Context: In the wake of the COVID-19 pandemic, there have been vociferous demands to strengthen the country’s public health system. Once the present crisis is over, however, public health will go into oblivion, as usual.

Poor health indicators

• Not surprisingly, the efficacy of the public health system varies widely across the country since it is a State subject.
• How good a public health system is can easily be judged just 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.

Inter-State Variation

• India failed to achieve the earlier Millennium Development Goals because of the poor performance of the northern States.
• It is surprising that the Government of India does not hold them responsible and accountable for poor performance but is satisfied with the average.
• Equally surprising and disappointing is that these State governments themselves are indifferent to their poor performance.
• These data are revealing. The northern States are performing very poorly in these vital health parameters.
• In Madhya Pradesh, the number of infant deaths for every 1,000 live births is as high as 48 compared to seven in Kerala.
• In P. the Maternal Mortality Ratio is 197 compared to Kerala’s 42 and Tamil Nadu’s 63. The percentage of deliveries by untrained personnel is very high in Bihar, 190 times that of Kerala.
• Some of these States are performing so poorly that they are comparable to the poorest countries in the world, pulling down the average for India.
• The Government of India is just looking at the averages which are somewhat reasonable thanks to the excellent performance of well-governed States.
• Despite Finance Commissions pouring 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.

Tamil Nadu’s example

• Enlightened political leadership was interested in the health and well-being of the people.
• The family planning drives and innumerable camps organized to eradicate cataract in the 1970s.
• The district administration was spearheading these health initiatives because of the government’s focus and drive.
• By the 1990s, family planning drives were no longer necessary, and all that was needed was some fine-tuning of the Maternal and Child Health programme.
• The result is that the 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).

Suggestions:

• The governments — both at the Centre and the Empowered Action Group States — should realize that public health and preventive care is a priority and take steps to bring these States on a par with the southern States.
• The Government of India has a vital role to play. With his huge mandate and popularity, the Prime Minister should get involved in this fundamental task of improving the health of the people.
• An important measure that can make a difference is a public health set-up in these States that addresses primary and preventive health. Tamil Nadu manages its public health set-up with just about 150 public health professionals.

Conclusion

• Unless we invest in human capital, FDI will not help. It will only increase the wealth of the already wealthy and accentuate income disparity.
• Investing in health and education is the primary responsibility of any government. It is time the governments — both at the Centre and States — gave health its due importance.
• The Empowered Action Group States must start in earnest at least now. There are no shortcuts; only persistent and focused efforts at the highest level of government will improve preventive care and primary healthcare.

https://www.thehindu.com/todays-paper/tp-opinion/building-a-robust-healthcare-system/article33712736.ece

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