A day after the announcement on her appointment as deputy director general (programmes) in the World Health Organization, making her the highest-ranking Indian ever in a United Nations agency, Dr Soumya Swaminathan was attending a consultation in Gwalior on tuberculosis among Sahariya tribals of Madhya Pradesh.
Swaminathan, 58, is the daughter of Green Revolution pioneer M S Swaminathan. She grew up in a “charmed” scientific environment, where Nobel laureate C V Raman used to be a house guest and another Nobel Prize winner, Norman Borlaug, a frequent visitor.
Swaminathan has served as secretary of India’s Department of Health Research and director general of the Indian Council of Medical Research (ICMR). In this interview, Swaminathan, a paediatrician and researcher in tuberculosis and HIV, talks about India’s TB plan, the WHO priorities as specified by the new director general, and her love for trekking. Excerpts:
When are you joining? What will be your priorities?
The date has not yet been finalised but it would be a few weeks. I have to wind up here. Possibly it will be some time in November. It is an exciting opportunity. The director general [of WHO, Dr Tedros Adhanom Ghebreyesus] has made his priorities clear. Universal health coverage is a very clear goal, for India and for other countries. UHC takes care of a lot of health issues and we have to work towards it.
India has been toying with the UHC idea for long. The High-Level Expert Group report came in 2011; the plan to give health cover to 10 crore people is with the cabinet since last November. Where do you think India stands on UHC?
Our commitment to UHC is enunciated clearly in the National Health Policy; we have accepted that it is the path forward. We have already moved forward on some components — conversion of sub-centres into health and wellness centres is one crucial step because promotion of preventive and promotive healthcare is a key component of UHC. Health assurance in some form will have to be brought, at least for people living below the poverty line, the ones who are most vulnerable. Both OPD and IPD (out-patient and in-patient departments) care will need to be included because bringing down out-of-pocket expenditure is very important. Some states are already doing it at their levels. The challenge is to roll it out nationally.
If it is indeed a priority, what is taking the cabinet so long to decide?
I cannot talk about the specifics; you will have to ask the health ministry. It is possible that it is being modified, strengthened or expanded. There is discussion about how much cover is to be given and what form that cover would take.
The global health landscape has changed with the advent of philanthropic organisations that are working on a global scale. How relevant does WHO remain in this scenario?
WHO still plays a very central role. Countries look to WHO not just for norms and guidelines but also for resolution of contentious issues, especially when there is disagreement between countries. It plays an important role in bringing people on the same page with some common goals. The Framework Convention for Tobacco Control is a good example. So many countries signing up for FCTC made a big difference to the global fight against tobacco. In today’s context, WHO can play an important role in building such global consensus on air pollution and access to medicines, the latter having become very crucial in the backdrop of anti-microbial resistance (AMR) and availability of newer therapies.
Do you see India’s commitment to FCTC slipping? The tobacco lobby has thanked the government for “listening to it”.
We have actually done exceedingly well. Tobacco taxes are up, there are bigger pictorial warnings and the latest GATS (General Agreement on Trade in Services) survey shows use is also down. More can, of course, be done, but there is actually no evidence that the government “listened” to the tobacco lobby. The health ministry has stood firm, they did not back down on anything. Neither did the finance ministry. Tobacco products are in the highest GST slab.
How high does India figure in WHO’s list of priorities?
India is very important, partly because of our large population. Anything in India has an impact on global health. My selection is evidence that India now has a bigger presence on the global stage and a voice in global health. We need to take leadership roles in TB.
The funding for the National Strategic plan for TB elimination by 2025 is yet to be released…
It is under process. Additional funds will be released once the revised estimates come in, somewhere around November-December. ICMR is working on indigenous TB technologies. When I joined, increasing health research funding was a priority. We have had almost a 50% increase of Rs 400 crore this year. If this is kept up, we can incentivise young scientists.
How do you unwind?
I like to trek. Not big Himalayan treks; I do not have time for that. But my last trek was in the Nilgiris. I love travelling, I love Ladakh and Arunachal. The ICMR job gave me an opportunity to interact with people from across the country.