Doctor is not in

India’s changing demographic and epidemiological profile requires us to think bigger and better .

Written by Kapil Sibal | Updated: October 15, 2016 11:18 am
Dengue, chikungunya, Malaria, chikungunya india, dengue in india, Health, India health, Indian health systems, India hospitals, doctors, India doctors, chikungunya treatment, fever, Dengue treatment, WHO, World Health organisations, National Rural Health Mission, NRHM, UPA, UPA government, AAP, Mohalla clinics, AAP's Polyclinics, Arvind Kejriwal, Diseases, India news, indian express news To fix India’s healthcare scenario, what is most needed is “systems thinking”. (Illustration by C R Sasikumar)

The outbreak of dengue and chikungunya across India has again directed our attention to the state of the Indian health system. The media is awash with stories of overcrowded hospitals and under-prepared government authorities struggling to deal with the magnitude of the problem. The sheer economic, social and personal costs of these diseases — in terms of healthcare costs, loss of productive work days and patient-suffering — are there for all to see. However, the most unfortunate aspect of this saga is that it seems to be an annual affair for India. Each year, as the monsoon sets in, we see a spurt in the reported cases of, and deaths due to, dengue, chikungunya and malaria. This bears testimony to the state of our planning in the public and private sectors to address disease outbreaks.

To fix India’s healthcare scenario, what is most needed is “systems thinking”. For far too long, India has followed a vertical approach in its health sector, which translated into disease-specific national programmes being set up. While many of these programmes have their own value, and have proved their efficacy over the last several years, there is an urgent need to adopt an approach that strengthens health systems to deal with problems such as the annual outbreak of diseases like dengue and chikungunya, as well as to prepare for the upcoming onslaught of non-communicable diseases such as cancer and diabetes.

As per the World Health Organisation (WHO), an effective and efficient health system consists of six key building blocks — service delivery, medicines, information, health workforce, financing and governance. We all know that save for India’s ingenuity in producing cheap generic medicines, the country’s record via-a-vis the other five blocks is dubious at best. Therefore, if we are actually serious about improving the health outcomes of India’s citizens, we must look at strengthening the country’s health system in its entirety, with an equal focus on disease prevention, health promotion, and disease diagnosis and treatment.

This translates into ramping up our commitment to disease surveillance and data collection systems, better medical research, health workforce training and staff-retention programmes, public provision of quality healthcare and nutrition services, equal access to safe and efficacious medicines, increased public financing for healthcare and nutrition, and effective public and financial management of our national healthcare and nutrition service delivery programmes. This roadmap is quite simple to follow, and all it needs is a strong political will, a long-term view of planning and management, and attention to detailed implementation. This approach, of course, raises questions about the feasibility of the so-called panaceas like the mohalla clinics, which may be well-intentioned but are poorly planned. As we have seen, the mohalla clinics seem to be courting controversy at every step, with the most recent episode calling into question their commissioning norms and spotlighting allegations of inflated property rents.

Considering that India has a great opportunity to leverage its demographic dividend like no other country in the post-modern era, it is incumbent upon us, the political leadership, to do the right thing. We know that health and nutrition are inextricably linked to each other. Research has shown that good health and nutrition during the early childhood period lead to proper physical and cognitive development amongst children, which is directly related to improved productivity and earning potential when these children become adults. Therefore, our failure to improve the health and nutrition outcomes of our children is a major disservice to the future growth and progress of India.

There is an urgent need for the Central government to take the lead in ensuring health and nutrition service delivery. Unfortunately, going by the current trends, the National Democratic Alliance (NDA) government seems to be averse to the idea of leading the way in health and nutrition. A quick analysis of the 2016-17 budget allocations to the National Health Mission (NHM) and Integrated Child Development Services Scheme (ICDS Scheme), compared to the 2013-14 allocations, shows an approximate increase of six per cent and a decrease of 14 per cent, respectively.

Given that India needs more public investment to strengthen its health system in line with WHO guidance, the paltry increase in the NHM allocation and the steep reduction in the ICDS budgets are ill-conceived. They seem even more regressive when one considers the historic steps — such as the launch of the National Rural Health Mission (NRHM) — that were taken by the preceding United Progressive Alliance (UPA) government to improve the health outcomes of India’s citizens.

The government must understand that it cannot substitute the health, nutrition and overall development outcomes of Indian citizens with “efficiency gains”. It also cannot shift its responsibility of delivering health and nutrition services to non-state actors. India’s changing demographic and epidemiological profile requires us to think bigger and better. The political leadership cutting across party lines needs to come together and look at new and more efficient ways to deliver healthcare to our citizens. That certainly is not possible in the face of shrinking public investments in the social sector.

More than any other time, when India is standing right at the cusp of a potential demographic dividend, we must get it right now.

