Health policy fraught with many challenges

The draft national health policy, made public by the government, aims at providing basic health services, including essential medicines and diagnostic and treatment facilities, to all people as an entitlement. It is an important measure in a country where the state of public health is very poor. The policy envisages giving of preventive and curative medical services to all citizens and to cut out-of-pocket expenditure on healthcare. There is a plan to offer health insurance, which takes care of the basic health needs, to all people, with free coverage for those below the poverty line and at subsidised rates for others. The programme is to be implemented in phases from this year and the existing schemes like the national rural health mission and the Swasthya Bima Yojna will be ultimately made part of it. Access to secondary health services will also be improved through more number of and better public hospitals and purchase of services from the private health sector. 

While the programme is welcome, it will pose challenges on many fronts at the implementation level. The policy wants the government’s healthcare expenditure to be increased from about 1 per cent of the GDP to 2.5 per cent in the next five years. But even this will not be sufficient to offer the services promised by the policy. It should also be noted that the government had recently made a 20 per cent cut in this year’s healthcare budget. Spending on health is the major item of expenditure in many families and much of it is borne by individuals and families. Death and disabilities due to the high costs of healthcare are common in the country. The fact that poor health conditions are mixed with poverty, malnutrition and illiteracy complicates the situation.

If universal healthcare is to be provided, medical facilities all over the country will have to be improved and upgraded. This is especially true in rural areas where health infrastructure and facilities are very deficient. It is estimated that only 30 per cent health infrastructure exists in the rural areas where about 70 per cent of the population lives. More hospitals and healthcare units will need more doctors and supporting staff. The number of doctors may have to be tripled and this will call for setting of medical colleges. The results can come only over a period of time. While there are great difficulties in implementing such an ambitious healthcare plan, all efforts in that direction will be rewarding.

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