Public health is a core components of democracy. Contemporary Health policies are unenable to build coherence with SDGs. It reflected the major execution constraints. Health Policies of India always been a disappointment point; the indecisive nature of Governance dragged country on the dangerous edge. According to world bank, India spend in Public health 3.54% of their GDP on 136.64cr demographic capacity. It is the lowest budget in World. Comparing to countries like Nepal, Myanmar, Haiti, South Sudan, Algeria and Cuba invested more than India; all spend at least 6% of their GDP in public health. Other developed nations like UK, Germany, France spend more than 10% and USA give 16% of their GDP to health care sector.
National health policy suggested that expenditure on health by states should be increased to up to 8% but none of the states ready to invest more than 5.4% of total budget in healthcare system. Spending less in health sector decrease our capacity to fight against the pandemic in most difficult times. We require to spend more, design appropriate Policy and most importantly implement and monitor those policies in structured manner for fruitful results.
National health mission was to provide health benefits in Rural(2005) & Urban (2013). Main functions of this programme are strengthening health system, prevention of communicable and non – communicable diseases, and create universal accessibility , affordable & quality healthcare service to all citizens in urban and rural areas. This programme was extended because of the tremendous outcome which only displayed on papers but still governance needs to played their proper role in designing and implementing accurate policy. India faces several challenges in the path of addressing health crisis; India lacks strategic Policy, constructive concepts, regulation and work ethics.
National health policy 1983 was the failure; cannot Considered to revive the healthcare crisis. Infact, liberalization opened the direction to move towards the public private partnership to achieve health services to all. To providing Healthcare services to urban poor is as essential as in rural areas. ORF mention in their report on URBAN HEALTH GOVERNANCE IN INDIA: A POLICY ROUNDTABLE addressing health as central component of urban planning and governance. Migration from rural to urban areas becoming extremely important aspect of urbanization, where people believes urban healthcare services are far more better than rural; but the urban system as crucially defected as the rural area, it raises question on the governance structure. Indian Health system cannot deal with diseases like tuberculosis, malaria, HIV+AIDS , deficiency of vitamins. Governance have to acknowledge the basic problem in health sector then only can able to build the health policy.
PUBLIC HEALTH ISSUES LEAD TO THE HEALTH CRISIS
National health policy 1983, 2002 and 2017 unleash to achieve an acceptable standard of good health system by upgrading infrastructure in existing public health; but it did not acquired the beneficial results out of these policies because Problem lying in Health Governance. Regulatory mechanism, Monitoring and evaluation of health policy aspects are not effectively pressuring for powerful outcomes. In India, 23% of sick population, 7% below poverty line population are not capable to afford Healthcare.
According to spending in healthcare, India rank extremely low, estimation of spending Rs 3 per person on per day that count 1.02% of the GDP, meanwhile other countries average spending is 6%. WHO in Health financing profile 2017 depicted 67.78% of aggregate expenditure was paid out of pocket, on the other hand, the world average is 18.2%. let’s examine state – wise spending in public health.
Bihar spend Rs 491 per capita on health (on 12.7cr population) less than half the Indian average spending 1.33. Madhya Pradesh spend Rs716 (on 86.8cr demography) and Uttar Pradesh Rs 733 (on 24.6cr population). On the contrary, we see complete different picture in Mizoram who spend Rs 5,862 of 4.2 % of it’s GDP (12.6cr population), Arunachal Pradesh Rs 5,177 (1.6% population) and Sikkim Rs 5126 (6.63 lakh). Two different spectrum in one country where few states neglect their public healthcare whereas others more inclined towards ensuring public health to their people.
Due to neglection of health sector, states who spend less suffering the most during Covid -19. These states had to faced the situation like lack of beds, hospital services, medical staff and medical equipments. This problem occurred because of years of neglection in health sector, health policy evaluation process was not used as weapon to counter the health crisis in India.
Lack of allocation to healthcare and lack of Governance capability caused the much bigger crisis. Covid -19 is global pandemic but it made Indian healthcare system came on it’s knees; when capital of country facing run out of beds, desperate hunt for oxygen cylinder, medical supplies it’s showed Indian healthcare system is rotten, toilsome and intricate.
Our Government and Governance is solemn enough to diminishing the health crisis. Capital of country not capable to fight against sudden health crisis then we can presuppose the conditions in rural areas. In this situation, Governance need to evaluate their mistakes that’s how Governance will play it’s sophisticated part, need some measures to ensure the public healthcare in entire country, should not resisted to only urban health centres.
Corruption in health sector, lowest quality health programme, poor cooperation between public & private sectors, lack of health awareness and no accessibility to medicines or testing machine services created cluster in health sector; which reflected as more weakness during Covid -19. When India became epicenter of global pandemic during dangerous second wave; India made international headline. The scenes of families from hospital were horrified. It also depicted how Government failed us.
