The Union cabinet recently approved the National Health Policy, 2017.
What are the features?
The policy includes progressive steps towards universal and affordable access to healthcare services for the underprivileged.
It does this by making provisions for comprehensive primary care via the conversion of 150,000 sub in Indian villages to “Health and Wellness Centres”.
Every family is to be provided with a health card that will link it to the primary care facility and make it eligible to receive a defined package of services anywhere in the country.
To increase “accountability and governance”, the government will aim at increasing both horizontal and vertical accountability by providing a greater role for local body participation and encouraging community monitoring.
What are the problems?
Absenteeism - In a study conducted by the World Bank and Harvard University in 2003, it was found that in 1,500 primary healthcare centres across India, 40% of healthcare workers in government health clinics were absent from work.
In another study conducted in the sub-centres of 135 villages of Udaipur from 2005-07, suggested that monitoring, coupled with punitive pay incentive, reduced the absence of nurses from 60% to 30% in healthcare centres.
This proves that healthcare workers are responsive to properly administered incentives, and that comprehensive monitoring does make a difference.
Distrust - For the underprivileged, a visit to a primary healthcare centre may mean the loss of a day’s wage, especially given a bad service delivery system.
A lack of understanding of the benefits of vaccination, and, to some extent, distrust in government healthcare services, exacerbate the problem.
A research study helped provide immunization services through mobile camps on fixed days in one intervention. In the other intervention, it incentivized parents with a gift of 1kg of lentils on immunization days and a thali on the completion of the whole schedule.
It showed that providing poor families with non-financial incentives in addition to reliable services and education about immunization was more effective.
Lack of evidence - While the healthcare policy relies heavily on technical research in pharmaceuticals and equipment, when it comes to service delivery, evidence-based policy has been absent in India.
Policymakers need to know what works and what doesn’t. There is evidence to show that projects fail largely as they are not evidence-based.
The government will also require a robust mechanism to implement and monitor the mammoth mission.
