Greater political commitment to health care now: K Srinath Reddy

'We've had enough warnings as our health sector has been challenged in many ways during the different waves of the Covid-19 pandemic', said Reddy

As the government readies for yet another pandemic year Budget, the health sector is in focus again. K Srinath Reddy, president of the Public Health Foundation of India, believes there is greater political commitment towards health now, after years of neglect, but a lot more still needs to be done. In a conversation with Ruchika Chitravanshi, he says the country needs to invest in tech, but the investment would be like a carriage on wheels if there is inadequate health workforce. Edited excerpts:  

With this being the second back-to-back pandemic Budget, what is expected of the government for the health care sector?

We’ve had enough warnings as our health sector has been challenged in many ways during the different waves of the Covid-19 pandemic. We have also seen that now, there is a greater degree of political commitment to strengthening the health sector after many years of neglect. This is true for both the central and state governments. They have recognised that unless we actually invest in strengthening the health sector, we are likely to see serious consequences for our economic growth, as well as social and developmental activities. This particular commitment was reflected in the Budget presented by the government in 2021. A lot more needs to be done to meet the challenges and, not only during public health emergencies, but even during other times when other health requirements of the people need to be met.

In the 2021 Budget, we saw a large allocation towards vaccination. Do you think we need that much this year as well?

I think so. For the simple reason that we understand that many of the vaccines that are available are not necessarily going to provide immunity over a very long period of time. Plus, many people who have been infected by the virus, have acquired some infection related immunity is a positive sign. But even that tends to go down. Plus, we have to be wary of the fact that we are being challenged by new Covid-19 variants, which have the property of immune escape. While vaccines are not able to prevent mild illness, it’s the serious illness, hospitalisation and death where they have worked. Then, the elderly and the immunocompromised, need better protection. We are also likely to see newer generations of vaccines. So, we have to invest a fair amount in the vaccination programme. Boosters may not be required for everyone, but should be there for at least those who are at risk.

What are the biggest shortcomings in the health sector now? Is it the lack of financial resources, bureaucracy, infra, all of these or something else?

We do not have a very good network of urban primary health care centres functioning in many states. Even on the rural side, despite strong investments and improvement over the last 10 years, a fair amount of work still needs to be done. We have to improve that infrastructure at various levels, from the sub-centres to the community health centres. It’s the district hospitals, though, that require the most attention. We saw that during Covid-19, where secondary care is vital, our district hospitals did not really measure up to the job. They need to be upgraded. Medical and nursing colleges can be attached to them so that they become major training centres for our health professionals and frontline workers.

We also need to invest in digital technologies. But that investment would be like a carriage on wheels if we do not have an adequate health workforce. Since creating a large number of doctors is going to take time, we must invest in technology which can assist health workers in providing primary healthcare in both urban and rural areas. That is the best defence against public health emergencies.

Do you think that the pandemic has taken away the focus from health sector-related issues that you’ve talked about?

That neglect has been long standing. The National Rural Health Mission had a limited scope. It only looked at maternal and child health services, some infectious diseases, and nutritional deficiency issues. It never looked at almost 85 per cent of the health care needs: whether it were problems related to the eye or diseases like blood pressure, diabetes, the non-communicable ones or those related to mental health, were all ignored. Now, the National Health Policy of 2017 says it’s going in for a comprehensive plan, bringing everything into the ambit, creating health and wellness centres. Excellent, but it needs faster implementation.

Similarly, they said basic diagnostic services and essential drugs will be provided in the health and wellness centres. Major portion of our expenditure is outpatient care which includes essential medicines and diagnostics. If you tackle that, you can greatly reduce the expenditure of people.