Health Policy and Planning Case study 2022

Health Policy and Planning
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Executive summary
In the recent decade India has become the 2nd largest populated country and the largest
democracy in the world facing changes in socio-economic mix and demographics and with a 7%
economic growth rate India is experiencing significant needs and requirements in the healthcare
sector. Compare to other developing countries India’s health policy is the poorest and needs
legislative and judicial government actions to resolve its action. India is facing an acute shortage
of health services in the rural areas and the government of India should implement national level,
state level and district level policies to improve the medical facilities. Changes in demographics,
corruption, poor governance, shortage of human resource and acute shortage of funds are major
challenges being faced by the Indian health sector. Proper measures should be taken by the
government in collaboration with healthcare institutions to address these challenges to provide
better healthcare to the Indian Population.
Introduction
Health policy is a process of actions, decisions and plans that are undertaken to accomplish
public health goals in a particular nation, region or society. World Health Organization said that
by implementing a perfect health policy will lead the civilization to a better future. The
government should enact a strong health policy for increasing the lifestyle and health of the
population. To implement an efficient health policy the government needs proper planning and
the success of the health policy depends on the effectiveness of the planning. This study will
explain different health policies of India, it different challenges and recommendations needed to
improve the Indian health sector.
Health Policy Challenges
India becoming the 2nd largest populated country in the last decade, there has been changes in
socio-economic mix, economy and demography which lead to changes in healthcare
requirements. Recently the Indian healthcare sector has observed massive growth in recent times
up to 16.5 percent from 2008 to 2016 (Naudé, Szirmai & Haraguchi, 2016).
Demographics
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India is facing a burden of non-communicable disease also called as ‘lifestyle’ disease which has
increased in recent years. India’s increasing working-age and middle-class population have to
lead an increase in lifestyle diseases such as diabetes, blood pressure and cardiac alignments.
There has been an increase in death rated due to lifestyle diseases from 42% in 2001-2002 to
50% in 2015. These types of diseases have a direct socio-economic impact on the population of
India (Hirota et al., 2017).
Public Vs Private sector
The Indian health care system has observed a weak contribution to the public and private sectors.
According to NSSO, a survey is conducted on a small sample population and it is observed that
in June 2014, 243 people out of 1000 have received medical care from the public sectors and 756
people out of 1000 have received treatment from the private sector. In total healthcare
expenditure India, accounted for 20% to the public sector and 80% to the private sector. Being a
large democracy and an emerging superpower India spends only 1.4% of GDP in the healthcare
sector, which is the lowest compared to BRICS nations. This has become a serious burden for the
poor and middle class to afford the medical expenditure. It is surveyed that 20% of India’s poor
class population 2.6 times most likely to forgo healthcare than the upper-class people (Savitha,
Kumar & Kiran, 2016).
Health Infrastructure
Infrastructure for health is another burden on India’s population. Being a populated country India
lacks in vital resource shortage and shortage of manpower. The is an acute shortage of beds in
hospitals with a ration of 0.5 beds per 1000 people and lacks behind compared to China with 2.3,
Brazil with 2.6 and the US with 3.2. India’s ratio is much lower compared to WHO approved
standards. Providing healthcare is quite expensive and a burden to the government.
Human Capital Crunch
The healthcare sector is made up of highly skilled and efficient doctors, nurses, pharmacists and
medical support staff. The ratio of doctors available to Indians is very low at 0.7 doctors per
1000 people compared to China’s 1.9 doctors per 1000 people. Doctors in India have a tendency
to shift in the urban areas and as a result, most of the rural population is facing a shortage of
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doctors. India has a shortage of 81% of specialist doctors in rural areas. India is facing a shortage
of more than 3500 doctors in its primary health care centers in rural areas.
Health Insurances
India has a poor healthcare insurance model and it lacks in covering three-quarters of the Indian
population and only 24% of the Indian population have private or government health insurance.
The contribution of government in providing health insurance is roughly 32% which is very low
compared to the UK’s 83.5%. The commercial health insurance in India only covers the hospital
treatment and prescription medicines are not covered by this insurance model.
Healthcare Policies in India
Indian Government has taken several measures to solve the challenges faced by the health care
system.
National Health Policy 2017
The union government has taken up a Five-year plan and launched the National Health Policy in
2017. The purpose of this policy is to ensure and provide better healthcare to the Indian
population. With this policy, the government tried to scale up the Indian healthcare industry and
provide it a progressive growth. Some of the objectives of this healthcare policy are-
 By 2025 the life expectancy at birth of the Indian population must increase 67.5 to 70.
 By 2019 infant mortality rate should be decreased to 28.
 By 2025 increasing the usage of the public health sector by 50%.
 Increasing family planning above 90% by 2025.
 With Swachh Bharat Mission government tried to provide access to safe water and
sanitation to every household by 2019.
 To increase the expenditure in health sectors in ratio to GDP from 1.15% to 2.5% by
2025 (Willis & Bishop, 2017).
 Will establish primary and secondary healthcare centers in rural areas and to maintain a
database of information on the health sector by 2020.
Pradhan Mantri Jeevan Jyoti Bima Yojana 2015
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This life insurance policy is government backed and announced in 2015 and the main purpose of
this scheme is to increase the medical insurance cover among the Indian population. People of
18-50 years of age group are benefitted by this policy and the beneficiaries should have a
Pradhan Mantri Jan Dhan Account. With a premium of Rs.330 per year this insurance policy
covered around 5.22 corer Indian families. This policy is a classic example of interlinking
different schemes by the government.
