India needs a renewed health-care system (The Hindu, GS-2, Health )

India needs a renewed health-care system (The Hindu, GS-2, Health )

Context:- There are few urgent questions in front of the newly selected Health minister in the purview of pandemic. These questions are:

  • What does the new Minister of health need to learn from past experience?
  • What unfinished tasks need to be taken forward? 
  • How should we as citizens expect the Government to perform better on the public health front under COVID­19 pandemic?

First Let’s explore Health Profile of India:-

  • Indian population is highly susceptible to communicable diseases and poor immunity (India ranks 135 out of 195 on UNDP Health Index)
  • Shortage of emergency healthcare infrastructure and professionals:
    • Doctor to patient ratio: 1:1445
    • Hospital beds to people ratio: 0.7:1000
    • Ventilators to population ratio 40000: 1.3bn
    • According to System registration system
      • IMR in India is 32.
      • MMR in India is 130.
      • According to government data 59% of women India are anemic.

Lets look into what National Family Health Survey-5 says about health in India:- 

  • Under NFHS-5 22 states have been scrutinized and data revealed that replacement level of fertility or RTFR (2.1) has been achieved in 19 out of the 22 States/UTs and only 3 states viz. Manipur (2.2), Meghalaya (2.9) and Bihar (3.0) have TFR above replacement levels now.
  • Contraceptive Prevalence Rate or CPR has increased substantially in almost States/UTs. Here it is highest in Himachal Pradesh and West Bengal (74%). 
  • Use of modern contraception methods have also increased in almost all States/UTs.
  • Full immunization drive among children within the age bracket of 12-23 months has recorded a substantial improvement across States/UTs. 
  • More than two-third of children have been fully immunized in all the States and UTs with the exception of Nagaland, Meghalaya and Assam. 
  • When we compare data between NFHS-5  and NFHS-4, we found that there is an increase in full immunization coverage is observed to be expeditious in many states and UTs.
    • This milestone goes to the flagship initiative of Mission Indradhanush launched by the government in 2015.
  • There is an increase in the percentage among the women receiving the recommended four or more ANC visits in many States/UTs and the percentage has increased in 13 States/UTs between 2015-16 to 2019-20.
  • Institutional births or births in hospitals have increased substantially with over four-fifth of the women delivering in institutions in 19 States and UTs.  
  • There has also been a substantial increase in C-section deliveries along with institutional birth in many States/UTs especially in private health facilities.
  • Sex ratio at birth has remained unchanged or increased, was observed in most States/UTs.
  • Child nutrition indicators show a mixed pattern across states. the situation improved in some of the States/UTs but deteriorated in others. 

Let us compare two States which are currently having the highest number of COVID­19 cases in India i.e. Maharashtra and Kerala.

  • There is a divergence in the fatality rates of both states which is 0.48% for Kerala and 2.04% for Maharashtra.
  • There are huge differences in the effectiveness of public health systems because one state works on the public model (Kerala) and other works on the private model (Maharashtra).
  • Kerala has per capita 2.5 times more government doctors with an equally higher proportion of government hospital beds as compared to Maharashtra.
  • Maharashtra has a large private health care sector and the weak public health system of Maharashtra has proved to be a critical deficiency.
  • Robust public health care services in Kerala have shown a lesson i.e.:
    • A more effective outreach with timely testing
    • Early case detection along with more rational treatment for COVID patients, which all together reduce fatality rates.

What is the lesson we can learn from the above trajectory of two states:-

  • One of the lessons from the data shows that health services should not be further privatised.
  • Public hospitals must be strengthened both from infrastructure point and from human resource point as well.
  • We must invest in public health.

A Need of the Hour for Central Government:-

  • There is an urgent need of attention of the  Health Minister for National Health Mission (NHM) because since 2017­-18, Union government allocations for the NHM have declined in real terms, Though government has boosted itself in this year budget by saying “Health sector allocation has increased by 137%”
  • One one hand urban people across India have experienced major shortages of public health services during COVID­19 but on the other hand the condition of the National Urban Health Mission (NUHM) remains pathetic. 

What is NITI AYOG stand on Health Sector:-

  • ‘Investment Opportunities in India’s Healthcare Sector’  report which is published by NITI AYOG depicts further privatization of health care in a country which already has one of the most privatized health systems in the world
    • The NITI AYOG report fails to acknowledge the negative aspects of unregulated private health care which has been seen during the pandemic.
    • There is a Proposal in the report for handing over public hospitals to private operators. The private player will now run these key public institutions on commercial lines under the ‘Viability Gap Funding’ scheme are deeply worrisome.

Way forward:-

  •  Parliamentary Standing Committee has recommended that the Government must allocate ₹1.6­lakh crore for public health during the current year in order to reach National Health Policy targets, 
  • There is a dire need for strengthening public health systems
  • Government must regulate private health care
  • Government must prevent further privatization of the health sector as has been boosted by the NITI Ayog Report.

Something Extra:-

About National Health Mission (NHM):-

    • On 1st May 2013, National Urban Health Mission (NUHM) was launched.
    • Outcomes for NHM were synchronised with 12th Plan and are part of the overall vision.
  • It’s main points are:-

      • Reduce MMR to 1/1000 live births 
      • Reduce IMR to 25/1000 live births 
      • Reduce TFR to 2.1 
      • Prevention and reduction of anaemia in women aged 15–49 years 
      • Prevent and reduce mortality & morbidity from communicable, noncommunicable; injuries and emerging diseases 6. Reduce household out-of-pocket expenditure on total health care expenditure 
      • Reduce annual incidence and mortality from Tuberculosis by half 
      • Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts 
      • Annual Malaria Incidence to be <1/1000 10.Less than 1 per cent microfilaria prevalence in all districts
      • Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks
  • NHM has six financing components: 

    • NRHM-RCH Flexipool
    • NUHM Flexipool
    • Flexible pool for Communicable disease
    • Flexible pool for Non communicable disease including Injury and Trauma
    • Infrastructure Maintenance and
    • Family Welfare Central Sector component. 

Download Plutus IAS Daily Current Affairs of 17th July 2021

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