As the chaos and confusion of the great Indian election season dies down and the re-elected Mr. Narendra Modi and his ministers take oath following a roaring victory, it is time to look forward to what is ahead and focus on the challenges for Modi 2.0 and his team of cabinet ministers. With opposition decimated and NDA set to win a majority in Rajya Sabha by 2020, PM Modi will enjoy unprecedented power and autonomy with very few political and social constraints. This will give him the freedom to implement and execute newer reforms that can change the way healthcare is viewed in India.
Over the past 4 years India made a few improvements on health indicators and eliminated Maternal and Neonatal Tetanus in 2015. India also intensified its Mission Indradhanush program to include 4 additional vaccines and rolled out the ambitious Ayushman Bharat health scheme. The flagship healthcare scheme of Mr. Narendra Modi- led NDA government, now renamed as PM Jan Arogya Yojana (PMJAY), has been met with wide admiration and criticism alike from national and international stakeholders. This ambitious scheme offers an insurance coverage of Rs. 5 lakhs per family, estimated to cover about 500 million Indians, a magnanimous task both in terms of implementation and monitoring. Government has also effectively attempted to cutting down the prices of cardiac stents and has tried to regulate the prices of other implants and prostheses. Health had always been a low priority for policymakers and politicians in India. PM Modi, to some extent, was successful in making healthcare a political subject in India by rollingout PMJAY, and getting one step closer to Universal Health Coverage.
The world is looking at India on how it handles its largest and most ambitious healthcare plan ever through a two pronged approach- insurance coverage to 500 million individuals and creation of 150,000 wellness centers across India. While visionary and innovative, massive policies like these always run into serious financial and resource constraints over time. Additionally limited human resources and budgetary constraints in several states makes it difficult to establish wellness centers in these states. As with the demonetization issue, where the motive was clear- that of formalizing Indian economy and clearing out black money- but lacked major implementation and execution issues, PM Modi’s policies for his second term will have similar resurrections.
However Universal Health Coverage is not the only issue that will dominate the conversation in healthcare sector in next 5 years. If India plans to show its improved stance towards healthcare to global players, it will have to soon deal with issues such as –Mental Health, Non-Communicable Diseases, Anti-Microbial Resistance and Climate Change- all cases of utmost concern both at global and national level. The newly introduced National Medical Commission (NMC) bill will play a decisive factor in regulation of medical sector both in private and public space. Replacing Medical Council of India as the apex body to maintain standards of medical education, regulate medical practice and give approvals to medical colleges; it has received wide criticism for its proposal of a bridge course for practitioners of AYUSH.
It remains to be seen how the succeeding government deals with it. The new government will soon have to engage with a new rising stakeholder in Indian healthcare scenario- youths. A meaningful youth participation at decision making table has a great potential for visionary and innovative policies and staying relevant to the rising young population of India. Amongst other issues that may need to be tackled at the earliest by the re-elected NDA government, creation of jobs specifically for youth, will be at the top of headlines. Healthcare is one of the biggest sector in terms of revenue and employment in India and may act as a big sources of employment for skilled but unemployed youths of India.
For Prime Minister Modi to roll out his ambitious plans and show his seriousness towards healthcare issues, he’ll need a foundationally strong health ministry, supported by a team of advisors who are experts in health policy and economics. With the appointment of doctor-turned-politician Dr. Harsh Vardhan as the Minister of Health and Family Welfare, Prime Minister Modi has clearly indicated that he means business. Dr. Harsh Vardhan has a clear track record and a stellar performance in his previous roles in government. He has been credited for overseeing successful implementation of Pulse Polio Program and was instrumental in bringing the first anti-tobacco laws of the country which prohibited smoking in public place. This experience will help in attainment of Tuberculosis and Malaria elimination goals while strengthening primary healthcare services. His additional portfolio as Minister of Science and Technology and Minister of Earth Sciences means that health ministry can comfortably collaborate with these ministries and harness the power of science, technology and innovation to achieve substantial goals within a reasonable time frame.
Mr. Modi needs to expand his “home delivery of services” model to include healthcare services under it. A “Digital India” is incomplete without covering healthcare services under its gambit. Inclusion of modern technological tools will make it easier to execute and monitor principle healthcare programs. India is emerging as a major “Startup Economy” and it needs to build on it to promote innovative startups and models in healthcare sector that can help reduce private health expenditure and widen the healthcare coverage. Credible incentives must include loan waivers and subsidies to individuals and organizations willing to establish healthcare services in rural and remote areas. Given the rising demands for quality healthcare services, government needs to strengthen public healthcare system and frame regulations to streamline the growth of private healthcare market.
A key factor that throttles India’s growth in healthcare sector is dismal proportion of healthcare professionals, specifically doctors. Creation of new jobs, filling vacant positions, offering opportunity and skill training will mitigate rising emigration of healthcare professionals to OECD countries for jobs and training. Replacing “100 days agenda” with a “1000 days agenda” is an opportunity to replace crumbling models and policies with innovative, futuristic and inclusive healthcare policies. Moreover– with Dr. Dr. Soumya Swaminathan as Deputy Director General of Programmes at WHO and Mr. Harsh Vardhan’s experience of working with WHO- there is a golden opportunity for India to form successful collaborations with WHO.
India will celebrate its 75 years of freedom in 2022 and it remains to be seen how the government projects healthcare as one of its success stories in spite of years of slow growth, debacles, challenges and dismal resources. Health is a fundamental right of an individual and it is high time that it is given its justified priority among other political issues at discussion.
About the author: Dr. Ankit Raj is a junior doctor working with International Students Surgical Network and a blogger and freelance writer on healthcare issues such as system strengthening, global surgery and health policy. Follow him on Twitter @RajAnkit14