Whenever we used to hear the word ‘health’ in an administrative context, it was natural to think only about the health department. To begin with, the Modi government in these four years has changed this very approach which was very restrictive and seemingly unimaginative. Under this government there has been a great co ordination and convergence between various ministries and departments in evolving a health policy for the people.
Health as Wellbeing: A Multi-layered approach
Now, health is neither considered as merely a treatment of diseases nor it is left to just the Ministry of Health. Apart from the Ministry of Health, Ministry of Drinking Water and Sanitation, Ministry of Chemicals & Fertilisers, Ministry of AYUSH, Ministry of Women & Child Development, Ministry of Consumer Affairs have also been actively involved in health policy and ensuring wellbeing of Indians.
The effort here is also to make health and wellbeing a mass movement. The focus and the importance given to Yoga and the interest its has generated among the people may bear testimony to this element. With this background, one may outline the new health approach of this government in the following points.
- Focus has been laid to preventive measures through sanitation, providing clean fuel, immunisation, Yoga and mental health initiative.
- Strengthening of health infrastructure through primary healthcare network, establishing new hospitals, increasing the number of medical seats etc.,
- Making health facilities affordable to people through the measures like Janaushadhi centres, capping the prices of essential drugs and medical instruments, providing health insurance cover.
Prevention is better than cure is an old adage which the Modi government appears to be effectively implementing as a health policy. The health emphasis some of the flagship programmes of this government have, is not the point to miss.
The growth rate of immunisation has seen a remarkable upward trend under this government. Before 2014, the growth rate of immunisation restricted to just 1 percent. Now it is at 6.7%. This assumes significant as the immunisation and vaccination programmes secures the health of a person right from the birth.
Mission Indradhanush, now turned as Intensified Mission Indardhanush, has achieved these things.
- 3.15 crore children vaccinated
- 80.58 lakh children fully immunized
- 80.63 lakh pregnant female immunized
- 91.94 lakh vitamin A doses administered
- 79.73 lakh ORS packets distributed
- 2.73 crore zinc tablets distributed
In addition to this, under Pradhan Mantri Surakshit Matritva Abhiyan 1.16 crore antenatal check-ups have been conducted and 6 lakh high pregnancies identified. More than 50 lakh pregnant women expected to benefit with every year with cash incentive of Rs 6000. There is a Poshan Abhiyan in place which aims to reduce malnutrition through convergence. The other steps that contributed to preventive healthcare are:
- 8 crore children vaccinated through Measles Rubella (MR vaccination) launched on February 2017
- 15.6 crore children and 3.29 crore adults were vaccinated in Japanese Encephalitis vaccination
- Nearly 3.87 crore doses of Inactivated Polio Vaccine (launched in 2016) have been administered to children
- Nearly 1.5 crore doses of Rotavirus vaccine have been administered to children
UJJWALA is not just an LPG cylinder distribution to BPL families but an act of ensuring the health of that family, especially the mother who used to directly inhale pollution from the smoking chulla earlier. According to a WHO estimation, about 5 lakh deaths in India are due to unclean cooking fuels. The study says cooking using firewood is like burning 400 cigarettes an hour. In this context, one can imagine the health benefit that has been already attained through the distribution of 4.1 crore LPG cylinders.
Swachh Bharat is another big contributor to the health of the people. Cleanliness and sanitation reduce the possibility of spreading of diseases. In its four years, the Modi government has built around 7.2 crore household toilets in rural category alone whereas in all of the period between 1947 and 2014 the number of household toilets built was 6.37 crore! As of June 2018, the sanitation coverage has increased to 84.66% from 38.7% in October 2014.
Even the other focus area under the scheme like ‘Swachh Swasth Sarvatra’ has health as its main concern.
- CHCs (Community Health Centres) in ODF block, supported under National Health Mission to achieve Kayakalp certification
- Gram Panchayat of Kayakalp PHC (Primary Health Centre) prioritised for ODF status
- Training in WASH (water, sanitation, hygiene) of CHC/ PHC nominees
Yoga has become a mass movement not just in India but through-out the world, and India is in the leadership role apparently because of the active advocating of Prime Minister Modi. Speaking at the United Nations General Assembly in September 2014, Prime Minister Modi had proposed to observe International Yoga Day. Afterwards, a draft was submitted from India in this regard and UN accepted the proposal. Since 2015, every year June 21 has been observed as International Yoga Day and has been seeing wide interest and participation across the globe.
Yoga has a key role to play in preventive healthcare, not just in physical aspect but for mental wellbeing as well. It provides remedy for non-communicable mental diseases like anxiety, depression etc., which have become common in modern lifestyle.
Ministry of AYUSH has been promoting Yoga through the measures like standardization, quality control and accreditation of education and profession and awarding the Yoga institutes.
