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(GIST OF YOJANA) Paving the Way for Better Home [MARCH-2019]

(GIST OF YOJANA) Paving the Way for Better Home

[MARCH-2019]

Paving the Way for Better Home

Introduction

In the recent years, the health and economic growth linkage bas become an important rationale and rallying point for countries to work towards advancing universal health coverage (UHC) by focusing on improving services provisions and developing mechanisms for financial protection. India has also committed to achieve UHC as part of the country's National Health Policy 20 J7 (NHP-2017).

Improving Health Services

In the last 15 years, there have been initiatives by both Union and State governments in India to improve health outcomes. First, the National Rural Health Mission (NRHM) and then National Urban Health Mission has created a foundation for strengthening provision of health services in India. Ayushman Bharat Program (ABP) has components to strengthen primary health care and health insurance for 40 percent of the poorest families in India. By 31 January 2019, a total of 6,600 HWCs have been made functional and under PMJAY, nearly 10 lakh beneficiaries received treatment worth Rs 1,000 crore.
The states have also taken up initiatives to strengthen health services. In February 2017, Tamil Nadu started an UHC pilot where 67 sub-centres in three blocks in three districts, were strengthened by improving infrastructure, provision of additional health workers, and ensuring supplies of medicines and diagnostics.
A year later, in February 201 8, an independent evaluation documented that this initiative had resulted in increased patient attendance at these facilities and reduced out of pocket expenditure (OOPE)
by patients.
This approach is now being scaled up in other districts of Tamil Nadu.
Broad Ranging of Health Services Improving health outcomes require provision of a broad range (promotive, preventive, curative, diagnostic, rehabilitative) of health services available to all citizens. India has a mixed health care system, where private sector provides majority (75 percent of out-patients and 65 percent of in patient) of health services.
One of the challenges in private sector dominant mix health systems is that the private sector incentives are very differently aligned from population health needs.
The private sector mostly focuses on care for sick people and provision of curative and diagnostic services and risk the system becoming curative focused.
Therefore, the onus lies on the government to intervene to ensure sufficient supply of all types of health services with special focus on preventive, promotive and other public health services. Considering that the government is, in most settings, the only provider of such services, there is need for rapid increase in spending in public health services in India, as recognized in NHP
2017 as well. In addition, there is need for setting up public health management cadre by all states of India.

Increasing Government Spending

Globally, the average government spending on health as a proportion of GDP stands at around 5 per cent and government expenditure on health in Indians around 1.15 per cent of GDP and nearly 4 percent of government budget.
In nominal terms, per capita government expenditure on health in India (in 2014-15) was Rs. 1,108 of in terms of proportion of government budget at 10 per cent.
The level of the total per capita health expenditure (MoHFW, 2016).

The NHP 2017 proposed

To increase government funding to 2.5 per cent GDP by year 2025 and;
That states should spend 8 percent of their budget on health by 2020. The current level of spending on health by states is variable and most spend around 5 percent of state budget on health.
Considering that Union to State government share in health expenditure is nearly 1:2, there is need to increase budgetary allocation by both Union and States to achieve NHP 2017 target in India.

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Interim Budget

In the interim Union Budget 2019-20 which was presented to the Parliament on 1 February 2019.
Total allocation of Rs. 63,371 crore has been made for MoHFW.
The total allocation to the Ayushman Bharat (AB) Program Rs 8,000 crore and NHM has received 31,745 crore.
In addition, a new AIIMS is proposed to be set up in Haryana, making total number of AIIMS in India to 22.
‘Healthy India' has been identified as one of the 10 dimensions under Vision for India by 2030. (PHC) first:
The government spending on PHC makes health services efficient; reduces the cost and helps in delivery of preventive and promotive health services.
The PHC system can tackle up to 80 percent of health needs and can reduce the need for specialized health services, Indian states have an elaborate network of primary healthcare facilities.
The existing network of nearly 1 92,000 primary healthcare facilities in India delivers only 10 percent of total out-patient services (excluding mother and child health services); while it has capacity to deliver much more. There is need for boosting and rapid strengthening of the PHC system in India.
Focus on Financial Protection and not ‘Notional Coverage' only: In 2015-16, only an estimated 22-25 percent of Indian population was covered with am health insurance schemes. The PMJAY,
supplemented by state specific schemes, is expected to increase coverage to around 55 per cent of the Indian population.
NITI Aayog's 5 year strategic plan for new India has proposed to increase health insurance coverage to 75 percent of the population by 2022.
India needs to learn from experiences in other countries and design and implement mechanisms where coverage from health insurance schemes will reduce both catastrophic expenditure and out of pocket expenditure (OOPH) and would contribute to improved health outcomes. Indian States to Take Lead and Innovate:
Health is a state subject as per Indian constitution. The experience from National Health Mission (NHM) has pointed that Union Government led initiatives can only be guiding and catalytical.
The impact of Union Government led health initiatives is dependent upon leadership and additional measures by the state governments. There is need for stronger engagement and ownership at state level, to transform health outcomes in India.

Conclusion

Better health of people is intrinsically linked to and contributes to economic growth and development of a nation. Health is a social contract between people and government.
The global discourse on advancing universal health coverage is an opportunity' for the governments at all levels to increase government spending on health, improve overall health services provision; make provision for public health services; and to develop mechanisms for providing financial protection. In a federal system such as India, the states have to assume increasingly more responsibilities and build upon existing/ongoing initiatives. With recent focus and attention on improving health outcomes and financial protection in India, it is another opportunity to pave the path to better health outcomes as well as sustained rapid economic growth in India.