WORLD BANK LENDING TO INDIAN HEALTH SECTOR- HEALTH

WORLD BANK LENDING TO INDIAN HEALTH SECTOR- HEALTH

News: World Bank to lend $1 billion to support India’s health sector

 

More in news:

  1. The World Bank is lending up to $1 billion to help India with preparedness for future pandemics as well as to strengthen its health infrastructure. The lending will be divided into two complementary loans of $500 million each.
  2. Through this combined financing of $1 billion, the bank will support India's flagship Pradhan Mantri­ Ayushman Bharat Health Infrastructure Mission (PM­ABHIM), launched in October 2021, to improve the public healthcare infrastructure across the country.
  3. The $500­million Public Health Systems for Pandemic Preparedness Programme (PHSPP) will support the government’s efforts to prepare India’s surveillance system to detect and report epidemics of potential international concern.
  4. Another $500­million Enhanced Health Service Delivery Programme (EHSDP) will support government’s efforts to strengthen service delivery through a redesigned primary healthcare model, which includes improved household access to primary healthcare facilities, stronger links between each household and its primary care facility through regular household visits and risk assessment of non­communicable diseases.
  5. Both the PHSPP and the EHSDP loans from the International Bank for Reconstruction and Development (IBRD)
  6. Final maturity of 18.5 years, including a grace period of five years.

 

Go back to basics:

1. Ayushman Bharat Health Infrastructure Mission (PM-ABHIM)

  1. PM-ABHIM is one of the largest pan-India schemes for strengthening healthcare infrastructure across the country.
  2. It will provide support to 17,788 rural Health and Wellness Centers in 10 ‘high focus’ states and establish 11,024 urban Health and Wellness Centers across the country.
  3. Through this, critical care services will be available in all the districts of the country with more than five lakh population through exclusive critical care hospital blocks, while the remaining districts will be covered through referral services.
  4. Under the scheme, a national institution for one health, four new national institutes for virology, a regional research platform for WHO (World Health Organization) South East Asia Region, nine biosafety level-III laboratories, and five new regional national centers for disease control will be set up.

Objectives:

  1. To ensure a robust public health infrastructure in both urban and rural areas, capable of responding to public health emergencies or disease outbreaks.
  2. To establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels.
  3. All the public health labs will be connected through the Integrated Health Information Portal, which will be expanded to all states and UTs.

Critical Components:

  1. Comprehensive surveillance of infectious diseases: Under this, health and wellness centers will be opened in villages and cities, where there will be facilities for the early detection of diseases. Facilities such as free medical consultation, tests, and medicine will be available at these centers.
  2. Comprehensive diagnostics and treatment facilities: This will involve the development of testing infrastructure. All 730 districts of the country will get integrated public health labs and 3,000 blocks will get public health units. Apart from that, five centers for disease control, 20 metropolitan units, and 15 BSL labs will strengthen this network.
  3. Comprehensive pandemic research: The existing 80 viral diagnostic and research labs will be strengthened; four new National Institutes of Virology (NIVs) and a National Institute for One Health are being established.
    1. Laboratory capacity under the National Centre for Disease Control, the Indian Council of Medical Research and National Research Institutions will be strengthened. Fifteen bio-safety level III labs will augment the capacity for infectious disease control and biosecurity.

 

2. Problems of India Health Sector:

  1. Shortage of Healthcare personnel:

There is a massive shortage of medical staff, infrastructure and last mile connectivity in rural areas. eg. Doctor: Population 1:1800 and 78% doctors cater to urban India (population of 30%).

  1. Low health budget:

India’s expenditure on the health sector has risen meagerly from 1.2 per cent of the GDP in 2013-14 to 4 per cent in 2017-18. The National Health Policy 2017 had aimed for this to be 2.5% of GDP.

  1. Poor availability of public health infrastructure:

There is a shortage of PHCs (22%) and sub-health centers (20%), while only 7% sub-health centers and 12% primary health centers meet Indian Public Health Standards (IPHS) norms.

  1. High out of pocket expenditure:

According to the latest National Health Accounts (NHA) estimates released in March 2021, patients bear a big chunk of health expenses, as high as 61 per cent of the total health expenditure, by themselves.

  1. Low Insurance penetration:

India has one of the lowest per capita healthcare expenditures in the world. Government contribution to insurance stands at roughly 32 percent, as opposed to 83.5 percent in the UK.

  1. Menace of fake doctors:

Rural medical practitioners (RMPs), who provide 80% of outpatient care, have no formal qualifications for it.

  1. Healthcare without holistic approach:

There are a lot of determinants for better health like improved drinking water supply and sanitation; better nutritional outcomes, health and education for women and girls; improved air quality and safer roads which are outside the purview of the Health Ministry.

  1. Dominance of Private sector:

●       Approximately 70 per cent of the healthcare services in India are provided by private players. If private healthcare crumbles due to economic constraints or other factors, India’s entire healthcare system can crumble.

●       Over 70 per cent of the total healthcare expenditure is accounted for by the private sector.

●       However, Private hospitals don’t have adequate presence in Tier-2 and Tier-3 cities and there is a trend towards super specialization in Tier-1 cities.

●       lack of transparency and unethical practices in the private sector.

●       Lack of level playing field between the public and private hospitals has been a major concern as public hospitals would continue receiving budgetary support. This would dissuade the private players from actively participating in Governmental schemes.

 

WAY FORWARD:

  1. Primary health Centers need to be strengthened as 80-90% health needs of a person in a lifetime can be provided by primary health care centers. For this in urban areas Mohalla clinics can be a good alternative while in villages SCs and PHCs should be strengthened.
  2. Increase the expenditure on health from current 1.4% to 2.5% as envisaged NHP 2017 to improve infrastructure in health centers.
  3. To meet shortage and availability of trained staff at PHCs and CHCs preference should be given to local people. Skill level of good performing ASHA, ANM workers and nurses should be upgraded and they should be posted in their own rural and remote areas of PHCs and CHCs.
  4. To remove misallocation, new medical colleges whether it is private or public should be opened strictly only in rural and remote areas. Special focus should be on large populous northern states or backward states.
  5. There should be proper regulation and monitoring against all the malpractices prevalent in the health area. Stringent laws and punishment should be there for all those who do unethical practices in this field.
  6. Use of technology can help a lot to reduce the cost as well as improving facilities in the health area.
  7. Overall help of community people should be sought for providing health care to all because no programme can be successful without active involvement of the community. Kerala is a good example for it that took help of educated youth and Panchayati Raj Institutions for implementing her health programmes.
  8. A National Health Regulatory and Development Framework Needs to be made for improving the quality (for example registration of health practitioners), performance, equity, efficacy and accountability of healthcare delivery across the country.
  9. Increase the Public-Private Partnerships To increase the last-mile reach of healthcare.
  10. Generic drugs and Jan Aushadi Kendras should be increased to make medicines affordable and reduce the major component of Out of Pocket Expenditure.
  11. The government’s National Innovation Council, should encourage a culture of innovation in India And help develop policy on innovations that will focus on an Indian model for inclusive growth.
  12. India should take cues from other developing countries like Thailand to work towards providing Universal Health Coverage (UHC) includes three components: Population coverage, disease coverage and cost coverage.