IJCRR

IJCRR - 14(3), February, 2022

Pages: 43-47

Date of Publication: 01-Feb-2022

Indian Healthcare Sector and the Sustainable Development

Author: Tavseef Ahmad Mir, Manvendra Singh

Category: Healthcare

Abstract:Sustainable development is one of the fundamental aims of health. Health itself is both a result and a contribution to development. Health is a crucial component in the right, people-centred, egalitarian, and inclusive approach to development. It is a vital part of human life due to material, psychological, social, cultural, educational, professional, political, and personal aspects of security. All these aspects are connected and interdependent. Investments in whatever form, in any part, necessarily improve other constituent quality standards. Many advances have been made in this sector under the era of Millennium Development Goals (MDGs). India has met with some progress in reduction of infant mortality rate, from 125 per 1,000 live births in 1990- 91 to 50 per 1,000 live births in 2015-16, and the maternal death rate reduced from 212 per 100000 live births in 2007-09 to 167 in 2013. Nevertheless, the scope exists to address the gaps in policy implementation at the ground level. New goals and targets have been set for us by Sustainable Development Goals (SDG). In addition, the COVID-19 outbreak has made it crucial for policymakers to reconsider our country's health policies and services.2 This study is a genuine analysis of the health-related sustainability goals and current health care structures and procedures in India and proposes solutions for making healthcare truly universal and consistent with sustainable development objectives.

Keywords: Sustainable development, Healthcare, Policy, National Health Policy, COVID-19 outbreak, Policy implementation

Full Text:

Introduction

Sustainable Development means development aimed at meeting present needs without compromising the potential of forthcoming generations to satiate their own necessities. Sustainable development maintains economic advancement and progression while protecting the environment by assimilation of environmental and developmental policies. There is an appreciation of our natural resource scarcities.¹ Truly rational, welfare-oriented, and effective governance requires a nation to consider policies that protect the environment and health of the citizens on which its whole march of progress depends. The developmental approach, not taking human health into account, is counterproductive. The nexus between health and development provides a powerful basis for having a sustainable healthcare system. Components of a sustainable system are quality infrastructure and a healthy personnel environment, accounted as public goods as they are non-competitive and non-exclusionary.  It is the primary duty of the public sector to run and regulate these goods and services. More recently, countries have adopted market-based mechanisms to provide healthcare facilities to the public. 

The overall motto of sustainable development is consistent economic and environmental stability, which is only possible through the proper analysis and acceptance of concerns related to economic, environmental, and social aspects of the decision-making process. Principles of Sustainable Development have participative decision-making at its core. It is this deeply ingrained concept of integrativeness that differentiates sustainability from other developmental policies.  It provides a working structure where society and the environment get mutually benefitted without damaging the environment. Thus, it is a developmental pathway and a conception that steers towards upgrading standards of living without injuring the earth’s ecological balance. Sustainable development decisions based upon judicious management of resources results in ever-lasting development for the society. These include decisions related to the allocation and management of resources available on this planet. Economic sustainability ensures a production and consumption system that satisfies present needs through sustainable use of resources. While social sustainability signifies equity, upliftment, availability, participation, and stability of institutions. This concept emphasises that human matter as development is all about them as it signifies a social organization system that reduces poverty and lifts the living standards.

The sustainable development goals relate to the tenets regarding fulfilment of developmental aspirations along with maintaining the consistent capacity of natural systems to replenish the resources. Though the idea of sustainable development is in vogue since times, its relevance deepens with every passing day as only the number of humans keeps on increasing, while other resources get diminished day after day. Concerned about this phenomenon, international level arrangements and programmes have been formulated regarding the adoption of sustainability principles.

