Health is Wealth, But Where is the Minimum Wealth to Create Health?
Public Health is the casualty again, with the promised health centres little more than an illusion
CHENNAI: The novel idea of revamping the primary healthcare scenario in India by transforming the sub-centre’s into Health & Wellness Centres (HWC) is in the public health domain for quite some time. The concept was first reflected in the draft National Health Policy 2015 and later incorporated in the Cabinet approved National Health policy, 2017.
Union Finance Minister’s budget speech to scale the numbers up to 150,000 Health and Wellness centres has brought the issue into focus.. This was one single model which got support from the public health professionals, general public and even the critics.
The recent tale of tragedies happening in the health sector- be it the Gorakhpur tragedy or the Max- Fortis scams underlines the criticality of the situation in India’s primary healthcare. The only silver bullet solution for India’s ailing health sector is strengthening public health through a comprehensive primary healthcare approach.
The whole concept of HWC received accolades against this backdrop. The proposed services provided under the HWCs move from selective to comprehensive primary health care and covers preventive, promotive, curative, rehabilitative and palliative care for a package of services related to RMNCH+A, communicable diseases, non- communicable diseases, ophthalmology, ENT, dental care, mental health, geriatric care, treatment for acute simple medical conditions and emergency and trauma services.
This is in contrast to the existing primary healthcare scenario in the country which is limited to selective interventions of immunization, maternal & child healthcare and few communicable diseases – which account for less than 15 % of the package.
The recently published Global Burden of Disease report “India: Health of the Nation's States - The India State-Level Disease Burden Initiative” shows clearly that seven of the top 10 causes of death among all age-groups in India are non-communicable diseases or injuries. Hence, the concept of HWC which moves beyond the usual MCH paradigm in India can be seen as a very good example of data-driven decision making in healthcare which is an unusual event in India.
However, several questions have now been raised after it was known that the budgetary allocation for the proposed 1.5 lakh HWC’s was only Rs 1200 crores. This comes to a meagre sum of Rs 80,000 per Sub-Centre to be transformed into a HWC.
The Ministry of Health & Family Welfare has calculated that the amount needed for this transformation requires approximately 17.5 lakhs per centre including the training and HR cost. If we go by that calculation, only 6857 sub-centers in the country can be transformed to HWCs in the current year - less than 5 % of the total HWCs as promised by the Government.
Also, if the central government is determined to strengthen the primary health care system, the referral chain also needs to be strengthened- i.e. simultaneous strengthening of the higher centres of healthcare delivery including PHCs, CHCs and district hospitals.
The few successful models in this regard like the Jan Swashtya Sahyog’s (JSS) program in rural and tribal areas of Bilaspur district in Chhattisgarh state is worth mentioning in this context. Other concerns relate to capacity building for the implementation of a mammoth scheme of this dimension. Remember the speech of the President in NIMHANS recently where he lamented the lack of qualified medical professionals and health workers in the country. So the lack of funds, lack of qualified manpower to attend to a vast population of ailing human beings and the absence of a well-managed health care system are worrisome aspects which cannot be swept under the carpet.
Everyone knows that the healthcare scenario cannot be tackled with a magic wand in the form of a budget proposal coming at the fag end of an outgoing government. But with a meagre increase of 2.5 % in the health budget in 2018-19 compared to the revised estimates in 2017-18, the governments aspirations in improving healthcare scenario is too far from reality. This hasn’t come as a shocker nor a surprise as it basically reflects the government’s commitment to health of the nation
The concept of HWCs has the potential to decentralize, democratize and communitize healthcare- which is indeed the need of the hour. Despite all the challenges and issues, HWC was seen as the window of opportunity for addressing this growing burden of chronic illness in a rapidly aging population in a resource poor setting such as India.
The conceptualization of HWC was seen by many as India’s first right step in pursuit of achieving Universal Health Care (UHC). The rise in prices of shares of private hospital operators and insurance companies after the budget announcement clearly shows what the Government is up to in its pursuit of achieving UHC in India.
(Dr. Adithyan G.S is with the National Health Mission- Tamil Nadu. The opinions are strictly personal and do not reflect those of the organization/institution where he works)