Overhauling Health Sector

In the backdrop of changes in governce structure set in motion by the Modi regime, it is creditable that Assam has competed among 14 States to win the NITI-Aayog’s partnership towards overhauling its healthcare delivery system. It needs be remembered that NITI-Aayog — supplanting the fund-disbursing Planning Commission of old — is primarily a think tank that provides critical inputs and advice to the Central government to help it in making policy. The idea is that if the NITI-Aayog gives a good rank and puts in a favourable word, the State concerned will prosper by getting the Centre to release funds under related schemes. But the NITI-Aayog is expanding its role through ‘Sustaible Action for Transforming Human Capital’ or SATH initiative. Under it, NITI-Aayog, State governments and a knowledge partner will set up partnerships to help improve various social sector indicators of States. Why the social sector? Because, according to the policy think tank: “Transformative change in social sector is challenging as the pace is slow, as compared to the infrastructure sector. The issues are multi-layered and complex, involving both governce and building capacity of human capital”. While making presentations seeking hand-holding in health and education sectors, the States put forth justifications why they should be selected for institutiol support, while highlighting initiatives they have so far undertaken and their willingness to speed up improvement. Filly, Assam, Uttar Pradesh and Kartaka were the three States selected by NITI-Aayog and Union Health Ministry experts for the health sector. The onus will now be on Assam government to commit itself to ‘time-bound, governce reforms in the health sector’. It will have to improve health structures and services under NITI-Aayog’s roadmap and monitoring, as part of which a Program Magement Unit will be made available for 30 months. The focus is to really implement health reforms on the ground, as the hand-holding process will be time-bound and outcome-oriented.

The expectation is that the initiative will at long last make a significant difference in Assam, where crores of rupees have been pumped through the tiol Health Mission (NHM) for years but with little improvement in healthcare, especially in terms of manpower and infrastructure in rural areas. A recent Union Health Ministry report has laid bare the acute shortfall of doctors, nurses and paramedical staff in public health centres (PHCs) and community health centres (CHCs) in the State. Several PHCs and sub-centres are running without power or water supply; many CHCs lack operation theatres, labour rooms, newborn care units and even X-ray machines. With public healthcare going to the dogs, is it any wonder that private sector hospitals and nursing homes are ruling the roost in Assam? Healthcare in private hands is a costly proposition — so the doors for treatment are either slammed shut on the poor, or they sink into utter penury after taking loans they can never return or by selling off ancestral land and other assets. Health Minister Himanta Biswa Sarma has begun a right initiative to retire GMCH doctors with VRS package if they refuse to quit private practice, but the restriction needs to be expanded soon to all other government hospitals across the State. The Health Department is also on the right track in forbidding GMCH doctors from prescribing laboratory or radiological tests to patients to be done outside the hospital premises. This will end the ‘commission raj’ and other malpractices among GMCH doctors, but what about other civil hospitals where similar situations prevail? Assam may be on track to soon overhaul its health infrastructure, but it must arrest the retreat of public health institutions which leaves the field open to private operators to the detriment of the poor.