Editorial: Healthcare reforms overdue

The pandemic has exposed India’s creaky healthcare system, abysmally low public spending and skewed priorities when it comes to addressing the challenges of infectious diseases. It also laid bare the gaping holes in the 125-year-old Epidemic Diseases Act, which is devoid of provisions for the management of a Covid-like national health emergency. Learning lessons from […]

The pandemic has exposed India’s creaky healthcare system, abysmally low public spending and skewed priorities when it comes to addressing the challenges of infectious diseases. It also laid bare the gaping holes in the 125-year-old Epidemic Diseases Act, which is devoid of provisions for the management of a Covid-like national health emergency. Learning lessons from the pandemic, the country is now finally setting the stage to repeal the anachronistic Act. The proposed National Public Health Act is set to replace the 1897 Act. The new law, the details of which are being finalised, will have an all-encompassing ambit, covering not only epidemics and pandemics but also public health emergencies caused by bioterrorism, natural disasters, chemical and nuclear attacks or mishaps. This law will empower Central and State governments to enforce preventive measures such as lockdown, masking and quarantine without invoking the National Disaster Management Act. The draft public health Bill has proposed a four-tier system involving public health authorities at the national, State, district and block levels. It is expected that the new law will improve coordination between various authorities and fix the accountability of officials at all tiers. A law to strengthen public health governance is long overdue, but the job will remain half-done as long as the shortage of doctors persists. India’s doctor-patient ratio has improved to 1:834, according to the Health Ministry, but it is still inadequate to handle the burgeoning population, especially during a health emergency. The biggest challenge will be to ensure that the new Act makes India’s healthcare future-ready.

While the proposed legislation on public health has been pending for years, it has gained momentum in recent months. The issues raised by the State governments and other stakeholders must be taken into consideration while fine-tuning the legislation. The proposed law also provides for the creation of public health cadres at the national and State levels. Along with this, budgetary spending on the healthcare sector must be increased substantially. At present, India’s expenditure on healthcare accounts for just 1.17% of the GDP, one of the lowest in the world. It has one of the lowest health workforce in the world. The pandemic should have served as a wake-up call to revamp the sector on a mission mode. Poor public spending on healthcare is a key hurdle in the fight against infectious diseases. Successive governments in India have ignored the public healthcare system leading to a situation where primary and secondary healthcare centres in most parts of the country lie abandoned or unmanned. Many infectious diseases could be prevented and controlled with a robust public health system and adequately trained public health personnel. The higher public health spending would help in reducing the overall out-of-pocket expense by patients, especially enabling access to healthcare for the poor.

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