JOIN USThe Twelfth Five Year Plan has started on the April 1, 2012. The macroeconomic environment that preceded the 12th Plan was not that promising. The approach paper to the plan starts with the general objectives of the plan. The Plan aims at faster, sustainable and more inclusive growth.
It is expected to raise total health expenditure to 2.5 per cent of GDP by the end of the Twelfth Plan. During the Eleventh Plan it had reached 1.8 per cent of GDP. For formulating the growth strategy for the health sector the Planning Commission had constituted a high level expert group on universal health coverage (UHC) under the chairmanship of Prof K Srinath Reddy. The committee’s mandate was to spell out a comprehensive health strategy for the next ten years. It is expected that the Twelfth Plan will re-strategise to achieve faster progress by prioritising the convergence among all the existing national health programmes. For example, the national rural Health mission (NRHM) has hitherto focussed heavily on child birth and pre-natal care. Under the Twelfth Plan, it must now expand to a more comprehensive vision of health care, which includes service delivery for a much broader range of conditions, covering both preventive and curative services.
The outlay for the health sector must be large enough for the massive reform proposals to usher in universal healthcare to all Indians through public and private hospitals.
Unique innovations
One of the unique innovations proposed in the Plan is that programmes are going to be evaluated on the basis of outcomes than outlays. The plan also seeks to break the vicious cycle of multiple deprivations faced by girls and women because of gender discrimination and under nutrition. According to the health statistics 2010, there is the shortage of 19,590 sub centres, 4,252 primary health care centres, and 2,115 community health centres in India. To address this issue it is expected to complete the basic infrastructure needed for good health services delivery in rural areas by the end of the 12th plan. This will require substantial plan assistance to the states for upgrading existing set up.
Significant government support would be required to make progress on a national programme offering free treatment under the UHC. Setting up of a national health regulatory and development authority to evolve norms for treatment, costs etc is the need of the hour. Provision of quality health care is a big challenge to the service providers. The global average of hospital beds to population is 2.9 per thousand, but India has only 0.9 beds. Preparing a frame work for the massive UHC itself will be a great responsibility for the government.
The approach paper mentions about computerisation and interlinking of health facilities. The possibilities of information and communication services should be exploited fully. One of the main challenges of the health care sector is the information asymmetry that exists between the health care provider and the health care consumer. The demand for health care products and services are mostly supplier induced. With the entry of corporate sector in the health care field and in the context of very efficient physicians transforming themselves in to health care entrepreneurs, profit is the main driving force in investing in the health care sector. Better health information for the patients provides the patient with an improved status in the patient doctor relationship by empowering the patient with complementary knowledge. This can reduce the information asymmetry that has plagued the health system. Information technology services can greatly influence the acquisition of health related knowledge of the population.
Again, the lack of trained human resources is as responsible for inadequate provision of health services as lack of physical infrastructure, especially in rural areas. .There should be the creation of trained public health cadres. Given the long duration of the training period of health professionals there is need for a long term perspective planning approach in health man power planning. The brain drain from the health manpower stock should be discouraged. The govt and the health system planners should evolve strategies to provide adequate incentives to the health professionals and encourage them to serve the country that has invested heavily in their education.
A Good health system is characterised by efficiency, equity and sustainability. Equity should not be at the cost of efficiency. There is the possibility of sacrificing efficiency and sustainability in our struggle to make free health care accessible to all. Also the health system will not be sustainable if we do not have sufficient financial resources on a continuous basis.