Transform India's healthcare infrastructure

Health systems have contributed enormously to better health and, but their contribution could be greater, especially for marginalized people. With its billion-plus population and less-than-equitable access to healthcare, India has the responsibility to utilize these building blocks to transform its health system, especially in the wake of the pandemic.

Recent experience of Covid-19 pandemic clearly depicts that in order to build a strong health system in India, there needs to exist an integrated system of primary-secondary and tertiary care institutions.

Multiple organizations interact to influence health systems service delivery, including the Ministry of Health and Family Welfare, public and private sector players, non-health sectors and actors, administrators, non-governmental organizations, and professional associations.

The role of the private sector is very critical as it strongly influences the service delivery of a health system. There is no one-size-fits-all way of maximizing synergies between various actors to strengthen health systems because local contexts vary significantly

India’s health workforce consists broadly of health service providers, nursing professionals, para-medics, management professionals for health and hospital with enormous variation in their level and skill. An efficient health workforce is also available, responsive, and productive.

To achieve this, managing dynamic labour markets and improving the distribution and performance of the existing health workforce is important. Suggestions for improvement during the pandemic include: increasing trained and skilled workforce in contract-tracing, case management; use of telemedicine and e-health for enhancing the accessibility and availability of various treatments and advises to the population at large.

There is a strong need to develop district hospitals as the center of excellence for providing training, technical and professional support to public and private sector institutions in the district – local capacity needs to be strengthened.

The generation and strategic use of information on health systems is an integral part of governance. A well-functioning health information system ensures the production, analysis, dissemination and use of reliable and timely health information by decision-makers at different levels.

Also, a well-oiled health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.

Recent experience strongly suggests revisiting the Indian Public Health Standards (IPHS) for district hospitals, sub-district hospitals, community health centers, primary health centers together are the nerves of the public health system in India, their standards in terms of service delivery, human resources, equipment, supplies, and infrastructure need to be re-visited.

A good health financing system raises adequate funds for health to ensure people can use needed services. There is an urgent need to increase public health spending in India. The National Health Policy, 2017 intends to increase the public health spending by 2.5% of GDP by 2025 from the current 1.3%. India’s health system is clearly underfunded, so the question arises: can we achieve the intended goal of National Health Policy with this speed and effort?

India’s health financing policies should focus more on making the health system resilient, and improving health security, and universal health coverage requires total transformation in our policy, coupled with state governments increasing their health budget by more than 8% of their state budget.

Leadership and governance is the most complex but critical building block of India’s health system that identifies the role of the government and its relation to other actors whose activities impact health systems.

Overseeing and guiding the private as well as public health system is key to ensure strategic policy frameworks exist and are combined with effective supervision, coalition building, providing appropriate regulations and incentives, attention to system-design, and ensuring accountability. The pandemic depicted that India’s health system requires a clear vision to enhance the standards of health for the population.

(The writer is a Health Economist and Public Health Specialist. Currently Pro-President of IIHMR University, Jaipur)