India's universal health coverage policy needs to be extensive, considering the role of the states and Centre and lower than expected performance of healthcare services, experts opined here on Saturday at a conference on healthcare.
Given the challenges of the policy making environment in the country and the government's low spending on healthcare, the sector is not performing at the level it should have been to meet the demand of quality healthcare for India's growing population, said Rakesh Kumar, joint secretary, ministry of health and family welfare.
"18 percent rural population in the country has no access to healthcare," he said at the inauguration of 'Delivering on the Promise of Universal Health Coverage in India: Policy Options and Challenges'.
According to Kumar, the burden of non-communicable diseases in the country has increased. "Seventy percent of deaths in India will be caused by non-communicable diseases by 2020."
"Today's conference is the culmination of collaboration between Jindal Global University, Harvard Global Health Initiative and the Harvard School of Public Health to examine legal, policy and regulatory issues relating to the universal health coverage in India,"said C. Raj Kumar, professor and vice chancellor, O.P. Jindal Global University.
"The conference brought together academics, policy makers, doctors, lawyers, public health practioners and government representatives to discuss and debate a central issue of public policy, which is about the efforts to achieve universal health coverage in India," he added.
Explaining the impact of poor healthcare on the country, Ramanan Laxminarayan, professor, Public Health Foundation of India, said India is "very different from other countries" where "people may go into financial impoverishment because of high primary healthcare cost".
Laxminarayan said the quality of healthcare services is an important issue and non-harmful care must be ensured for the people.
He highlighted the achievements of public sector undertakings like railways, saying that "public sector in India does deliver".
Laxminarayan said when public sector banks have an excellent level of accountability, why can't it be replicated in the healthcare sector.
Highlighting the state of medical education in India, Kesav Desiraju, former secretary, Department of Consumer Affairs and former secretary, Ministry of Health and Family Welfare, said the government has no interest in revising the curriculum of MBBS.
"The problem is much deeper than we think at the undergraduate level," he said.
Desiraju said of the 416 medical colleges in the country, about 60 percent are in the private sector. "At macro level the numbers could be impressive but we are not getting the desired results."
"About 28 percent of the rural population and 20 percent of the urban population has absolutely no money to pay for healthcare services," the former secretary said.
Imrana Qadeer, senior fellow, Council for Social Development and former professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, gave a historical perspective of universal healthcare.
She said "diseases are rooted in poverty" and all healthcare plans in India focus mainly on technology while poverty reduction is never incorporated into them.
Analysing India's healthcare initiatives, Peter Berman, professor of the practice of global health systems and economics, Harvard T.H. Chan, School of Public Health and coordinator, India Health Partnership, said the National Rural Health Mission (NRHM) launched in 2005, which has now been renamed as NHM with spending cuts, was an important policy change for the healthcare sector in India.
"NRHM had set the target of spending 2-3 percent of the gross domestic product (GDP) on health by 2012. It had set specific targets for the Centre as well as states," he said.
Rajeev Malhotra, professor, Jindal School of Government and Public Policy and executive director, Centre for Development and Finance, said universal health coverage can be quantified.
"Public and private sectors have mutually reinforcing role in providing healthcare in India," he said.
Stating that tracking the global impact of diseases is important, he said the breakout of Ebola upset all economic development projections in Africa.
Saying that the AYUSH programme of the government has not been tapped properly, he said: "The government has to take a call whether it wants to see itself as a player or a provider...Private sector's role needs to be strengthened in the value chain."
