The recommendations coming from the high-level group (HLG) on health sector to the 15th Finance Commission were ideated to evaluate existing frameworks on healthcare, suggest ways to improve and optimise budgetary allocation and spending and also to look at the best practices globally in healthcare, which could be emulated in an Indian setting.
The recommendation to declare Right to Health at the 75th Independence Day as a fundamental right is welcome. The move has been long due and popular governments in the past did not see the real need to, due to other conflicting priorities, implement it. We could also argue that healthcare was never a human fundamental right because the Indian vote bank never voted on healthcare as an issue of electoral importance.
The HLG went on to suggest introduction of short courses at MBBS level and also tweaking the nature of the course, thereby making it competency-based. Some universities have already implemented it through borrowed learning.
What remains of concern is confining undergraduate teaching to residential campuses. We cannot build doctors of tomorrow by confining them to residential campuses. It is important for future doctors to inspect, palpate and auscultate and appreciate human life in motion through their formative years.
The HLG goes on to recommend that private medical hospitals that have Diplomate of National Board (DNB) courses must be given tax incentives. Wisdom would question the merit of the same. Private medical hospitals want to utilise a workforce through the interpretation of DNB curriculum, charge the candidates in the name of fees, not engage senior doctors in poor patient care but rather operate through the DNB-trainees and then claim tax deduction from government?
I find it rather strange when the HLG talks about faculties in medical colleges not being allowed private practice. Historically, doctors of government medical colleges were discouraged from private practice, yet we see clinics all over the place with absolutely no action having been taken in all these years.
Why I feel the HLG needs rethinking is because the ideas remain obsolete, disconnected from modern-day realities and show no signs of leap-frogging the healthcare sector with innovation and inter-sectoral coordination.
Indian Medical Services, which existed in British India, continue to be ignored, with no one being able to envision the bright side of what it could do to the healthcare sector. District health officers today are appointed based on political closeness and not merit. Many of them are unable to interpret guidelines, use discretion and build the spirit of collaborations. For India’s public health to get a boost, this needs to change, and change soon.
Regretfully, the HLG does not speak about committing to Sustainable Development Goals in heart and spirit, nor does it pave the way for medical institutions to work on those lines. It further lacks the understanding on how civil society and non-government organisations built India brick by brick, and the importance of collaborating with non-governmental bodies in enhancing medical care. Ideas are being attempted to be emulated through forms of best practices, but we refuse to learn the importance of non-government bodies in achieving public health victories. One classic example is the fight against polio, where governments and non-government organisations came together in shaping a new reality for humanity. The drivers of change were the powerful non-government sectors of India that held the country together.
Primary healthcare gets recognised as a fundamental tenet from a rights-based approach; however, the most powerful discipline of community medicine remains neglected.
In fact, one of the HLG members goes on to mention that community medicine may not be required in medical college. I think those who are not qualified to speak on community medicine, must best avoid it and collaborate, rather than paint a narrative built on jargon. If India’s ill has to be bailed out, community medicine physicians are the only ones who can do it. Working together with the strong public health workforce has a snowballing effect to work miracles.
India needs integration in all forms and the HLG is right when they agree to restore postgraduate diploma because all forms of medicine stand integral to healthcare survival of India. HLG will need to rethink ways in which the NGO sector is involved in field-based research in collaborating with academic institutions, promoting healthcare agendas of governments and building linkages that help in community-based learning.
HLG ideally should have held state-wise consultations before arriving at decisions. Complex democracies like India cannot have a one-size-fits-all approach. India’s powerful resident doctors, medical students should have been consulted, as they are the torch-bearers of tomorrow’s healthcare reality in India.
With 25,650 Primary Healthcare Centres, 5624 Community Health Centres, and 1,56,231 sub-centres, I clearly see no need to build 3,000-5,000 hospitals as recommended by HLG. We should rather strengthen the existing massive public infrastructure and integrate the rest of India with the powerful development sector institutions working at the heart of rural well-being.
India’s health systems need a rejig, with community health physicians and public health champions leading the space, focusing on quality, committing to global goals and strengthening governmental ownership in healthcare.
In the end, may the conscience of India win.