Ayushman Bharat
In 2018 union budget Union Finance minister Arun Jaitley announced a major healthcare
initiative. Under this flagship, Indians will be benefitted under the National Health Protection
scheme and around 10 Crore families with 50 Crore beneficiaries will be covered under this
scheme. This policy provides the cover of five lakh rupees per family every year (Lahariya,
2018).
Union Budget 2018
Along with Ayushman Bharat union government launched another healthcare flagship to
establishes 1.5 lakh healthcare facilities in India, this healthcare will provide free vital drugs and
diagnostic services and an amount of Rs.1,200 Crore has been allocated in the budget for this
policy.
Pradhan Mantri Bharatiya Jan Aushadhi Pariyojana
This flagship healthcare scheme has been launched by BJP led government to provide the best
quality drugs at an affordable price. Several outlets have been created to provide generic
medicines at low prices to the Indian population. With this flagship Indians are heavily benefited
and they can afford life-saving drugs at low prices. GOI has collaborated with the Department of
Pharmaceuticals to launch this healthcare scheme (Mishra & Sathyaseelan, 2019).
Retrieving the Indian Healthcare
Indian healthcare should cover pro-preventive care with medical care. Special importance should
be given to the primary health care needs. Elements like vaccinations, primary healthcare,
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sanitation and health education have a social impact in the society and should be given utmost
importance by the government (Halabi, 2019).
Governance
The main focus of NHP (2017) is to increase expenditure in the public healthcare system. It is
observed that the problems in the Indian healthcare system are its poor administration, its poor
management and its governance structure. Various healthcare indicators must be observed to
better analyze the healthcare system. Better capacity and management in the states lead to the
maximum utilization of National Rural Health Mission funds. Corruption, private practice and
chronic absenteeism have crippled the Indian health care system (Sachdeva, Batra & Bhalla,
2017).
The government of India must ensure flexibility, balance responsibility and accountability in its
healthcare structure. A pioneered and proven model of Tamil Nadu Medical Services
Corporation must be implemented throughout India to improve the medical service and drug
supply process. The state government of Tamil Nadu has set up a system to procure drugs for the
public health sector. Independent boards have been set up managed by a health secretary and an
IAS officer as its managing director. This has improved Tamil Nadu’s supply of drug and health
standards. The government should highly skilled professionals on this board for better
management of the system. It is the willingness to change by the people and time needed for
changes in government structure. State governments must layouts the medical system structure
and must employ efficient professionals and imply rules and regulations for the proper
functioning of the system and a moderate expenditure by the government are required
operationalizing this system (Gayathri & Kannan, 2018).
Information management System
One of the main disadvantages of the Indian medical system is that it lacks information about
patients. There is an asymmetry between doctors and patients in the Indian Healthcare system.
There is a lack of knowledge in patients about his medical history and healthcare. This problem
can be tackled by the government by sharing information via the internet and by keeping a
medical record. Government’s Digital India scheme has increased the accessibility and usage of
the internet in India and linking the patient’s Aadhar number with the medical records can solve
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the information problem and doctors will be able to the records through Aadhar number.
Governments should provide information on doctors, healthcare services and facilities to the
required patients by information sharing. With the unique identification of Aadhar number, it has
been very easy to access medical records of patients by the doctors. Technology advancements
and an increase in usage of mobile internet will play an important role in information sharing
management (Lakshminarayanan et al., 2017).
Healthcare Financing
Healthcare financing is a primary burden for most of the population and only 30% of the
population has insurance cover. Uncertain medical expenditure is a major problem for the
common man in India. Medical savings accounts are one of the major solutions for this emerging
health expenditure. MSA is like a regular saving account and with tax exemption. The poor class
will not be able to maintain this type of accounts and this is where the government should
intervene to maintain medical savings account for the poor class. These medical savings account
is a collaboration between the health sector and the Indian government. It is difficult to
implement due to the complexity in the relationship and also mandatory to implement the
scheme. This policy has a high expenditure and the government should allocate adequate funds
in the budget (Thangarasu et al., 2018).
Human resources
The shortage of human force in the healthcare sector is a major concern for the government.
India is also facing problems in the quality of education in medical schools. Rural areas are
facing a maximum shortage of medical staff due to low salaries and poor working conditions.
The Union government should focus on increasing the medical staff in rural areas. The
government should provide training to the students in preventive healthcare. The government
should encourage this student to pursue their career in rural areas and with experiencing and
gaining adequate knowledge they should be given further training to develop as a medical
professional. A model has experimented in Chhattisgarh, graduates are hired as Rural Medical
Assistants in public health centers. It is concluded by a survey that PHCs run by RMAs are
equally as good as health centers by M.B.B.S in terms of preventive healthcare and management.
The RMA model has achieved success in different scenarios and should be implemented across
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India. The government should provide better training to the assistant to achieve success in this
model (Shah & Thakkar, 2019).
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Conclusion
The healthcare sector of India is facing severe problems and the right policy action needed for
the betterment of this sector in the future. Being the largest democracy and 2nd populated country
India has a great potential to become an example in the medical and healthcare sector to the
world. The healthcare industry of India is facing challenges such as changing demographics,
shortage of financial resources, poor quality of healthcare infrastructure, poor governance,
corruption and shortage of human resources. The government of India has implemented the
National Healthcare Policy to address these challenges. The shortage of government funds in the
public sector is the main reason for its downfall and this policy is lacking in good governance
and funding. This study has explained different measures that should be taken by the government
to address these challenges and ensure better healthcare to its population. Expenditure on
healthcare should be increased by the government and not only funding will solve this problem,
but with better governance, it can be tackled properly (Shah et al., 2019).
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