Strengthening public healthcare systems should be one of the immediate priorities of the new government, which is set to come to power in the state.
If the new government intends to draw up a comprehensive plan to reform the healthcare sector, it should accept the need for a large injection of funds. An influx of funds to address the various infrastructural and technological deficiencies is urgently needed to promote equitable and accessible healthcare for all.
Currently, the government spending on health is about 1 per cent of the Gross State Domestic Product (GSDP). It is the reason why the common man is forced to meet their health expenses out of their own pockets while availing treatment at government hospitals.
The functioning of public health institutions in the state has largely been dependent on the NRHM (the National Rural Health Mission) funding from the Centre. However, under the new National Health Policy (NHP), funds allocated to states for NRHM has been slashed significantly, arguing that there was marked increase in the states’ share in Central funds. In such a scenario, the State government needs to allocate an increased share of funding for the health sector to offset the budget cut levied on it.
Several public sector hospitals, including medical colleges, have been established in the State in the recent times. To ensure smooth functioning of these institutions and improve the efficacy of healthcare facilities in the public sector, the government needs to probe more funding options. To make it possible, another sector needs to be kept under-resourced to meet the fiscal deficit target. Definitely, it is not a viable option as far as Kerala is concerned. So the government will be forced to explore ways to levy additional tax or cess and the amount collected should be spent to improve the health sector.
A systemic reform of the health services in order to achieve the objectives of efficiency and quality is another key area the new government needs to focus on. Corruption and irregular practices associated with procurement of medicines and medical devices as well in appointments and transfers of doctors and other medical staff remain unchecked. The procurement system modelled on Tamil Nadu to purchase medicines and manage the supply chain of centrally administered programmes seems to have no desired outcomes. Therefore, evolving the system of decentralisation appears to be the way forward.
Though new norms have been implemented to check complaints of irregularities in the transfer of staff and large-scale corruption, they continue to be flouted due to lack of proper supervision. To put an end to such corrupt practices, the government requires strong political will.
The mechanism of social health insurance has been hyped up as the panacea for improving the quality of health services in the public sector. But, pointing out the shortcomings in the proposed reliance on expansion of health insurance, the high-level expert group on universal health coverage has found it impractical to implement in India.
Strengthening public healthcare systems in the State, which is plagued by a gamut of problems, should be an immediate priority of the new government.
Our health machineries swing into action only to counter the spread of epidemics. Instead, they should draw up action plans as prevention is the more effective approach to curb the outbreak of contagious diseases.
Unfortunately, the proposal to develop a dedicated cadre of public health management professionals within the system still remains on paper. Though the private sector is a vital cog in the healthcare machinery, there is no effective mechanism in place to ensure its accountability or to supervise the quality of services delivered.
The private sector does not maintain transparency and accountability even in healthcare service. It is up to the people’s representatives to come up with a law for regulating private institutions on providing quality healthcare and transparent functioning.
(The author is a professor at the Thiruvananthapuram-based Sree Chitra Tirunal Institute for Medical Sciences and Technology).
