Improving the health care delivery system

  • India fairs poorly in comparison to its peers in govt health spending regardless of the indicator used — as a share of

GDP (1.3%) or as a share in total govt spending (4.8%) or as a per-capita govt health spending (< $20)

  • Health experts are demanding govt health spending by doubling the govt’s share in GDP from 1.3% at present to upwards of 2.5% of GDP over the next few yrs
  • Undoubtedly, the govt needs to increase its health spending. But for a huge step-up in its health spending, it needs to get the delivery system — particularly at the primary care level right
  • Low govt health spending in India is the result of the faulty design of its delivery system, particularly the primary care system, on at least 3 counts:
    1. the system is not designed to address much of the health-care needs of the population at the primary care level; it is totally oblivious to the emerging burden of non-communicable diseases (NCDs)
    2. there are huge vacancies across all cadres of health workers. For eg., the share of vacant positions of doctors in primary health centres is over 25%
    3. the govt health delivery system in many States has a reputation of poor management & governance bcz of weak incentives & loose accountability mechanisms; the system is designed to focus on inputs instead of on quality care & improving health outcomes
  • Therefore a vast majority of the cases (70-80%) go to private providers for non-hospitalised care, with all its pernicious consequences notably high household spending
  • Thus, the govt health delivery system is trapped due to low confidence in the primary care system is resulting in low funding of the sector

Primary care system needs a radical transformation

  • A primary care system acts as the first point of contact for all medical needs (preventive, promotive & curative care), of the population, & also serves as the referral point for higher level health facilities
  • There is a need for higher level of political commitment to redesign the primary care system
  • The primary care system has to provide care at the household, community & health facility levels for a wide range of services including early screening & detection of NCDs, & management of its risk factors
  • Further, the new design ought to be paramedic-centric & performance-oriented
  • It should leverage the power of Information Technology (IT) that has the potential to overcome access barriers, economise on the scarce factors such as doctors & improve patient satisfaction o IT-based interventions, such as eg., tele-consultation, telemedicine, & teleradiology, are fast becoming the reality

States in the driver’s seat

  • States play a major role both in the delivery & financing of health services
  • Following the 14th Finance Commission recommendations, the role of States in the financing & delivery of primary health care has become even more important
  • While learning from the experience of countries such as Thailand & Turkey, States need to do their own experiments o The idea that States test Universal Health Care (UHC) pilots was actually mooted in the 12th Five Year plan but it never got off the ground o States could partner with the international development agencies to test a few primary care pilots
  • States should prioritise health, get on with pilots, & come up with their own design blueprints & road maps before a huge step-up in their health spending

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