This article has been written by Manya Dudeja, from the University School of Law and Legal Studies, Guru Gobind Singh Indraprastha University. This article reviews the public health policy of India in a time when health has become a luxury and institutions of public health care in a crisis.
Table of Contents
Introduction
“Covid-19 provides a stark reminder of the tremendous social value of robust public health systems and the harrowing consequences when those capabilities are allowed to atrophy.”
– National Academy of Medicine
Society has collectively worn the veil of ignorance on the importance of an efficient public health policy. With the collapse of the healthcare system or rather the shattering of the veil, this ignorance stormed us in the form of the Covid pandemic. Thousands have been rendered helpless in the absence of resources. There is a lack of adequate policies in place to protect the poor and the most deprived. If only the electorate demanded accountability on a public health policy, we would have steered through this chaos better. Hence this is what brings me to write this article, it is high time we understand the public health policy of our country and make amendments to nurture a healthy population.
This article will be divided into two parts, the first part will be dealing with public health policy in the pre-pandemic era and its unequal access to the population, and the second part will be dealing with the ravages of the pandemic and the collective helplessness of the community due to inadequate health policies.
Pre-pandemic public health policies in India
The right to a healthy life is a fundamental right granted by Article 21 of the Indian Constitution. Yet, India’s expenditure on public health has been dismally low. India spends only 3.54 percent of its GDP on health expenditure. Public health in India is governed by the National Health Policy, 2017, prepared by the Ministry of Health and Family Welfare. Though health is a subject in the State list and different states have different policies regarding the same, here we will be looking at the Central Health Policy of India. The policy aims to strengthen, prioritize and clarify the role of the government in public health through organizing healthcare services, preventing the spread of diseases, and promoting good health. It will strive to improve access to technology, develop human resources, encourage medical pluralism, build a knowledge base, work on strategies of financial protection and strengthen regulation and health assurance.
The National Health Policy, 2017: Overview and analysis
“A policy is only as good as its implementation.”
The National Health Policy, 2017 concludes with the above quote. No matter how well a policy document may be drafted, its ultimate success comes from its effective implementation:
- While the National Health Policy sets for itself various numeric and general goals like increasing the government expenditure on health from the existing 1.15 percent to 2.5 percent of the GDP and increasing the life expectancy at birth from 67.5 to 70 by 2025, bottlenecks like inadequate facilities, lack of infrastructure, coverage, access, and quality will continue to haunt it.
- This ambitious policy aims to have the private sector as a partner to fill the gaps and provide quality and affordable healthcare services for all, furthering the agenda of universal health coverage.
- The new policy also emphasizes more on prevention of diseases as well as early screening and diagnosis. Prevention will be focused on by using methods like sanitation and discouraging the consumption of tobacco to ensure a healthy population.
- The Make in India initiative would be used to boost the production of drugs in India.
- The use of health care to provide free services to families is a welcome step too.
- The policy also promotes alternate means of medical care, for example, AYUSH.
- While the policy has brought hope for some, others find it to be inadequate and have called it a low bar for improving public health.
Criticism
There is criticism based on the policy’s financial feasibility. They are as follows:
- Even though the policy proposes to strengthen existing medical colleges and converting district hospitals to new medical colleges to increase the number of healthcare professionals and specialists, the policy does not spell out the source for these funds.
- The policy does not comply with the demands made to include the right to primary healthcare as a fundamental right and talks about the availability of adequate infrastructural facilities as a precondition to making it a right.
- The policy does not put forward any provision to deal with the problem of quacks and malicious people acting as self-styled doctors.
Public health policy of India amid the pandemic
The pandemic has caught India unprepared. Despite the devastation caused by the first wave and the warnings of a second wave, adequate steps were not taken to deal with it. At this point, India had to make a number of decisions regarding its public health policy such as vaccinating a large population and increasing the number of healthcare facilities. The following sub-headings would explain the country’s response to the healthcare crises during the Covid pandemic.
Vision 2035: Public health surveillance in India
Visions 2035 is the white paper released by the NITI Ayog in order to strengthen the public health surveillance system in India. It aims at:
- Making India’s public health system more responsive as well as more predictive, to strengthen preparedness to take action at the various levels.
- Enabling a client-feedback mechanism as well as creating a system that is citizen-friendly and protects their privacy and confidentiality.
- Improving data-sharing system between the Centre and state, for better disease detection, prevention, and control.
- It also sets a goal for India to become a leader, regionally and globally, to manage such events that constitute a public health emergency at the international level.
The Covid-19 pandemic led the government to revisit the spread of diseases caused due to interaction between humans and animals. The white paper emphasizes the importance of an integrated public health system across primary, secondary, and tertiary levels of care in order to break the chain of transmission and create a resilient surveillance system. In order to conduct this surveillance, individual health cards would be used and thereby making India a global leader in the area of health surveillance.
