Imeratives for heath sector

Third Wave

By Dr Oishee Mukherjee

A third wave is predicted in India any time between September and December. Scientists and leading doctors predicting this wave speak with confidence. But a section of experts also feel that there may not be any scientific reason to believe that this wave will hit kids in a big way. It may be stated that infectious disease modelling is a specialised field and modelers need to analyse detailed data on the virus and people and places affected by it. Meanwhile, data indicates that m-RNA vaccines seem to perform best at limiting both infection and disease.
Vectored vaccines also do well at preventing disease and slightly less well at preventing infections due to some variants, which means that vaccinated people can still spread the virus, although not as much as unvaccinated people. As regards the Delta variant, there is need to immunise a greater proportion of the population than the 60% originally envisaged to slow the spread of the virus. All countries are now vaccinating as fast as they can but supplies continue to be limited for middle and low income countries. In India, there is an average of 4 million doses a day though the country has the ability to vaccinate double that number. With just one quarter of Indians having received one or two doses of vaccine, there is a long way to go to provide vaccine induced coverage.
Meanwhile, the induction of new Union Health Minister may not find applause among the general public but the Centre’s approval of Rs 23,123 crore package allocated for emergency response to Covid-19, with the focus on immediate needs for the next nine months of the current fiscal, is indeed welcome. This is expected to help in creation of more infrastructure for paediatric care, repurposing of hospital beds for Covid management, strengthening of genome sequencing, augment ICU facilities, installation of oxygen tanks and creation of buffer stock of key medicines.
This is the 2ndsuch package while the first Covid response package was given in April 2020. However, it needs to noted that the sum appears quite meagre when experts are talking about augmented resources towards strengthening health care infrastructure. There is no denying that hospital capacity needs to be augmented with pre-fabricated structures for closer to home hospital care facilities in rural and tribal areas and bigger field hospitals, specially in sub-divisional towns where the density of population is high. Apart from this, installation of 1000 plus liquid medical oxygen storage tanks are also a must to provide its supply to all districts.
Equally important is the need for doctor, nurses and para medical staff as well as epidemiologists for detecting and responding to outbreaks, assessing co-morbidities in the population and promoting healthy behaviour. In all public health capacity must be augmented in all States and it calls for expansion of medical education.
Meanwhile, the G-20 recently stated that an upsurge in new corona virus variants and poor access to vaccines in developing countries, threatens global economic recovery. And pointed that “the recovery is characterised by great divergence across and within countries and remains exposed to downside risks, in particular the spread of new variants and different paces of vaccination”.
Though it has been stated innumerable times that poor health infrastructure is a cause for concern, the brunt has been felt by the poor and the disadvantaged sections over the years. The National Health Policy, formulated way back in 2017, had stated that government spending on health must reach 2.5% of GDP by 2025. To achieve that target, spending would have to grow from the 2017-18 level by nearly 20% year-on-year. The average total spending on health has been hovering at around was around 1.4% which may have increased to say 1.5% of GDP in the current fiscal obviously due to the pandemic.
To reach the level of 2.5%, the combined spending on health should grow by more than 19%. As per WHO data, there are about 30 countries mostly in the poverty stricken sub-Saharan Africa and also in India’s neighbourhood that allocate less than India does as a percentage of GDP. Most developed countries such as France, the US, UK, Canada spend about 8% or more of their GDP on health, while Germany spends about 9.5%. Among BRICS countries, China at 3.2% was significantly higher, almost double, than of India.
Understandably expansion of medical facilities cannot be accomplished immediately but would take at least 3-4 years if the government is sincere about improving public health. As usual, the poor and the EWS sections continue to suffer as increase in government expenditure in the health sector has been marginal. Though public-private partnerships are envisaged, such projects are not expected to bring much relief.
Likewise, the National Medical Commission deleted the minimum land requirement of 10 acres for setting up a medical college and its affiliated teaching hospitals in Ahmedabad, Bangalore, Calcutta, Delhi, Hyderabad, Mumbai, Kanpur and Pune and 20 others elsewhere, as set by earlier regulator, Medical Council of India. Besides, bed requirements for various departments at teaching hospitals have been ‘rationalised to align’ these with annual student intake, the teaching time in clinical specialties and minimum patients required. The effect is a 10% reduction in teaching beds compared with earlier regulations. The new regulations mandate for the establishment of a medical college, the availability of a fully functional 300-bed multi-specialty hospital that had been operational for at least two years at the time of application.
Experts believe the changes will lower the hurdles for establishment of medical colleges while making it possible for certain district hospitals to be converted into medical college through government funding or PPP. But while these regulations are, no doubt, welcome, it needs to be ensured that private entrepreneurs who set up medical colleges do not take advantage of this and not keep free beds for the poor and EWS sections.
There are instances where land has been given to private parties to set up medical colleges and hospitals at throwaway prices. But records show the owners charge enormous rates, even beyond the reach of the lower middle class, and give no concession to the poorer sections. Thus, relying on private sector to strengthen and/or modernise district hospitals, as envisaged by the government, may not be of much help to those who do not have the capacity to pay.
Given that health is a neglected sector, there is need for rethinking to tackle both traditional as also new types of diseases. While allopathic treatment has been progressing, alternative therapies need to be given equal importance. Various systems may be able to make important contributions to healthcare, more with different types of pandemics emerging.
An equitable distribution of resources and enthusiasm would be vital in allowing Ayush to flourish as a whole. The current pandemic has taught us that no healthcare worker is extraneous. India has done well in mobilising social health activists and other auxiliary workers to shoulder this burden. The need now is a truly integrated healthcare system for which traditional and Ayush practitioners should be mobilised in greater numbers.  An encouraging news is the setting up of a Global Centre for Traditional Medicine in India, by the WHO, prompting the Prime Minister to say that the country has emerged as the “pharmacy of the world.”
Be that as it may, with the devasting second wave of Covid-19 having left deep scars, the country must learn from the adage a stitch in time saves nine and be well prepared to handle the third wave. — INFA