India needs a renewed health-care system

Synopsis: 

India needs to focus on the core lessons from the pandemic and rebuild trust in public health.

The pandemic and the vulnerability of the public health system:

For any population, the availability of functional public health systems is literally a question of life and death. This is evident by comparing two States which currently have the highest number of COVID-19 cases in India — Maharashtra and Kerala.

1. Their per capita gross state domestic product (GSDP), reflecting the overall economic situation in each State, is similar.
2. However, their COVID-19 case fatality rates are hugely different — this being 0.48% for Kerala and 2.04% for Maharashtra. This simply means that a COVID-19 patient in Maharashtra has been over four times more likely to die when compared to one in Kerala.

How public health system fared against the Pandemic?

• A major reason for such critical divergence between states is likely to be the huge differences in the effectiveness of public health systems.
  • Despite Maharashtra having a large private healthcare sector, its weak public health system has proved to be a critical deficiency.
  • In contrast, robust government healthcare services in Kerala have translated into: a more effective outreach, timely testing, early case detection and more rational treatment for COVID patients, which all together reduce fatality rates.
• Large scale misuse in the private sector: Massive hospital bills have caused untold distress even among the middle class; COVID-19 care often costs ₹1 lakh to ₹3 lakh per week in large private hospitals. The ‘Remdesivir panic’ was significantly linked with major overuse of this medicine by unregulated private hospitals, despite the drug lacking efficacy to reduce COVID-19 mortality. 
• The central government is yet to take necessary steps to promote the implementation of the Clinical Establishments (Registration and Regulation) Act (CEA).
  • The Act was passed in 2010 and presently applicable to 11 States across India. But this Act is not effectively implemented due to a major delay in notification of central minimum standards, and failure to develop the central framework for the regulation of rates.

Lesson learnt during the pandemic:

• Neglect of public health systems can mean large-scale, avoidable losses of lives; hence, public health services must be upgraded rapidly and massively as a topmost priority.
• The government need to regulate rates and standards of care in the private sector and implement the Clinical Establishments (Registration and Regulation) Act (CEA) in letter and spirit.
• A logical corollary of the first two lessons is that health services should not be further privatised.

Suggestions

• Parliamentary Standing Committee recommended that for reaching National Health Policy targets, the Government must allocate ₹1.6-lakh crore for public health during the current year. This is double the amount of the present central health Budget.
• A logical corollary of the lessons is that health services should not be further privatised. But the NITI Aayog’s recently published document, ‘Investment Opportunities in India’s Healthcare Sector’ advocate further privatisation.
• It is critical to rebuild people’s trust in public health systems. This would help in overcoming COVID-19 vaccination hesitancy while strengthening the promotion of healthy behaviours necessary to deal with the current wave of COVID-19 and prevent a third wave.