Collapse of infrastructure
The small number of healthcare workers in India has been overworked and exhausted. In the absence of resources, they are forced to choose between lives and decide who gets to live. Life-saving drugs, oxygen cylinders, and hospital beds became a luxury and people died as a result of this scarcity. While the government created makeshift hospitals and camps, they were soon out of space too. Also, the process to be followed that required referral from the DSO (District Surveillance Officer) and other approvals before a patient could get in a Covid facility was extensive, as a result of this, many died waiting for a bed.
India’s vaccine policy
Mass vaccinating India’s huge population efficiently and timely has been seen as the only solution to tackle the spread of Covid 19. However, amid a shortage of vaccines and fund-deprived state governments, this has come as a huge challenge. Initially, the Government of India approved two vaccines for emergency use, Covishield, and Covaxin. The vaccine was to be administered only to those above the age of 45 and those who had any comorbidities (when someone has more than one health issue at a particular time, each health condition is referred to as comorbidity). The exclusion of the young did not serve well for the country as the virus kept spreading rapidly. In the next phase, the vaccine has been opened up for those above 18 years of age and they are being encouraged to get vaccinated by registering through the CoWIN app.
This again became a fight for limited slots as the vaccine was scarce. Many even questioned the use of an online application which alienated those who did not have access to smartphones or were not digitally literate. However, walk-in vaccination has now been permitted by the Union government. Also, approvals for other vaccines like Sputnik and Pfizer are also on and efforts are being made to start their manufacturing in India. The Centre has allowed vaccine companies to strike deals with states and private hospitals. This move threatens to create regional divides as some states have more paying capacity than others. The Supreme Court of India also expressed its dissatisfaction with the vaccine policy, making states compete with each other to procure vaccines. It also questioned the dual pricing policy where the Centre has already negotiated the prices for the vaccine and has left the states to make their own deals and the reason for leaving pricing of 50 percent of vaccines with the manufacturer. The Court rebuked the government for not having a policy document regarding this and directed it to produce the files.
Judicial intervention
During this time of crisis, courts have actively intervened and directed the government to address the grievances of people who are struggling to get resources like oxygen, medicines, vaccines, and beds in hospitals. Recently, the Delhi High Court pulled up the Central Government for playing the “irritating” message during phone calls, asking people to get vaccinated while there are not enough doses available with the government. The court also directed the government to devise strategies and to use audio-visual aid to effectively disseminate Covid related information to the people.
Lessons learned
Along with the devastation and destruction of life that Covid brought, it also brought some lessons for the public health system of the country and the governments that have been sleeping on the need for an effective and robust public health mechanism.
It taught us the value of the old and famous but ignored proverb, “health is wealth”. Even though the most important, the health sector of the country has been often neglected with low budgetary expenditure allocation. Investing in health infrastructure has become the need of the hour today. The health system of India was never great, it always had issues, however, privilege hid these issues. It was only the poor who had to face the brunt of inadequate healthcare facilities because of their inability to afford private and expensive healthcare. The pandemic did not discriminate and privilege failed. The system was so overburdened that money could not get one a hospital bed or an essential drug. India needs to massively restructure its developmental plans with respect to health. It is hoped that this painful lesson paves the way for India’s future policy decisions which should be health-centric and efficient, ready to deal with such pandemics and disasters.
Conclusion
Public health is an important arena of governance and requires the government’s attention. Its long neglect has proved to be fatal for the country. The Covid pandemic is a 21st-century health crisis and will not leave the world easy. The government needs to ramp up its health facilities and infrastructure in the post-pandemic era, not only to stay prepared for future health emergencies like this but also to start valuing human life more. The National Health Policy, 2017 laid down goals and ambitions to improve the health conditions and facilities in India, but the policy implementation has been slow and laid back. Because of this India was not ready to face the wrath of the pandemic and fell to its knees. India should learn from this mistake and bring out a health policy that does not just lay down provisions but also focuses on a strategy for effective implementation. Globally, health systems have collapsed and made the world realize the importance of investing in the health sector.
References
- Gauttam, P.; Patel, N.; Singh, B.; Kaur, J.; Chattu, V.K.; Jakovljevic, M. Public Health Policy of India and COVID-19: Diagnosis and Prognosis of the Combating Response. Sustainability 2021, 13, 3415. https://doi.org/10.3390/ su13063415
- Narayan K M. Public health challenges for the 21st century: Convergence of demography, economics, environment and biology: Nalanda distinguished lecture. Natl Med J India 2017; 30:219-23
- https://thewire.in/health/national-health-policy-hype
- https://theprint.in/judiciary/india-is-union-of-states-sc-schools-modi-govt-on-why-centre-must-buy-vaccines-distribute/669285
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