India on the path to make affordable care available to all

Savita Verma

With Indian doctors’ prowess giving foreigners a confidence to seek treatment here, India has come a long way since independence in healthcare. The country has a booming medial tourism industry, coupled with improved score in health indicators like life expectancy, infant mortality and fertility rate. India now has a strengthened network of primary health centres, community health centres and tertiary care super specialty hospitals along with an army of trained medical personnel to provide health care to its people. Simultaneously, more hospitals are being opened, drug prices being regulated, technology being made affordable for masses, network on communicable diseases being strengthened and efforts being made to invest more in the healthcare.
The Gross Domestic Product per capita, which indicates a country’s standard of living, has increased 21 times from the 1960 level when it was $81.3 to $1709.4 in 2016, according to World Bank estimates. The life expectancy at birth, the average number of years a person is expected to survive if existing patterns of mortality stayed the same throughout their life has increased by 65.8 percent or 27 years between 1960 when it was 41 years and 2015 at 68 years. Crude birth rate has also reduced from 37 in 1970 to 22.2 in 2012 (per 1000 population). Population stabilisation efforts have paid off with total fertility rate for the country going down to 2.3 while some states like Delhi at 1.7, Kerala at 1.8, Tamil Nadu at 1.7, Maharashtra at 1.8, West Bengal at 1.6 and Himachal Pradesh at 1.7 attaining fertility rates even lower than the replacement rate of 2.1 children per woman.
The country has shown impressive progress in bringing down the infant mortality rate – the number of babies per 1000 who die before their first birthday. From 165 deaths per 1000 children in 1960, the IMR has come down to 38 deaths in 2015. A major reason for this is the country’s vaccination program. After launching its first vaccine – BCG – in 1962 as part of the national tuberculosis control program, India now has come a long way. An expanded program on immunization as part of the World Health Organisation’s initiative was launched in India in 1978 which included BCG, DPT and typhoid vaccine. Oral Polio vaccine was included in the program in 1979. In 1985, the program was converted into Universal Immunization Program (UIP) with a goal to cover all the children.

Over the years new vaccines like those against hepatitis B and Japanese encephalitis have been added. The thrust on vaccination has made India polio free. The country was removed from the endemic countries’ list on February 25, 2012 by the WHO. Vaccination has also contributed to the decline in under-five mortality rate from around 233 to around 47.7 per 1,000 live births in 2015 in last five decades, though in numbers this is huge burden – an estimated 5.9 million children died under the age of five in 2015, 45 percent of them being newborns.
Despite the progress, health sector in India still faces some challenges. For example, a large proportion of population – two-thirds of children and more than half of the women – suffer from anemia and malnutrition. High cost of care is a cause of concern which makes accessing care difficult for the poor and the weaker sections. Statistics show that even the well-to-do families reach the brink of poverty if faced with a serious illness. This is because of low government investment in health and private sector becoming the main source of healthcare.
New National Health Policy
However, the government has initiated landmark measures in the past three years to overcome these problems. It has brought out of a new national health policy which aims to provide universal access to good quality services at affordable cost. There is an emphasis on strengthening of the public health system by increasing public expenditure on health to 2. 5 per cent of the GDP in a time bound manner. The policy also proposes free drugs, free diagnostics and free emergency care services in all public hospitals to reduce financial burden of health care on people. The policy envisages giving choice of treatment to patients by co-location of AYUSH remedies in public facilities. Yoga should be introduced in schools and work places as part of promotion of good health, it says. The policy advocates strengthening of district level services so that people get secondary care there itself rather than in medical college hospitals, and recommends proactive engagement with the private sector.
In line with the intention of health policy, government has already initiated measures to reduce cost of medicines and medical equipment while bringing more people under the health insurance net. There are plans to provide about 500 medicines free of cost in government district hospitals across the country. Fifty basic medicines will be provided free in primary health centres and 300 medicines in community health centers. The government has opened 83 outlets under the Affordable Medicines and Reliable Implants for Treatment (AMRIT) program. It also intends to empower citizens to access quality healthcare services using better mobile and internet connectivity. Aiming for equitable care, the government has been opening new AIIMS, including the latest approved for Assam.
Affordable medical care is the focus of this government. The National Pharmaceutical Pricing Authority has added 30 more essential drugs in the price control list taking the total medicines under price control to about 760. A draft national medical device policy aimed at bringing most medical devices within the ambit of price regulation and boosting their local manufacturing has also been prepared. Currently, only a few critical medical devices are under indirect price control and 80 per cent of all devices are imported products. The government has already fixed the ceiling prices of orthopaedic implants used in knee surgeries to prevent unethical profiteering at the cost of patients. In addition, medical devices which are notified as drugs must now carry maximum retail price (MRP) on the packs. There are 22 medical devices notified as drugs under the Drugs and Cosmetics Act, 1940 and the Drugs and Cosmetics Rules, 1945. These include cardiac stents, bone cements and heart valves.
Government has included several new vaccines in the Universal Immunisation Programme – vaccine against rotavirus, injectable polio vaccine, pentavalent vaccine one shot of which protects against diphtheria, pertussis and tetanus (DPT), hepatitis B and Hib, and anti-pneumonia vaccine which protects against severe forms of pneumococcal disease, such as pneumonia and meningitis. These vaccines were already available in the private sector. By including these in the national program, the government has ensured equitable access. A government program, “Mission Indradhanush” launched on December 25, 2014 is already on to increase full immunisation coverage by approximately five per cent annually from 65 per cent in 2014 to at least 90 per cent children in five years.
To overcome the problem of widely prevalent severe acute malnutrition, the health ministry is working on guidelines and a toolkit to help frontline workers reach out to parents and orient them on their role in ensuring early childhood development. The Ministry of Women & Child Development has also been implementing several schemes to address the issue of malnutrition.