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Angus Deaton, Nobel-winning economist, in his 2013 book, ‘The Great Escape: Health, Wealth and the Origins of Inequality’, wrote that the cholera epidemic in London in the mid-nineteenth century and the Spanish flu pandemic after the first World War made people and governments all over the world conscious about the importance of public health. However, the development in healthcare was not uniform everywhere and in developing countries like India, it was lagging behind. Several commentators in India feel that the Covid-19 pandemic brought the health policy of the country to the centre stage.

An article titled ‘Running to stand still: Healthcare in India in 2021’ by Oomen C. Kurian, Head of Health Initiative at Observer Research Foundation (ORF) stated that India’s health outcome indicators have revealed slow but consistent improvement over the past few decades. However, much of this progress has been achieved despite the lack of proper policies and funding. Kurian writes, “When the National Health Policy 2017 set a target of reaching 2.5% of GDP worth of government expenditure in health by 2025, most analysts were of the view that it was highly ambitious. India indeed appeared to be far from able to achieve such a target. However, the global Covid-19 pandemic in 2020 forced the Government of India to spend way beyond its own 2025 target, and in many ways, above its means.”

Major challenges

The treatment of non-Covid patients is going to be the primary challenge in 2021. Kurian wrote that by some estimates, India’s GDP product has contracted by 10·3% and is not showing any signs of revival. This means that new sources will need to be tapped for sustained, extra funding for the healthcare sector. The Fifteenth Finance Commission had projected a `5.38-lakh crore requirement for the Ministry of Health between 2020 and 2025 for providing primary healthcare. The widely expanded requirements of immunisation, screening, testing and treatment of Covid-19 may lead to the revision of this estimate. This may lead to an almost parallel structure to treat non-Covid-19 conditions in the coming years.

There are certain areas that require urgent attention in India. In a Business Standard report titled, ‘Primary health to insurance: Five non-Covid-19 areas to focus on in 2021’ by Anoo Bhuyan, T. Sundararaman, former dean of the School of Health System Studies at the Tata Institute of Social Sciences, said, “If the focus in 2020 was on Covid-19, 2021 would be about the vaccine to fight it. India would struggle to carry out large-scale vaccinations especially without a parallel increase in financial and human resources.” Blessina Kumar, CEO of Global Coalition of TB Activists, stated, “We were lagging behind on tackling tuberculosis (TB) even before this pandemic hit. In 2021, I want TB services back. And I do not want things to be where they were before the pandemic. I want things to be improved and better. We have seen how quickly a response can be planned during this pandemic; how different sectors can come together. I think there is scope for us to do better work on TB in 2021.”

Recommendations

In November 2020, Healthcare Federation of India (NATHEALTH) said that it has urged the government to prioritise the health sector and has submitted certain recommendations. NATHEALTH said, “It is important to note that the private health sector has been standing alongside the government in managing the pandemic, in spite of considerable loss in revenues that it has faced, the situation is expected to continue in the foreseeable future, which makes these recommendations very important.” In a statement, NATHEALTH stated that in the short term, the federation has requested for zero-rating of GST for healthcare services which will not only ensure that the credit chain is intact but also ensure that the input taxes are not loaded into the cost of healthcare service - thus making healthcare more affordable. It also added that companies engaged in healthcare services which have un-utilised MAT credit should be allowed to avail the reduced corporate tax regime of 25%. The government may also consider 5-year interest-free loans for the sector. Lowering the TDS for FY21 and FY22 can also be considered taking into account the financial burden on the private healthcare sector due to Covid-19 pressure and escalating costs.

There was a lot of hope surrounding the Pradhan Mantri Jan Arogya Yojana (PMJAY) that it will strengthen the primary healthcare system. However, Covid-19 has exposed the bottlenecks of all these policies. Chhaya Pachauli, Director, Prayas, an organisation that works on health equity said to media, “As opposed to health insurance, I hope that the centre and the states move more towards health schemes which are universal in nature and at the same time, help to make healthcare services more accessible and affordable for everyone.”

Future

According to the report titled, ‘Aggregate availability of doctors in India: 2014–2030’ by Basant Potnuru, Associate Professor, Economics and Business Policy, FORE School of Management, published in the Indian Journal of Public Health, India needs 2.07 million doctors by 2030 to provide equitable healthcare. With an aim to fill the rural gaps, the government is expanding medical seats, both in the public and private sectors. According to latest available estimates, the number of MBBS seats has seen a jump of 48% - from 54,348 in 2014-15 to 80,312 in 2019-20. There has also been a 47% rise in the number of government medical colleges during the period between 2014 and 2019 - compared to a significantly lower 33% increase in the total number of medical colleges — including government and private — in the past five years.

According to experts and industry insiders, digital innovations are essential to improve healthcare access in India and it should also aim at bridging the digital divide. India’s strengths as a digital powerhouse are yet to be harnessed by the healthcare system to accelerate its progress towards a high-quality, affordable, comprehensive, accountable, accessible and inclusive healthcare ecosystem.