Building a Robust Healthcare System

Context: there is a need to take continued efforts to strengthen and revamp the country’s public health system so that we are better prepared to handle such emergencies in the future.

• The effectiveness of a public health system can be judged by looking at certain health parameters such as Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate for which annual surveys are conducted through the Sample Registration System.

Concerns with the public health system:

• Varied performance across the country: as health is a state subject.
• Non-achievement of Goal 3 (good health and well-being) of the Sustainable Development Goals (SDGs) set by the United Nations General Assembly in 2015.
  • Poor performance by some states: India failed to achieve earlier Millennium Development Goals because of the poor performance of the northern States.
• Indifference towards poor performance: by both center and states.
• Poor performance by Northern states: despite Finance Commissions granting non-Plan funds into these states in addition to substantial plan allocation from the Ministry of Health and Family Welfare for the Empowered Action Group States.
  • Infant mortality: Madhya Pradesh has 48 infant deaths for every 1,000 live births (7 in Kerala).
  • Maternal Mortality Ratio: In Uttar Pradesh-197, compared to Kerala’s 42 and Tamil Nadu’s 63.
  • Percentage of deliveries by untrained personnel: is very high in Bihar, 190 times that of Kerala.
  • Total Fertility Rate: very high in Bihar (3.2) against the stabilization rate of 2.1 & Tamil Nadu’s 1.6.

Lessons from Southern states: Tamil Nadu’s example

• Total Fertility Rate of Tamil Nadu: is among the lowest in the country (1.6) comparable to that of Germany (1.57) and Japan (1.43).
• Enlightened political leadership: focused on improving health outcomes and supported by the administration has led to the creation of a public and preventive health structure.

Way forward:

• Close monitoring: of performance on above parameters.
• Focused political executive: supported by an accountable administrative structure will lead to better health outcomes hence benefitting people of the state.
• Prioritising public health and preventive care: both at the Centre and the Empowered Action Group States level and bringing these States on a par with the southern States.
  • Investing in health and education is the primary responsibility of any government.
• Building a public health cadre: States should provide a public health set-up that addresses primary and preventive health.
  • E.g.: Tamil Nadu manages its public health set-up with just about 150 public health professionals.

Conclusion: Investing in human capital, i.e. health and education must be given its due importance to make a lasting improvement.