Sustainable Development Goals

The adoption of Millennium Development Goals (MDGs) signified a major paradigm shift in global political will for the elimination of poverty and the wellbeing of the people. Since the MDGs were conceived, new changes emerged like the rate of environmental degradation increased, inequality has deepened, and the unemployment rate has grown. People across the world are asking for more participative governments and better governance. These striking challenges have necessitated the formulation of global goals. The Seventeen Sustainable Development Goals collectively called Sustainable Development Goals try to achieve the following targets.³ Eradication of poverty as well as hunger levels, universalisation of accessible basic services like drinking water, hygiene, inclusive education, as well as dignified work. Encouragement of new ideas and buoyant infrastructural systems that can produce and consume sustainably. Reduction of inequality on basis of economic potentials and social belonging in the world. Protection of ecological integrity by taking measures for combatting various environmental disasters. Promotion of collaborative practices between various stakeholders for ensuring peaceful production and consumption of goods and services.

Agenda 2030 has five main themes which include people, planet, prosperity, peace, and partnerships covering the seventeen sustainable development goals. They

are aimed at fulfilling the vision of sustained development. It has received a lot of focus in academics, particularly in the areas of management, planning and development interventions. Many organizations working with the government or otherwise have adopted it as a feasible developmental model.⁴ It is because most of the advocates of this model seem to accept that the challenges faced by the people such as drastic climatic changes, ozone layer deterioration, water shortage, and poverty can be remedied by adopting the tenets of this paradigm. Economy, society, and environment form the elements of this development process of an ecosystem so this process cannot be carried out in watertight chambers. All decisions need to be aimed at promoting the overall positive and balanced growth of the system. Though sustainable development is considered a serious issue by everyone, international, national, regional organizations, civil society, and government organizations are considered to express concern through the modes of stewardship, partnerships, participation and proprietorship.

Health has been recognized as one of the primary concerns for international progress for the last twenty years, during which many initiatives were undertaken to reduce morbidity and mortality either for the whole of the population or through focused programmes on targeted subgroups (like “the poor, women and children"). The Millennium Development Goals (MDGs)formulated in 2000, comprised of health-oriented goals to be achieved by 2015 were reduction in infant (under five years) death rate (Goal 4), reduction in maternal death rate and availability of reproductive health services (goal 5), and preventing the spread of HIV, tuberculosis, and malaria (goal 6). They are important for the diversion of global resources towards developing and underdeveloped nations. The Sustainable Development Goals (SDGs) era gave healthcare a prominent space. The health goal (SDG 3) is wider in its ambit which states that governments must Ensure healthy lives and promote well-being for all ages.⁶ The statement emphasizes that to achieve the health goal, ‘we must achieve universal health coverage (UHC) and access to quality health care, and no one must be left deprived.  Universal Health Coverage is at the centre of the SDG 3 health goal. This goal acts as a contributor to as well as a beneficiary of sustainable development, with linkages to all the other Sustainable Development Goals. Achieving SDG 3 targets will depend on progress in other SDGs like reduction in poverty; education levels; nutrition standards; gender justice; clean drinking water and better sanitation facilities, sustainable use of energy resources and safer cities.⁷

Healthcare in India

Sustainable Development Goals (SDGs) formulated by United Nations are to be followed by each member nation. India being its member is committed to meeting the targets of this framework. India’s ranking is down two places from last year to 117th about progress for meeting Sustainable Development Goals (SDGs). Over the next coming years, as these new targets are applied globally, countries have mobilized resources and efforts to end all poverty in all its forms, reduce inequality and tackle climate hazards. The Sustainable Development Goals build upon the successful results of the Millennium Development Goals and intend to further progress towards the removal of all forms of deprivation. The goals are special as they direct all countries to act to ensure prosperity and protect the planet. India has formulated its National Health Policy 2017 and meeting these goals is one of its objectives. The National Health Protection Scheme (Ayushman Bharat) was launched to cover the health expenditures of secondary and tertiary care of people living below the poverty lines. Opening of Jana Aushadhi Kendra which is a chain of pharmacy stores to provide medicines at doorsteps. These measures testify to the Indian government’s commitments towards the targets set up by sustainable development goals.⁷

