Days after the World Health Organization (WHO) country strategy for India till 2023 was released, WHO India representative Dr Henk Bekedam spoke to Abantika Ghosh on why Ayushman Bharat is different from the other health schemes and why he is very excited about India.
Compared to the past, what is India doing differently under Ayushman Bharat?
At any given point 60 million Indians are impoverished because of health expenses. That is why when late finance minister Arun Jaitley announced Ayushman Bharat (AB) on February 1, 2018, I saw that there is a clear point moving beyond only talking about increasing (health budget) and getting health also on the political agenda. I think AB has been very important. You saw the PM’s involvement very early on in AB, Mission Indradhanush and neglected tropical diseases. We do see that if the PM starts supporting it then the PMO is following up… when we go to districts and states sometimes the immunisation officer is complaining about how many calls he gets on following up on immunisation.
Is the involvement of the PM what makes AB different?
That and also the fact that it is focussing on the poor and the vulnerable. That conception of looking at the vulnerable is very important, the real difference between PMJAY and RSBY. The latter was looking only at the poor but this one is looking at the vulnerable too. Every country needs the health care of the poor and vulnerable to be subsidised and it has been done quite well in PMJAY.
Your recently released country strategy for India talks about Universal Health Coverage. There are not enough doctors for even the 500 million we are targetting under AB, how do we bridge the manpower gap required for 1.3 billion?
Last week you heard the PM talk about how AB will generate 1.2 million jobs. We strongly endorse that and think if you give it a little more time there may be even more jobs. It is true that when you talk about human resource there is the issue of training etc but I believe that if the PM is saying, it is a good start. I was very impressed that it came up and I have seen states like Uttar Pradesh do some honest analysis on HR. Every state needs to do that. The infrastructure you see is the states’ responsibility, not the Union’s.
We have targetted to end TB by 2025, five years ahead of global goal but are woefully behind. The annual rate of reduction is just 2% and we need around 10%. What role can health and wellness centres play in that?
HWCs are enormously important for awareness, early detection, and treatment — to tell people to go to the hospital and get investigated. They are also very important to ensure that patients continue the treatment. They are close to the community, I would expect them to know how many are on treatment and follow up. There is also the aspect of data as HWCs are the places where people go first and there will be a patient ID that will then be carried everywhere. There is the National Digital Health Blueprint for data integration and the Integrated Health Information Platform that we have worked with the government very closely on. It is important to integrate information to make sense of it. The digital health blueprint will eventually pave the way for moving towards electronic health records. For EHR we also need to look at confidentiality.
But we do not even have a data privacy law in the country.
The National Health Authority is very much aware of that (privacy concerns) from what I understand from my discussions. This needs to happen and will happen. Also, the Integrated Health Information Platform (IHIP) is linked to the National Information Centre, which has the capacity to protect.