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Over time, a ratings system with cash incentives should energise the state health delivery system

By: Editorial | July 1, 2016 12:34:18 am

Someone at the health ministry has used his or her imagination, and a rating system has been proposed to incentivise government facilities — and state governments by extension — which keep their premises and services in good working order. Initially covering community health centres, it is an intelligent step towards a transparent, responsive and responsible health system, though the proposal is only foundational and admittedly requires development. A minimum head count of doctors, nurses and laboratory technicians assures a single star rating. More stars are earned according to pharmaceuticals available, services offered and success in engaging patients. The fifth and final star is to be earned by benchmarks like the performance of at least five Caesarean sections and implantation of at least three intrauterine devices every month.

Points aggregated by states can be redeemed for a 5 per cent incentive in the outlay from the National Health Mission. The innovation is designed to spark competition and should have a salutary effect, encouraging states to compete for extra funds. Institutions which contribute significantly to state aggregates will naturally earn prestige, and perhaps better allocations. However, statutory warnings must be issued against indiscriminate competition. For instance, Caesarean sections are already preferred in India for non-medical reasons like a favourable astrological chart, and further enthusiasm for the procedure would harm public health. IUDs should be cautiously used as a benchmark too, since the choice of contraceptive method is the patient’s right.

Besides, the criteria for earning stars must be sharpened. The trouble with the delivery of state services is not the lack of qualified personnel, but absenteeism and poor application. Specifying a minimum number of personnel only lays down a baseline. Other human resource criteria must be applied to measure the quality of their work. Similarly, the mere presence of services and equipment indicates nothing. Government hospitals are junkpiles of clinically dead equipment which remains on the record. Patients often have to seek private providers for radiological and imaging tests, for instance, and lives are tragically lost because a ventilator or resuscitator is kaput. It is not uncommon for hospitals to acquire equipment and then leave it crated, for want of space or support facilities. The condition of equipment matters more than mere numbers. However, the availability of drugs, which is often conditioned by local interests, will certainly improve under scrutiny. A points system will improve over time, and we must not cavil at its initial deficiencies.

 

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