Government and bureaucrats have no capability to overturn the crisis and find relevant solution in serious conditions in country. Indian government lack leadership quality, Political will. Governance cannot work until top political leaders and bureaucrats show some credibility to disperse the crisis. India estimated 4.34 lakh death due to covid-19. Health crisis is not new in india, Government never capable to find dynamic Policy to eradicate diseases like Tuberculosis, Malaria, HIV+AIDS. Tuberculosis caused 220,000 death every year. WHO estimated 2.64 million TB cases in 2020. KPMG report revealed that 74% doctors practice in urban areas this simply means rural area lack primary healthcare treatment facility. India has huge scarcity of doctors, nurses, paramedics and testing machines especially in rural areas. That’s how migration become prominent from rural to urban. WHO also suggested 1 doctor for 1000 people meaning 1:100 but India has 1:1445.
National TB Elimination Programme was not as effective as thought to obliterate the deadly disease from the country; where all other nation found the way to kill the health crisis. We need to revive the health policy structure and find new future oriented health policy to counter any sudden global health crisis. Let’s discuss few criteria to resist the health crisis in India.
RECOMMENDATIONS TO BUILD COLLAPSING HEALTH SYSTEM
PUBLIC PRIVATE PARTNERSHIP
Last two years shook Indian healthcare system, demanded to take evident steps in healthcare sector. This is a accurate time to transform the ancient health policy and bring unique & innovative public health programme concerning the target population. Two main components of health crisis are affordability and accessibility which majority of population cannot reach to. Well governed PPP is the direction to improve the Indian healthcare system; through PPP India have seen success in the fields such as education, urban development and infrastructure.
• PPP provide resources to Government, which will bring experience and finances of the private sector. It will create a bridge between affordability and accessibility to all citizens.
• PPP ensures the expertise, finances, affordability, technology, specialist doctors.
• Now, one aspect need to consider that Public – Private sector will bring the resources but how, where, what to utilize at what place and in how much quantity for that Non – Government Organization can play the role of agent to fulfill the necessary requirements & provide research to private sector.
• Non – government organization can play essential role to ensure the PPP goals spread to all citizens. These organization overlook the formulation, Implementation and functioning of PPP. It can be great gap filler between affordability and accessibility.
• But, PPP should manage in control manner make sure by Governance it’s roles and functions otherwise PPP increase the burden of expenditure on common citizen. Governance needs to evaluate time to time the working mechanisms of PPP.
• Also, it is necessary to collaborate with non profit organization to maximize the result of PPP. Need to tackle down the any coming vagueness in PPP, maintain regulation.
INCREASE ALLOCATION TO HEALTHCARE
India must increase the spending on public healthcare. It should not differ state to state. Each state has to spend good amount of their GDP in Public health. Centre Government construct one same Affordable healthcare Programme for all states. Through INTER – GOVERNMENTAL RELATION center Government ensure overlapping authority model to communicate. Govt should spend at least more than 6% of their GDP. It will provide huge access to necessary medical services in the country.
NATIONAL FREE MEDICATION AND COUNSELING
Center and state government incite medication facility including counseling and spread awareness regarding health issues of human body. Make citizens more conscious about their body. Now, this method has challenging step concerning in rural areas with help of NGOs, ASHA workers, door to door awareness is necessary to spread the words about the sanitation, coronavirus precautions, HIV+AIDS awareness and TB awareness programme. In digitalized world, Mobile clinic can play great outlay of serving information of diseases to the people. Lunch effective powerful awareness programme in urban and rural areas Ensuring the awareness reaching to all citizens in country.
Center and state government incite medication facility including counseling and spread awareness regarding health issues of human body. Make citizens more conscious about their body. Now, this method has challenging step concerning in rural areas with help of NGOs, ASHA workers, door to door awareness is necessary to spread the words about the sanitation, coronavirus precautions, HIV+AIDS awareness and TB awareness programme. In digitalized world, Mobile clinic can play great outlay of serving information of diseases to the people. Lunch effective powerful awareness programme in urban and rural areas Ensuring the awareness reaching to all citizens in country.
CONCLUSION
Health Governance is one kind of Governance that we must deal with caution. Good Public Health Governance reflect the sincerety of Government ; it ensure the transparency, accountability and promote citizen centric Approach. Government determine universal Public healthcare no resistance to PAN areas. Providing Healthcare to citizens consider as enriching the immunity of country. Policy makers recite properly the Implementation part while performing the health policy; Keep the track of Monitoring then only we can decisively conclude the success of health policies.
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