Pragmatism wins over populism

201704ehm03India finally got a new National Health Policy (NHP), 15 years after the last one. The NHP 2017 takes a cautious stance, with the accompanying situation analysis, as a background to the NHP acknowledging the uphill task. The backgrounder sums it up very succinctly: The failure to attain threshold minimum levels of public health expenditure, remains the single most important constraint.

This pragmatism has been met with cautious support from industry. The NHP 2017 proposes to increase health expenditure by government as a percentage of GDP from the existing 1.15 per cent to 2.5 per cent by 2025. Experts point out that the draft NHP proposed to reach this percentage earlier, by 2018, but the government realises that this was too tall a target, given the budgets and the lack of time. The accent on Preventive and Promotive Health, witnessed in the move to a more holistic package of services to be dispensed by Health and Wellness Centers gives hope that the approach will be more broad based.

NHP 2017 is also very clear that it is not yet feasible to make healthcare a fundamental right. Again, this was mentioned in the draft with health activists pressing for a health rights bill, making health a fundamental right, like the Right To Education. But NHP 2017 makes the point that for health to be a right, there has to be a certain level of infrastructure available and secondly, when health is a state subject, would it be desirable or useful to make a Central law? So the NHP 2017 very pragmatically advocates a progressively incremental assurance-based approach, with assured funding to create an enabling environment for realising healthcare as a right in the future.’

Another sticky issue that NHP 2017 tries to tackle is engagement with private healthcare providers. The policy specifies a dozen odd areas where ‘strategic purchasing’ is permitted to fill the gaps in the public healthcare system and the incentives to private players. But are the incentives strong enough for the private sector to provide beds, diagnostics, medicines free or at a subsidised rates?

Some of these incentives have not worked in the past. Many corporate hospitals complain that they face delays in payment from the government. Pharma companies supplying medicines too face the same problem. Payments delays are a huge disincentive. For example, Cipla stopped making Lopinavir syrup, an antiretroviral drug, used for the treatment of paediatric HIV/ AIDS cases, which it supplied to National AIDS Control Organisation because of payment delays from 2014. Faced with bad press and an appeal from children living with AIDS, the government released Rs 6 crore to Cipla but this is but a single example.

This is why many PPPs in the healthcare have been mired in legal issues and have sputtered to a stop. Is poor implementation and coordination between the private and public healthcare organisations the only factor, or does it go deeper, to a clash of two diverging mindsets?

Attributed to guidance from Prime Minister Modi, one TV channel quickly dubbed NHP 2017 as NaMoCare, a take on President Obama’s signature Obamacare. But there are lots of learnings that the Health Ministry can take from Obamacare, which was roundly criticised by his successor. President Trump who failed to roll it back but the buzz is that Obamacare might just roll to a halt on its own as more insurers stop backing it. NHP 2017 should beware the same fate.

With elections due in 2019, the government stayed clear of promises that it would find difficult to keep. NHP 2017 might have been a disappointment for people hoping for big bang announcements. But it sets the right course, and if we can implement these steps, the nation’s public health will see a slow but sure improvement. As Union Health Minister JP Nadda himself cautions in the last paragraph of NHP 2017, a policy is only as good as its implementation. Let us hope we see this take shape in the days to come. A dose of pragmatism is better than a placebo pretending to be a panacea for every ill. We have had enough of meaningless sugar pills.

Viveka Roychowdhury