Dr Harshvardhan returns to the health ministry after his rather unceremonious exit in 2015. Medibulletin writes an open letter to him
In 2014 when you took charge of the health ministry you had talked about health assurance. In 2019 – it is deja vu – when you do the same again, health in India, for the first time in the last decade and a half perhaps, is the cynosure of global attention. Thanks to Ayushman Bharat, the health assurance scheme that was finally rolled out at the fag end of the last government under J P Nadda who had succeeded you in the ministry.
There is a reason for that. Ayushman Bharat is widely believed to be just the first step on the long road whose ultimate destination is Universal Health Coverage. Yours could be the hands that usher India finally into the era of Universal Health Coverage. As a former minister yourself and as a doctor, there is nobody more acutely aware of the problems in India’s health system. Low insurance penetration, unregulated private healthcare and impossible overcrowding of public sector hospitals have made healthcare out of reach of everyone but the elite. Even if Ayushman Bharat covers its targetted 50 crore – right now less than 3 crore cards have been issued – there will be another 85 crore Indians left at the mercy of profiteering private hospitals and apathetic government ones. Many of them have voted overwhelmingly for the Narendra Modi government. Nothing less than UHC will bring succour to these millions. They would hope this government comes with a plan for them.
WHO defines UHC as: “Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”
That NDA III’s primary task will be consolidation of Ayushman Bharat is a given – that the government realises that Ayushman Bharat still has a long long way to cover was evident in the way the scheme, after the initial hype, lost out to schemes such as Ujjwala and Pradhan Mantri Awas Yojana in the BJP’s campaign pitch. However, as the health ministry’s 100-day plan focuses on the consolidation of Pradhan Mantri Jan Arogya Yojana – that gives an annual health cover of Rs 5 lakh – and health and wellness centres – there are latent fears about the future of another scheme.
The National health Mission – that started in 2005 as the National Rural Health Mission during UPA I has been credited with creation of rural health infrastructure where there was none. There are many loopholes still, lack of manpower, lack of drugs, sometimes lack of oversight. But to let NHM become a derelict and to build health and wellness centres on the ruins of NHM would be a travesty. NHM brought medicine to places where quacks once ruled. With the National Health Authority having been carved out to administer PMJAY, the best way forward for health and wellness centres would be to be subsumed into the NHM framework. The final mile obviously would be integration. Nobody could be more aware than you of the fallacy of a health system where the primary and secondary care arms work in silos. There are of course many other unfinished items on the agenda. The National Medical Commission Bill will have to clear Parliament, women have waited long for a more progressive abortion law and despite the work done in the last term there is a lot that still remains to be done on medicine prices. Congratulations on your not so new ministry.
