PMJAY needs robust plan, funds

The Pradhan Mantri Jan Aushadhi Yojana (PMJAY) has sparked debates ever since it was launched in September 2018. The debate has been on the thought, investment, execution and the impact of the PMJAY on Indian citizens. Let’s dwell deeper, to go to the root of the healthcare situation in India, and to highlight the core issues that need to be addressed for making a Universal Healthcare Scheme successful in India.

In a country where approximately six crore people slip below the poverty line by paying for healthcare from their pockets, the PMJAY is a revolution whose time has come. Broadly the PMJAY aims to provide healthcare cover of up to Rs 5 lakhs to 50 crore people.

As per reports, close to 3 crore beneficiary cards have been issued till April 2019 beginning, which cover 5 crore citizens. So far so good. Now, where will the cardholder opt to go for healthcare services, a private clinic, or a hospital, or a government community health center/ hospital?

The 71st NSS Health Survey shows that more than seven out of 10 citizens go to the private sector for their healthcare needs. And interestingly, this is irrespective of whether the patient is from urban or rural India. The report clearly shows the preference of the Indian citizen for the private sector as a service provider for their healthcare needs though they can ill-afford it.

The government by introducing the PMJAY, where the patient can seek treatment at a private hospital, is indirectly acknowledging the overall deficiencies in healthcare delivery through its own channel. Robust healthcare delivery needs healthcare infrastructure that comprises not only bricks and mortar, equipment but also skilled healthcare workers. The government’s contribution in producing healthcare workers has always been dismal since Independence.

In 2018, the private medical colleges had two seats for every one seat from the government medical colleges. Moreover, the college fees required to educate one MBBS doctor in a private college is equivalent to producing at least five MBBS doctors from a government medical college. That is why when experts optimistically cite our doctor-patient ratio reaching the WHO standard of 1 doctor per 1000 patients, the optimism may be unwarranted. The proportion of medical doctors coming from government colleges needs to increase manifold.

Every doctor who graduates from a government medical college should be informed before enrolment, over a mandatory service for an initial fixed period in a government primary or secondary health center at any location. This is the ‘contribution’ that the new doctor has to make to the country for subsidising his/her education.

Increase funding

Any initiative needs to be funded, and the current governmental spending on healthcare hovers around 1.15- 1.5% of GDP. The ambition to increase it to 2.5% is still woefully short when compared to even our neighbors like Bangladesh that has consistently been more than 5% of GDP. It is precisely for this reason why their performance on key health indicators like infant mortality rate has surpassed that of India.

Interestingly, the military spend of Bangladesh is around 1.15% of GDP compared to more than 10% for India. No one is suggesting that we compromise the security of our country and its citizens.

But, it is high time the government gives healthcare the priority not by piggybacking on the private sector infrastructure, but actually investing in its own infrastructure right from producing skilled healthcare workers to developing healthcare infrastructure. After all, defending India’s citizens whether from external enemies or disease is the government’s primary responsibility.

The steps taken by the government indicate the right intent, but intents not backed by robust planning and fund allocation will not be enough to fulfill the government’s vision for a healthy India.

(The writer is founder, WhiteSpace Consulting and Capability Building)