Existing public healthcare system in India is in the form of a pyramid, starting from the sub-centres and going up to the Medical Colleges, passing through primary health centres, community health centres, rural hospital, taluk hospital, and district hospital. Centres which provide primary healthcare are: sub-centre (SC) per 1000 population, primary health centre (PHC) per 30,000 population and community health centre (CHC) per 1,20,000 population.
As per rural health statistics 2017, India has 1,56,000 SCs, 25,650 PHCs and 5,624 CHCs. These centres don’t have adequate infrastructure and personnel. The efforts of the government of India in providing generous allowance for the deficiencies in past have been disappointing.
To rectify these ailments in our public health services, The Government of India has announced two major initiatives in health sector in Budget 2018, as part of Ayushman Bharat programme.
1. Health and wellness centre:
The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring health care system closer to the homes of people.
These centres will provide comprehensive health care, including for maternal and child health services, mental health services, vaccinations against selected communicable diseases, and screening for hypertension, diabetes, and some cancers. These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs.1200 crore for this flagship programme.
2. National Health Protection Scheme (NHPS):
The second flagship programme under Ayushman Bharat is NHPS, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
The impact of NHPS will be in terms of benefitting more than 37% of the population, meaning that nearly all the poor and vulnerable families will be covered mainly for secondary and tertiary care.
Ayushmaan Bharat assures the people of India of both, availability and financial security. This example is complimentary to the topic of universal health coverage. Since Health is the responsibility of the state governments in India, Comprehensive and far reaching Health reforms can happen only with a cohesive approach by the central and state governments.
This is the need of the hour in India, where public health system is poorly maintained; neither have we had manpower nor infrastructure to run a primary health centre or community health centre. More than a quarter of our Sub Centres and Primary Health Centres do not have even a water or power connection.
Right implementation of NHPS lays in identifying right beneficiaries, state ownership and monitoring the impact on regular intervals. The planned wellness centres will be successful when equipped with adequate human resource and technology.
WHO director-general Tedros Adhanom Ghebreyesus lauded the National Health Protection Scheme and Ayushman Bharat initiative, saying they have the potential of transforming the lives of hundreds of millions of Indians.
He outlined three precautions GOI must take: focus on quality of services in primary healthcare, prioritize disadvantaged who would be given enormous gain relatively cheaper and equip and empower nurses and mid-level healthcare workers.
The scheme is innovative and path-breaking in the history of public health in India, which may have a transformative impact if implemented in an effective and coordinated manner.