Discussion

NITI AAYOG, the main think tank for developmental planning, developed the Index for Sustainable Development Goals (SDGs), which scrutinises the progress of states and Union Territories (UT) for various parameters which include healthcare, education levels, gender justice, economic growth, institutions, measures to combat climate change, and the environment protection. It was first launched in December 2018 and became a key instrument for tracking the developmental path towards the Sustainable Development Goals in India. This contributed to the development of competition between states and their ranking according to global goals. The index was developed in partnership with the United Nations. It monitors all states and Union Territories on 115 metrics that are in tandem with the National Index System of the Ministry of Statistics and Program Implementation. This tool is important regarding dialogue, formulation, and implementation of targeted based initiatives. This helps to oversee important gaps in monitoring and to highlights the necessity of having indigenous statistical programmes in India.¹¹ It helps identify weaknesses in the implementation of SDGs and the need for developing indigenous statistical systems. Kerala ranked first in the NITI Aayog India SDG Index 2020-21, while Haryana, Mizoram and Uttarakhand are the top achievers in improving their rankings since 2019.

The global COVID19 pandemic has presented the Indian health care system with many challenges which this country is fighting with remarkable synergies between industry, civil society, and governments at different levels⁵. India has met with some progress in the reduction of infant mortality rate, from 125 per 1,000 live births in 1990- 91 to 50per 1,000 live births in 2015-16, and the maternal death rate reduced from 212 per 100000 live births in 2007-09 to 167 in 2013. India progressed in reducing the spread of HIV and AIDS in India various vulnerable categories, with prevalence declining from 0.45 percent in 2002 to 0.27 percent of the adult population in 2011. However, a quarter of the world’s tuberculosis cases are reported in India, where almost 2.1 million people get infected from this disease and approximately 423,000 die each year.

Considering the different diversities of the country, its size, and the differential phases of development among regions, it is requisite to draw up local specific targets and programmes. Strong political commitment is fundamental to increased investment in health-related major policy reforms. Universal Insurance Program in Thailand, Health Transformation Program in Turkey and Obama Care in the United States signify strong political commitment towards the wellbeing of the citizens. Around 1.2 percent of the Gross Domestic Product (GDP) is spent upon public health in India, which is one of the lowest public health expenditures globally.

Making “health” a citizen’s right can motivate policymakers to propose increased investment in healthcare, accelerate industry reform, and improve health outcomes. Several countries have recognized the right to health as a right governed by “civil society” movements and have recognized health as an electoral tool. India missed this opportunity when it proposed, Right to Health, in the National Health Policy-2017 but was taken out on the premises of health systems being not ready. However, evidence shows that considering health “A Fundamental Right” is necessary for the health system’s readiness.

Health is currently a “state subject,” meaning that the state legislature is responsible for enforcing it. To ensure policy uniformity, effective coordination and response, and the ability to transfer health benefits uniformly across the country, there is a need to put health on the Concurrent List where both central and state governments would be responsible for the execution of various programmes. To improve centre-state cooperation and guide multiple actions, the role of the political executive on health-related issues is of high importance. At present, the National Health Mission Steering Group (NHMSG) is the apex policy-related guiding institution, the Central Council of Health and Family Welfare (CCHFW) takes care of logistics and advises the Department of Health on formulations of various policies. The scope of the NHMSG needs to be extended to the entire health sector by placing it under the chairmanship of the Prime Minister, with the union minister for Health and Family Welfare as co-chairman. Likewise, in sync with the vision of National Health Policy 2017, the role of the CCHFW needs to be widened about guiding health Sector Plans (HSPs)’.

Healthcare is one of the rapidly growing industries in India, and despite being a prominent exporter of the health workforce to developed nations, the country itself faces a scarcity of doctors and nurses. Therefore, sharing best practices, providing participative roles, engaging with crucial stakeholders within and outside the health sector, building strategic partnerships with the private sector and voluntary organisations should be the focus of the Ministry of Health and Family Welfare. Measures need to be taken for strengthening the legal framework, health standards, and encouraging the best performers by rewarding them and how the developing of the human capital, information systems, and research. Vision needs to be redefined and goals standardized to help countries align with the overall goal of universal health coverage.

