals in a short span of time is a particularly challenging task. Here providing basic training to select people from the local population for administering basic medication will be helpful. This concept is already there in rural areas in the form of ASHA, or accredited social health activists. This needs to be further scaled up.

 

  • In fact, China also has had the concept of barefoot doctors, who were essentially farmers who had been trained in minimal basic medical knowledge for promoting preventive healthcare and treating common illness in the rural parts of the country.

 

  • The role of the private players needs to be increased to meet the jump in demand for healthcare in the country; however, it is equally important to tighten the regulation of the private players in the industry. As he regulatory standards for private hospitals are not adequately defined and they are also poorly enforced. The quality of the service is questionable, and there is a lack of transparency on the pricing front.

 

  • According to the National Sample Survey of 2015, the cost of treatment was four times higher in private hospitals as compared to that in the government hospitals. Tighter regulation of the sector will ensure a sustainable insurance model for all the stakeholders, including the government, hospitals, insurance companies and the public.

 

  • The NHPS will be easier to implement by the southern states like Andhra Pradesh, Karnataka and Tamil Nadu, given their better health infrastructure and the experience of running regional health insurance schemes. On the other hand, implementing the NHPS will be a bigger challenge for poorer states in north India, given their weak healthcare infrastructure.

 

Way forward

 

  • An incentive-based model for the government hospitals will help improve their performance and ease some of the supply constraints. The government should purchase healthcare services from the private players, wherever the government doesn’t have the wherewithal to cater to the demand.

 

  • According to a World Health Organisation (WHO) report, unless a country spends at least 5-6% of its GDP on health-with the government expenditure being a major part-it is difficult to meet the basic healthcare needs of its population. While, the total healthcare spending-to-GDP ratio in India is around 4%, with the government spending-to-GDP ratio at a low of 1.15%. 

 

  • Also it will be important for the government to increase the spending on primary and preventive healthcare. This will, among other things, help reduce the demand for secondary and tertiary healthcare services. In fact, increased spending on preventive healthcare-such as sanitation and hygiene maintenance-will result in healthier population in the long run and also reduce the need for curative healthcare. This, in turn, will reduce the overall healthcare financing requirement.

 

Question Increased spending by the government on healthcare and greater participation by the private players, coupled with tighter regulation would help the healthcare sector gear up for the effective implementation of the NHPS. Critically examine.