Recommendations
It is against this backdrop of a weak public healthcare system, existing health inequalities and the ongoing pandemic that this report provides the following recommendations:
1. The right to health should be enacted as a fundamental right that makes it obligatory for the government to ensure equal access to timely, acceptable, and affordable healthcare of appropriate quality and address the underlying determinants of health to close the gap in health outcomes between the rich and poor.
2. The free vaccine policy should adopt an inclusive model to ensure that everyone, irrespective of their gender, caste, religion or location i.e. people living in hard-to-reach areas, gets the vaccine without any delay.
3. Increase health spending to 2.5 percent of Gross Domestic Product (GDP) to ensure a more equitable health system in the country; ensure that union budgetary allocation in health for SCs and STs is proportionate to their population; prioritize primary health by ensuring that two-thirds of the health budget is allocated for strengthening primary healthcare; state governments to allocate their expenditure on health to 2.5 percent of Gross State Domestic Product (GSDP); the centre should extend financial support to the states with low per capita health expenditure to reduce inter-state inequality in health.
4. Regions with higher concentration of marginalised population should be identified and public health facilities should be established, equipped and made fully functional as per the Indian Public Health Standards (IPHS).
5. Widen the ambit of insurance schemes to include out-patient care. The major expenditures on health happen through out-patient costs as consultations, diagnostic tests, medicines, etc. While the report does not endorse Government-financed Health Insurance Schemes (GFHIS) as a way to achieve UHC and stresses that insurance can only be a component of it, it is imperative that GFHIS widens its ambit to include outpatient costs as a way to reduce out-of-pocket expenditure (OOPE).
6. Institutionalize a centrally-sponsored scheme that earmarks funds for the provision of free essential drugs and diagnostics at all public health facilities.
7. Direct all states to notify the Patients’ Rights Charter forwarded to them by the Ministry of Health and Family Welfare, and set up operational mechanisms to make these rights functional and enforceable by law.
8. Regulate the private health sector by ensuring that all state governments adopt and effectively implement Clinical Establishments Act or equivalent state legislation; extend the price capping policy introduced during the COVID-19 pandemic to include diagnostics and non-COVID treatment in order to prevent exorbitant charging by private hospitals and reduce catastrophic out-of-pocket health expenditure.
9. Augment and strengthen human resources and infrastructure in the healthcare system by regularising services of women frontline health workers especially Accredited Social Health Activists (ASHAs), establishing government medical colleges with district hospitals prioritising their establishment in hilly, tribal, rural and other hard-to-reach areas, enhancing medical infrastructure and establishing contingency plans for scenarios such as the second wave of the pandemic.
10. Inter-sectoral coordination for public health should be boosted to address issues of water and sanitation, literacy, etc. that contribute to health conditions. Specific roles and Statement of Purposes (SoPs) of departments/ ministries, and convergence plans need to be detailed out for reducing health inequality in the country.
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