COVID-19 exposed several weaknesses in India’s underfunded health system.
• Rural primary care is underfunded and has shortages of staff, equipment, drugs and infrastructure in many parts of the country.
• Urban primary healthcare has still not emerged as an active programme in many States.
• District and medical college hospitals suffer shortages of specialist doctors and support staff.
• The private sector ranges from advanced tertiary care hospitals in big cities to informal and often unqualified care providers in villages.
• During the pandemic, it could not assuredly provide affordable care or deliver vaccines in large parts of India.
• There was a disconnect between the various levels of care within the public system, and the private system operated in a separate universe. Most government-funded healthcare insurance programmes did not cover outpatient care.
• This patchwork quilt of a mixed healthcare system frayed fast when challenged by the surging second wave of the virus.
. Alerted by the experience of the first wave of 2020, the government proposed in the Budget greater investment in the health system. The Fifteenth Finance Commission too recommended strengthening of urban and rural primary care, stronger surveillance systems and laboratory capacity as well as creation of critical care capacity at different levels of the health system.
Training public health professionals
. There is a need to train and deploy a larger and better skilled health workforce. Upgraded district hospitals offer the best opportunity for creating new training centres. Public health expertise will be needed for programme design, delivery, implementation and monitoring in many sectors that impact health.
. Institutional capacity for training public health professionals will be scaled up.
. To provide a continuum of care at different levels, HWCs will be linked with the Pradhan Mantri Jan Arogya Yojana, for all entitled beneficiaries.
. The hub-and-spoke model of block, district, regional and national public health laboratories will enable effective microbial surveillance. Private sector participation in service delivery may be invited by States, as per need and availability.
. ABHIM, if financed and implemented efficiently, can strengthen India’s health system by augmenting capacity in several areas and creating a framework for coordinated functioning at district, state and national levels.
. It can enable data-driven decentralised decision-making and people-partnered primary care at the block level while strengthening national connectivity for delivering universal healthcare.
. Many independently functioning programmes will have to work with a common purpose by leaping across boundaries of separate budget lines and reporting structures. That calls for a change of bureaucratic mindsets and a cultural shift in Centre-State relations. Perhaps the platforms for active citizen engagement can catalyse both.