Mumbai Center Director Underscores Importance of Investing in Health to Promote Economic Development
The director of the Columbia Global Centers | South Asia, Nirupam Bajpai, was invited by the Indian Institute of Health Management Research (IIHMR) Jaipur to deliver a guest lecture on “Improving Access and Efficiency of the Public Health Sector in India” to their faculty and students on March 10, 2014. Students and faculty members from the Bangalore campus of the IIHMR also joined at this event via videoconferencing. For a country of India’s size and public health challenges, said Bajpai, up until eight years back, there was no school of public health in the country, an absolutely shocking fact. He commended the efforts of IIHMR to begin a Master’s Program in Public Health.
Bajpai underscored the importance of investing in health to promote economic development and to reduce poverty. Extending the coverage of crucial health services, he said, including a relatively small number of specific interventions, to India’s and the world’s poor could save millions of lives each year, reduce poverty, spur economic development, and promote global security.
Most importantly, said Bajpai one of the key problems with the Indian health system is the lack of government spending in the health sector (1.2% of GDP in India vs. 2.4 % average spent by lower middle income countries) and the inefficiencies and misuse of the meager resources that are available. Since 85 percent of health care is an out of pocket expense, despite all the gains via the National Rural Health Mission (NRHM) the systemic change that is needed over the next few years is to reverse these numbers – of the total health spending, 85 percent should be public health spending and the balance out of pocket. The ambitious goal of providing universal health care for all (In 1978, India was a signatory to the Alma Alta declaration, undertaking to provide “Health for All” by the year 2000) was far from being achieved, especially in remote rural locations even fifteen years beyond the target year.
Bajpai questioned, if the State has universal health care and poverty alleviation as its basic objectives; if there have been gains, however patchy and inadequate; if there are systems in existence though not actually thriving, why is the current health scenario so bleak? He pointed out that this is due to the mismatch between these objectives and resources being spent to achieve them. Policymakers need to define realistic goals and allocate much higher levels of resources for the health sector. He noted that the foremost objective of the Indian health system should be financial risk protection for poorer and weaker sections of the population.
Citing India’s recent achievement of becoming a Polio Free country, Bajpai said this was an enormous feat to be achieved by a country as large and diverse as India. It has now been more than three years since a polio case has been reported from any part of India. The Polio eradication campaign, he said, has been the biggest, most complex, and meticulously planned and implemented vaccination campaigns in human history. However, he felt that Indians did not fully appreciate this achievement and had hence not celebrated this accomplishment as it should have been.
Bajpai said, what this feat demonstrated was if there was a clear goal set out (as in this case first for the city of Delhi in 1994 by the then Delhi Government Health Minister, Harshvardhan and then after a few years converted into a nation-wide campaign by the Vajpayee led NDA government and then finally achieved by the Singh led UPA government); support for a national initiative across party lines; continued monitoring and surveillance; exemplary support from the community, including school teachers and children, health workers, local governments, NGOs, private sector and their foundations and international organizations, such as WHO, Rotary and UNICEF etc., goals can be achieved and that India’s 16 year journey of a Polio Free India had major takeaways for several other national programs said Bajpai. He emphasized that building on India’s Polio eradication campaign experience, India should now be aiming for a Measles free India.
Bajpai said an assessment of utilization patterns of public health care providers shows that with the provision of free or low-cost services at government health facilities, demand for public sector outpatient services are rising amongst that part of the population which falls below the poverty line. The people are increasingly turning to public health facilities even for treatment of infectious diseases such as TB and Malaria. The high percentage of outpatient curative services, ANC, institutional deliveries, PNC, immunization etc. are being sought from the public sector as it is getting better organized, managed, staffed and service-oriented.
Bajpai said many parts of rural India are experiencing an epidemiological transition and this is reflected in a growing burden of non-communicable diseases. Non-communicable and chronic diseases are increasingly being seen as a leading cause of death in rural India. Hypertension, Type II Diabetes and Cardiovascular diseases are on the rise in rural India. It is critical to keep these emerging disease burdens in mind while scaling up health services, but surely not at the cost of providing for basic primary health services.
He said since the launch of the NRHM, undoubtedly, the Mission has achieved a great deal, especially in the areas of putting in place an ASHA for every 1000 population; creating greater awareness about ante-natal care, institutional delivery, post-natal care and child immunization; raising institutional deliveries; raising the numbers of outpatients being provided with healthcare services in the HFs; provision of un-tied funds for all HFs and so on. However, the scale of the challenge that still remains is immense, said Bajpai.
Bajpai said he believes that seven broad issues are critical if the NRHM has to succeed on scale: 1) a much higher level of public health spending in general and much higher outlays for NRHM in particular; 2) comprehensive training, effective control and oversight and timely and adequate payments for the ASHAs; 3) an effective and efficient management structure for the health facilities at the village, block and district levels; 4) a well-defined and implementable model of intersectoral convergence at the district level; 5) commensurate physical infrastructure and human resources in the sub-centers and the Primary Health Centers with the growing needs of the regions;6) scaling up necessary interventions to bring down the IMR and MMR; and last, but certainly not the least, real-time data driven decision making, said Bajpai.