The accessibility of affordable healthcare as well as utilisation of available healthcare facilities, especially in rural areas, continue to be a major challenge in the country. Keeping this in mind, Narendra Modi led NDA government has accorded top priority to health sector. Prime focus of the Ministry of Health and Family Welfare (MoHFW) has been to provide quality, low cost and accessible services for marginalised population. Infant mortality rate (IMR) and under-five mortality rate (U5MR) are the two major indicators of population health.
Child Mortality Report 2014 of United Nations indicates that going by the current pace of decline, India is unlikely to achieve its target of reducing the infant mortality rate to less than 39 per 1,000 live births by the end of this year.
As per the estimates developed by the UN Inter-agency Group, in India every year 1.34 million children die before completing five years, of which 7,48,000 die within the first months of their life. This means more than 2,000 newborn die each day in India.
The current IMR is 40 per 1,000 live births while the U5MR is 52 per 1,000 live births. Thus, the county accounts for the highest burden of under-five deaths in the world. The report also reveals that neonatal deaths account for 56 percent of under-five deaths in India which is much higher than the global average of 44 percent.
Health experts point out that the progress in reduction of neonatal mortality has been slow and four states – Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan – account for half of the under-five deaths in India. As per the report, Assam with 75 per 1,000 live births tops the chart among states having under-five mortality above the national average of 52, followed by Madhya Pradesh (73), Odisha (68), UP (68), Rajasthan (59), Bihar (57) and Chhattisgarh (55).
The government was moving forward with set targets to improve on these two critical parameters and launched universal immunisation programme – Mission Indradanush. The Ministry targets 95 percent immunisation cover by 2016-end.
“The U5MR has come down to 49 in 2013-14 from 118 in 1990. Similarly, the IMR has been reduced from 80 in 1990 to 40 in 2013-14," says JP Nadda, Union Health and Family Welfare Minister.
"The government is targeting to immunise 95 percent children population in the next 1.5 years. The government today is ready for all types of linkages and partnerships with the industry and innovators," he adds.
To enhance immunisation mission and to make cost-effective vaccines, the government seeks help from the private sector. Progress made with the help of Indradaush is satisfactory so far. The government has immunised close to 15 lakh children under the first phase of ‘Indradhanush’ immunisation programme in 201 districts, where the immunisation was less than 50 percent.
"When our government took over last year, around 17 lakh children were partially immunised and 20 lakh were totally unimmunised. Under the ‘Indradhanush’ programme, approximately 53 lakh children have been partially vaccinated and 15 lakh have been totally immunised," the Minister says.
Public Private Partnership
The Ministry plans to engage private sector in the cold chain management and logistics as well for better management of its immunisation programmes in rural areas. Addressing industry captains last month, Nadda said, “This is one area where we need your help and innovations so that the cold chain management and logistics can be developed in far-flung rural areas."
“There is a need to incorporate ‘cooperative thinking’ in the system by diverting efforts towards provision of universal basic care. We need to bring the authority of public sector and efficiency and energy of private sector together,” says Dr. Ashok Panagariya, former vice-chancellor of Rajasthan Health University and former Member, State Planning Board on health issues.
The role of NGOs and Civil Society Organisations (CSOs) are also very important. The government efforts are being supported by the Global Alliance for Vaccines and Immunisation, now known as GAVI Alliance which is a public-private partnership committed to save children’s lives and protecting people’s health by increasing access to facilities. The Alliance for Immunization in India (AII), a CSO platform for strengthening immunisation programme, has also undertaken many initiatives and various field level activities to spread awareness about the importance of routine immunisation (RI) across their respective areas of work.
Anuradha Gupta, Deputy CEO of GAVI Alliance, says, “We need to look at ensuring all vaccines for all children and AII must focus on pockets with low immunisation coverage within the state.”
In view of high IMR in the state, Rajasthan Chapter of AII is preparing district level volunteers to expand the coverage of immunisation. AII Rajasthan secretary Vikram Singh Raghav says, “We are trying to create adequate health workforce by developing skills for immunisation and exploring the possibility of skill development of health workers with the help of Rajasthan Skill Development Corporation.”
National Health Policy: Delayed or Denied
As soon as Modi government took charge last year, Former Health Minister and present Science & Technology Minister Dr Harsh Vardhan started exercise for a comprehensive National Health Policy. The Health Ministry solicited views of all stakeholders for National Health Policy. But, the policy has not been announced yet and all stakeholders have kept their finger crossed. Senior officials of Health Ministry argue that the government wants to make both National Health Policy and National Health Assurance comprehensive and holistic. For National Health Policy, the Ministry received more than 7,000 suggestions and recommendations. Officials say that compilation is a huge task. After that a final draft will be prepared to get approval of the Cabinet.
National Health Assurance scheme is a very ambitious scheme of the government and health insurance coverage would be the main component. According to the officials, since the scheme involves huge financial liabilities on the government, so Finance Ministry’s approval to the scheme is awaited. Once the approval comes, the scheme would be rolled out.
The Way Forward
As per National Family Health Surveys (NFHS), only 13 percent of rural population had access to primary health centers. The overall healthcare utilisation is also low, only half of (52 percent) of Indian mothers received three or more ante natal checkups and only 43.5 percent of children in India received all vaccinations. Undoubtedly, the NRHM had helped reduce infant mortality rate, measles and rubella by providing healthcare to marginalised sections and far-flung areas of the country.
Health is a state subject, but the Centre needs to be committed to providing all assistance and resources to the states in achieving better health outcomes. Fourth round of immunisation drive has recently concluded and the inputs from frontline workers should be included before designing best healthcare schemes. Policymakers say that health is a priority but that should also be reflected in budget allocations. The government should provide adequate resources and higher spending on preventive healthcare. There is a gross disconnect between primary, secondary and tertiary care facilities. This is high time that we redefine healthcare and come out with comprehensive National Health Policy and National Health Assurance scheme to provide quality and affordable healthcare services to all.