Create a workable framework of implementation based on National Health Policy 2017 with a focus on activities, targets, goals, schedules, and accountabilities. This framework need not be rigid, it should provide adequate flexibility to states to modify the work plan according to the needs of the region and feedback tracking should be a built-in mechanism for programme modifications. Strategies and programs within the framework should converge into an integrated Universal Health Coverage with adequate resource allocation and monitoring. It will facilitate the introduction and promotion of the Universal Health Care program through a multi-tiered approach. “State Health Investment Plans” should be intermingled with State Health Plans to strengthen physical infrastructure, human resource capabilities, and other subsystems. These plans must reflect the reality of the health system of that region, with a focus upon building capacities, including middle-level service dispensers, employing private sector partners and ensuring the accessibility of essential drugs, vaccines, and other health supplies. An integrated health information system is essential, where every transaction can be recorded through a unique identification number linked with the Aadhar database to ensure smart service delivery.

There is a need of strengthening primary healthcare centres for robust delivery of healthcare services. The NHP-2017 provision of establishing “Health and Wellness Centres” to provide a complete package of necessary services by a primary centre team led by a middle-level provider is a feasible working model in the Indian setup. These care providers need effective liaisons with upper-level care providers to ensure continuity of patient care. Recipients should have the right to choose the providers from whom they can avail the service and pay the initial fees. Innovative models based upon performance management framework can be introduced after the full implementation of the policy and increase in demand.

The government needs to prioritize prevention and health promotion by allocation of more resources to address Non-Communicable Diseases, traffic accidents, and enhancing immunities. For instant effective management of health threats, building upon the learning from the “Integrated Disease Surveillance Programme,” which should be serviced by a well-coordinated chain of service providers, enablers, laboratories, hospitals, and surveillance units managed by the competent personnel. They should be in touch with a nationwide real-time networked information system operated by one main centre.¹⁰

To ensure access to basic health services by all, the government needs to develop a robust system with a pool of public funds that can ensure the provision of essential packages of health services to the citizens which would result in reducing burdens upon their pockets. The Government of India should ensure universal access to the specific package of essential services all over the country, with the state governments modifying services as per requirements within the state.⁸ Private health insurance should function as add on service to cover conditions not specified in governmental programmes. Evidence suggests that the “Purchaser Provider Split,” separates the roles of buyers and suppliers, resulting in benefits such as increased efficiency and reduced costs. Separation of the functioning of buyer and service provider leads to improvement in efficiency and cost reduction by agreeing upon better prices and regulation of quality. Under the Governmental structure of India, the purchasing agency must be at the state level with the support of the national standards body. As it is equally important to reduce health inefficiencies and improve public financial management.⁹

India’s mixed public-private health system has witnessed a steady decline in public services, because of the unregulated growth of formal and informal private service providers. To manage provider networks, government and national health agencies must have a vibrant information communication framework to monitor service provider working and aberration management. It will result in effective action to address ethical issues, including quality treatment, diagnostic teams, medical records, and payments.

Conclusion

World over experiences has shown that well-coordinated health sector reforms can contribute to "inclusive development" by enhancing the health and wellbeing of the citizens, eradicating inequities, and avoiding circumstances adversely affecting public health. Innovative policies and enhanced health financing can help achieve universal health coverage and make a country healthier. Progress on Universal Health Coverage cannot be made instantly. A basic principle for realising it is “progressive universalization,” starting with what is readily available and slowly adding health services and enhancing financial protection to the broader spectrum of the population as the healthcare system develops. In a larger perspective, the assimilation of the Sustainable Development Goals agenda into National HealthPolicy2017 and NITI Aayog Health Vision-2032has provided a historic opportunity for healthcare advancement.

Healthcare in the country has become the highest priority, particularly after the outbreak of COVID-19 and not investing in this opportunity can have devastating consequences for the future. Primary and secondary levels of healthcare need upgrades in form of infrastructure and capable human resources. There is the utmost need of investing in healthcare and its allied industries. To touch the goalposts, set up by SDGs, it is necessary to make it more participative for other stakeholders as well. It is time to learn the lessons from the past, build on past achievements and tread upon a goal-oriented journey

Source of funding: NA

Conflict of Interest: None

Authors’ Contribution: The first author collected data and framed the overall paper. Co-Author analysed the whole paper and framed the discussion part.

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