Innovative Financing : Strengthen India's Health Systems

Enhancing healthcare finance and to realign the allocation to emerging priorities, fulfilling its commitment to UHC and SDG; rising trends in disease burden of non-communicable diseases; continued challanges in poor maternal and child health especially in Empowered Action Group and North East States; unfinished agenda of Millennium Development Goals for communicable diseases, especially TB and Malaria; and phenomenal rise in health care costs, the Government of India and the State Governments have to substantially raise spending on healthcare in India. The National Health Policy, 2017 aims to double the government healthcare spending from the existing 1.2% of the GDP to 2.5% by 2025.

Over the past decades, since independence, India has made a phenomenal progress in access and availability of health services adding a network of -

1,58,417 Sub-Centres (SCs),

25,743 Primary Health Centres (PHC) and

5624 Community Health Centres (CHCs).

More than 30,000 SCs and PHCs to provide provide comprehensive primary health care since 2018.

India Achieved :

• Reduction in infant mortality rate  (IMR) from 74 per 1000 live birth in 1994 to 33 in 2017.

• Maternal Mortality Ratio (MMR) from 600 per one lakh live births to 122 per one lakh live births in 2015-2017.

• Crude Death Rate (CDR) and Crude Birth Rate (CBR) declined to 6.3 and 20.2 per 1000 population.

• The life expectancy at birth has increased from 58 years to 69 years from 1990 to 2017.

• India has successfully eliminated diseases like small pox, guineaworm, neonatal tetanus and polio and

• Effectively controlled many communicable diseases like leprosy, malaria, filariasis, kala-azar and progressing well towards ending tuberculosis by 2025.

• Reduction in Deaths due to infectious and communicable diseases.

Challenges :

1. Non-communicable Diseases (NCDs)

• Changing Lifestyle and risk of behaviour like smoking, alcohol consumption, unhealthy diet.

• Inadequate physical activity.

• The growing incident of non-communicable and lifestyle diseases like cancer, diabetes, chronic kidney diseases, cardiovascular diseases, chronic lung diseases and mental health disorders etc.

• Increasing proportion of ageing population also increase NCDs burden.

• NCDs account for 55.4% of the diseases burden and 62% death in India and expected to rise further to over 70%.

• NCDs emerging new challenge and the challenge of fighting malnutrition and Communicable disease still continue, India is facing double disease burden.

2. Financial Challenges :

• Approximately 63% health expenditure is met by Out-of-pocket expenditure (OOPE) by the households.

• It exorbitant and put extra pressure on low socioeconomic population.

• Almost 10 crore population goes below poverty line (BPL) due to high OOPE.

• The Centre government expenditure is 1.28% of the GDP.

• The State health spending is around 2% of SGDP on average with variations across the States.

• Currently, 45% of the total expenditure is spent on primary health care followed by 36% for secondary care, and 13.9% for tertiary care.

• The average expenditure for hospitalisation in private institutes is much higher (3.4 times) as compared to government facilities (2.9 times).

• Lack of health facilities in Rural India.

• India had highest OOPE (62.4%), almost double of China (32%) and 4.5 times of Japan.

3. Administrative Challenges :

• The issue of critical regulation systems on food, drugs and diagnostic etc;

• Implementation of clinical establishment rules.

• Gaps in medical, dental, nursing and pharmacy institutions which will not be addressed by market forces requires government intervention.

4. Nutritional Challenges :

• Obesity : due to unhealthy diets like sugar sweetened beverage.

• High salt intake resulted high blood pressure.

• Consumption of tobacco increase the cases of cancer.

• Alcohol : high consumption is injurious to health.

Government Commitments :

• India has largely achieved Millennium Development Goals (MDG) and is committed to Universal Health Coverage (UHC) which is one of the targets of Sustainable Development Goals (SDG) by 2030. 

• The SDG 3 targets to achieve UHC, including Financial Risk Protection, access to quality essential health care services, and access to safe, effective, quality and affordable essential medicines and vaccine for all.

• The Government of India and the State Governments have to substantially raise spending on healthcare in India.

• The National Health Policy (NHP), 2017 aims to double the government healthcare spending from the existing 1.2% of the GDP to 2.5% by 2025.

• To ensure primary health expenditure to be 2/3rd of the total health expenditure.

NEED :

• Raising taxes on harmful commodities may not only improve health but can generate more fiscal space for health.

• The Government need to subsidize LPG (clean energy) heavily instead of diesel, kerosene and coal for cooking.

• The Government should be promote fruits, dairy products and protein sources products for healthy lifestyle.

• The food subsidy can be used towards subsidies on pulses, fruits, vegetables and milk which will have a far more beneficial impact on nutrition.

• The government should be assist to shift from tobacco and sugarcane to not harmful crops for human health.

• India need more Infrastructural development in health sector.

• Increase Medical College with PPP model.

• Health insurance to finance hospitalisation to reduce OOPE and catastrophic health expenditure can also be introduced.

• Ayushman Bharat has a great promise but the coverage should be extended to the whole population.

• To use of Artificial Intelligence (AI) in health sector (Technological impart).

• Till now, the health sector had been focusing on "More Money for Health and More Health for Money" but in the current pandemic (COVID-19), the health sector needs to focus on "More Health for Money" turning towards innovative financing by striving to do more with less.

Reference

Yojana

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