Focus mustn't waver, we must continue to invest in health: K Srinath Reddy

We have to create a multi-layered, multi-skilled health workforce. This is good even from the point of view of employment generation, says PHFI founder

With the threat of pandemic receding, will the 2023-24 Union Budget lower its focus on health care allocations? Or will there be further cohesive planning to prepare for future pandemics? Outlining the vision for this year’s Budget, public health policy expert K SRINATH REDDY, founder and past president, Public Health Foundation of India, in conversation with Sohini Das, says the pandemic has revealed the need to invest in an efficient health care system. Edited excerpts:

This will be the first Budget in a ‘post-pandemic’ era as it were. What kind of policy-level changes are required?

We are hoping that the attention to health will not fade away. The pandemic has shown the world that if we don’t invest in an efficient health system that is empathetic and functional in a steady state, even without a public health emergency, one cannot create a swift, strong surge response when it is required.

It is important to continue to invest in health. We are the largest population in the world and we have a demographic window of opportunity. We must continue to invest in the health and skills of people.

We have to create a multi-layered, multi-skilled health workforce. This is good even from the point of view of employment generation. We are also hosting the Group of Twenty (G20), and health is an important agenda in the immediate aftermath of the pandemic.

The focus on pandemic preparedness is there in the G20 agenda, and this would have some reflection in our Budget. The upcoming elections of 2024 will also have an impact on the Budget.

Do you expect more allocations to flagship schemes of the government like Ayushman Bharat? Have these schemes been able to bring the desired impact on the ground?

I see Ayushman Bharat as a work in progress. It is building together a fairly credible structure which links primary health care with financial coverage for secondary and tertiary health care. There are still many things to be done to make sure the template works efficiently.

Primary health care still does not have the resources it needs. The urban health mission has not taken off in a big way. We saw during the pandemic that it’s the big cities from where the microbes enter and then they spread to rural areas.

If we have a weak primary urban health care system, we are unable to identify cases, isolate them, and take action promptly.

Rural primary health care needs better resources – both human and financial.

Urban primary health care needs to emerge out of the shadows and start to become visible and effective.

We should promote the idea of health at home or close to home.

Mid-level health care providers like Accredited Social Health Activist (ASHA) workers are required. We need to double their numbers. We need to make health care comprehensive.

Does the Budget need to make provisions for research and development (R&D) for new drugs and vaccines to prepare for future pandemics?

We need to connect our surveillance systems, right from wildlife to free-living and captive veterinary populations to the human habitat to make sure that whatever microbes are migrating from wild animals to human bodies, can be identified early and the spread stalled, and prepare ourselves with appropriate drugs and vaccines.

We need to create the laboratory capacity and the manufacturing wherewithal.

Non-communicable diseases are also a public health emergency in slow motion. We need to focus on their R&D.

We need to also strengthen our public sector institutions, because the private sector may not always find it attractive to produce certain drugs whose demand is not on a large scale, or which does not give them a large profit margin. We need to build public-sector capacity, along with the private sector.

Previous Budgets have placed focused on viability gap funding to create hospital bed infrastructure in tier III/IV cities. Do you think this approach has worked? And should this year’s Budget also make provisions?

I don’t think it has succeeded. To depend on the private sector alone to take up the responsibility for bed creation in districts is not going to work.

We need to strengthen our district-level and sub-district-level hospitals in the public sector. The private sector can enter where it can, and it can be supported. We need to connect all the players on the ground – private and public sectors and the voluntary sector.

What should this year’s Budget do to expand universal health coverage?

Universal health coverage needs to advance further. The idea of progressively unifying our health insurance programmes into a single-tiered system is going to be an important element.

Universal health coverage can only be delivered if we make it affordable. We need to cover outpatient expenses and drugs which are not a part of the Pradhan Mantri Jan Arogya Yojana (PMJAY) at the moment.

We need to link primary health care with PMJAY so that outpatient care and medicines are also included, not just care at the time of hospitalisation.