The writer is a former Union minister and MP, Rajya Sabha from the Congress party

For all the latest India News, download Indian Express App now

  1. P
    Prashant
    Oct 15, 2016 at 7:24 am
    All his so called "historic" steps failed "historically",,,this is the only reason why India even after 67 yrs of independence is behind some of the small countries like Sri Lanka, malaysia etc,,,,congis have a v peculiar habbit of finding faults with other without looking into their own "girewaan"
    Reply
    1. P
      Prashant
      Oct 15, 2016 at 7:04 am
      They leave no stone unturned in blaming modi ,,, shameless fellow ,,they were sleeping for past 65 yrs,,,they are comparing 2 yrs of Modi rule from their 65 yrs torturous regime during which country suffer ed the most!! ,,,Kapil sibbal is the main culprit who ruined our Higher education system.
      Reply
      1. R
        Rajat
        Oct 15, 2016 at 2:14 pm
        Congress had been in power for more than 50 years. This person was a minister for 10 years in the UPA government. What was he doing all these years?
        Reply
        1. S
          SubbuI
          Oct 15, 2016 at 7:55 am
          MY COMENT POTED FEW HOURS BACK AND APPROVED AND PRINTED DOES NOT APPERA IN BELOW ALLCOMMENTS COLOUM.PLESE DO THENEED FULL
          Reply
          1. S
            Sudhip Kumar
            Oct 15, 2016 at 1:41 pm
            This guy's thinking seems to start when Cong gets the kick on the butt. So I guess we all know what to do...
            Reply
            1. K
              K SHESHU
              Oct 15, 2016 at 2:32 pm
              Political will is important for taking measures of healthcare by the governments.
              Reply
              1. A
                Arayan
                Oct 15, 2016 at 10:54 am
                Mr Kapil you are very intelligent. Please join BJP and guide them.
                Reply
                1. A
                  Anant Sahni
                  Oct 16, 2016 at 5:02 am
                  Sir, lt;br/gt;Your idea is well intentioned and well reasoned. But why are you not implementing the same in the states that you are in power.lt;br/gt;Even in states that are about to go for elections - this does not seem to be part of Election Manifestos. lt;br/gt;So is health a priority - or as always we are poking s as Opposition members?
                  Reply
                  1. B
                    Balaji
                    Oct 15, 2016 at 1:15 pm
                    At-least you should not give the idea and suggestion for good Governance. In past You got the chance to show all this talent with you but failed . Now you just wait and see how other group are doing. Public has the capacity to compare the work of two group for deciding good and bad.
                    Reply
                    1. D
                      DA
                      Oct 15, 2016 at 1:13 pm
                      The writer makes his case well. All facts are clearly laid out. However, the criticism of the central government is highly misleading. He fails to point out that more money has been allocated to states, at the expense of central programmes. lt;br/gt;lt;br/gt;These central programmes have been an enduring feature of all congress led governments of the past. And they have failed. Spectacularly. As the writer's analysis itself proves. lt;br/gt;lt;br/gt;Health is a state subject, and central intervention lets state governments off the hook. The central government does not have the means or manpower to deliver health services on the scale that is required in India. And, one size fits all approach is inherently problematic for a diverse country like India.
                      Reply
                      1. S
                        ss
                        Oct 15, 2016 at 3:01 pm
                        The chap who could reduce Rs. 1,76000 crore to zero is talking of thinking big. A bit rich surely.
                        Reply
                        1. J
                          Jayesh
                          Oct 15, 2016 at 6:15 am
                          Without reading his article .... I can say there shall be zero gain by reading what this person says.
                          Reply
                          1. K
                            kamal Sharma
                            Oct 16, 2016 at 6:58 pm
                            Sir,lt;br/gt;Please do not write any other article about improving "anything" in India.
                            Reply
                            1. A
                              anil
                              Oct 15, 2016 at 6:06 am
                              Just like hotels, Hospitals should be given accredition showing its abilities, facilities and proper system levels.
                              Reply
                              1. P
                                poo ki
                                Oct 16, 2016 at 12:11 am
                                Adding up everything in India which could be easily embezzled and proving that they all addup to zero!
                                Reply
                                1. P
                                  poo ki
                                  Oct 16, 2016 at 12:09 am
                                  The sum total of Sibal's gigantic thought = everything in India adds up to zero more especially if it has anything to do with the embezzled state funds and the sun shines out of the dienastic butts. Sibal very simply cannot think of any thing other than the dienastic butts.
                                  Reply
                                  1. R
                                    Raj
                                    Oct 15, 2016 at 1:31 pm
                                    Zero loss fame kapil giving another senseless argument
                                    Reply
                                    1. R
                                      Raman Govindan
                                      Oct 15, 2016 at 12:06 pm
                                      The media is awash with stories of overcrowded hospitals and under-prepared government authorities struggling to deal with the magnitude of the problem."lt;br/gt;lt;br/gt;that was wonderful until 2 years ago! and everything started to slide immediately NMody took over the reign! does Sibal want us to believe!
                                      Reply
                                      1. R
                                        ravneet
                                        Oct 15, 2016 at 2:17 pm
                                        Mr Kapil scamgressi,lt;br/gt;lt;br/gt;India's past 30 years were bad. Present is looking good. So give your advice to alu ki factory famed pappu.lt;br/gt;lt;br/gt;You need to apologize all of us for reading your useless stuff written herelt;br/gt;lt;br/gt;Never want to see you again in power... good bye
                                        Reply
                                        1. R
                                          rddy
                                          Oct 15, 2016 at 8:25 am
                                          Dear Sibalji, what were your congress party doing from past 65 years ,Machar Marrahete Kya, now ready to give lectures how to govern shame on you
                                          Reply
                                          1. S
                                            S K
                                            Oct 15, 2016 at 2:47 pm
                                            when you got a chance you cozied up to chors who were looting the country and you were also justifying them. so what locus standi do you have now to talk There are now people at the helm who are aware and who will do something about these things
                                            Reply
                                            1. Load More Comments