Mental health previously a much-ignored area has also assumed importance under the current dispensation. Mental Healthcare Act, 2017 adopts a rights-based statutory framework for mental health in India and strengthens equality and equity in provision of mental healthcare services to protect the rights of people with mental health problem.
National Health Policy 2017, which came after the gap of 14 years, lays focus on mental healthcare. The policy aims to create a “network of community members to provide psycho-social support to strengthen mental health services at primary-level facilities” and “leverage digital technology in a context where access to qualified psychiatrists is difficult”.
Further, NHP-2017 commits itself to culturally appropriate community-centred solutions to meet the health needs of the ageing community, in addition to compliance with constitutional obligations as per the Maintenance and Welfare of Parents and Senior Citizens Act, 2007.
Strengthening Health Infrastructure
Ayushman Bharat the programme announced in Budget 2018 has proposed 1.5 lakh Health & Wellness Centre across India with Rs 1200 crore allocation. Further, it aims to ensure at least 1 medical college for every 3 Parliamentary Constituencies.
This act of strengthening at the primary level is followed by the actions in next level. Under Pradhan Mantri Swasthya Suraksha Yojana tertiary health and medical educations being strengthened.
- 20 New Super Speciality AIIMS –like Hospitals being set up
- Total 92 Medical College (46 Govt. and 46 Pvt.) have been set up in last four years, which resulted increasing of 15354 MBBS seats
- 73 Government Medical Colleges being upgraded
- Since July 2014, 1675 hospital beds added in the six functional AIIMS
- 2 new AIIMS announced for Jharkhand and Gujarat
- Total 12646 PG Seats (Broad & Super Specialty Course) have been increased in last four years
Making Healthcare Affordable
Providing people access to health is one thing, but what is equally important is to make health affordable to people. Here, Modi government has come up with some arguably remarkable measures.
- 1054 essential medicines, including lifesaving drugs, brought under Price Control regime after May 2014, giving the consumer total benefit Rs. 10,000 crores.
- Pradhan Mantri Bhartiya Janaushadhi Pariyojana
As of June 2018, 3,164 PMBJP outlets were functional across 33 states & Union territories. More than 600 medicines and 154 surgical aids and consumables can be availed here for cheap price.
- After the intervention of Ministry of Chemicals & Fertilizers, cost of Cardiac Stents has come down to 85%and Knee Implants cost became 69% lesser. It gives a huge financial relief to patients. The average MRP in the market for Bare Metal Stents (BMS) was Rs 45,000 and for Drug Eluting stents (DES), Rs 1,21,000. This was reduced to Rs 7,623 for BMS and Rs 31,080 for DES. This has resulted in a gross relief of Rs 4450 crores a year.
- AMRIT (Affordable Medicines and Reliable Implants for Treatment) pharmacies provide drugs for cancer and cardiovascular diseases along with cardiac implants at a 60 to 90 per cent discount on prevailing market rates. As of now 124 stores have been opened so far across 22 states selling over 5200 drugs (including cardiovascular, cancer, diabetes, stents, etc), implants, surgical disposables and other consumables at significant discount of up to 50 % on market rates.
- Pradhan Mantri National Dialysis Programme launched in 2016 offers free dialysis services for poor and subsidized services to all patients under National Health Mission. Under this programme, 5 lakh patients availed service and 25 lakh dialysis session held so far. There are 497 dialysis operational units/centres and 3330 total operational dialysis machines.
- Ayushman Bharat provides comprehensive health Coverage to 10 crore poor and vulnerable families (approx. 50 crore beneficiaries) up to Rs 5 lakh per family per year for secondary and tertiary hospitalization.
There has been significant progress and the visible change of approach in fighting some diseases. One major example is of tuberculosis (TB). The National Strategic Plan for TB Elimination (NSP 2017-25) was launched with the objective of eliminating TB by 2025. Some of the important measures taken in this regard are:
- Treatment for drug sensitive TB is provided through a network of more than 400,000 DOT Centres.
- House to house screening of TB symptoms covering 5.5 crore population under active case finding.
- Rs 500 per month for nutritional support to all TB patients for the duration of TB treatment through DBT.
Some progress has been made under National Vector Borne Disease Control Programme as well.
- Reduction of 28% in reported positive cases of Malaria 840838 in 2017 (provisional) as compared 1169261 in 2015.
- Reported deaths due to malaria reduced by 73 % in 2017 to as compared in 2015.
- Reduction of 37.7% in cases of Kala-azar: from 9241 in 2014 to 5758 in 2017
- Reported deaths due to Kala-azar reduced to 100% 11 in 2014 to Nil deaths in 2017.
It is evident that the Modi government has been working on a well-rounded action plan on health. The National Health Policy 2017 proposes raising public health expenditure to 2.5% of the GDP in a time bound manner. The focus of the policy is on preventive and promotive health care and universal access to good quality health care services. The Modi government in these four years has already tread this path to an extent and there is a clear roadmap for the future which has both preventive and palliative healthcare approaches.