Evolution of healthcare
Ayushman Bharat has brought India on the threshold of new healthcare ethos
By Dr Pankaj Gupta
When India achieved independence in 1947, it was left on a tightrope that could swindle anytime – economically drained by remaining a feeder economy of Britain for two centuries had force it to trade the riches for illiteracy, poverty and hunger/malnutrition. According to the 1951 Census, India’s population was 36.1 crores and only 18.33 per cent people were literate and overall life expectancy was 32 years. The infant mortality rate (IMR) was 145.6/1000 live births while maternal mortality ratio (MMR) in the 1940s was 2000/100,000 live births. There were only 50,000 doctors across the country and only 725 primary healthcare centers covered an area of over 3,287,263 square kilometers.
Bringing these people of an almost inhumane living conditions was an immediate but mammoth task that our first set of governors had in hand. Along with an impoverished population, they had to counter the colonial legacy of the deeply-contested value of public health which was further jeopardized due to the massive influx of people caused by the Partition. However, there is no denying the fact that as the country started to pick the shards, public health never received its due attention – it is no coincidence that until a few years ago, India invested only 1.6 per cent of its gross domestic product (GDP) for health-related initiatives. Consequentially, after 72 years of independence, India is a global disease burden leader – the share of non-communicable diseases (NCDs) has almost doubled since 1990s and is a major reason of worry.
Inadequate Access to Healthcare
This remained a challenge for a very long time as India struggled to set up primary healthcare centers that would act as the first point of contact. Even if there was a center, finding staff to manage it was, and to an extent, is, a challenge. The limited number of medical colleges produced a number of doctors and staff insufficient to cover the country. Moreover, cities were always a preferred location to them due to better facilities and pay. This created a gap in the unmet need for healthcare services and their availability, which was gradually filled by volunteers of civil societies and much later, by the private healthcare providers. It was after much delay that India opted for ground-level intervention under the National Rural Health Mission (NRHM) in 2005 when accredited social health activist (ASHA), the community health workers, were instituted to facilitate better access to healthcare services.
Health as a state ‘subject’
Public healthcare in India took a giant leap in 1983 when the Parliament endorsed the National Health Policy. However, India was already launching schemes and programmes for specific target groups – in 1975, it launched Integrated Child Development Services (ICDS) to improve the nutrition and health status of children in the age group of 0-6 years. Besides, India set up National AIDS Control Organisation (NACO), Pulse Polio, National Leprosy Eradication Programme, Mission Indradhanush (immunization programme), among others. Noticeably, out of all these, the anti-HIV campaign is the only one of the two successful health campaigns in India so far, anti-polio being the other. The limited success of other health programmes aims at the conflicting nature of the real enforcer – these campaigns were launched by the government of India whereas as a ‘subject’, health is a matter to be handled at the state level. As a result, these programmes could not be enforced equally in all parts of the country.
With Ayushman Bharat, for the first time India has dared to venture beyond the obvious. It aims to lift up its people out of the burden they could have probably never dreamt of. However, in its pursuit of providing specialised treatments, it should not loose sight of the primary well-being; taking care at that level may actually reduce the burden on an already battling health infrastructure.
Dr Pankaj Gupta is President with IIHMR University, Jaipur.