Dileep Mavalankar

The pandemic has given us an opportunity to modernise our health system. Our public health system has been anemic for long time. Past patchwork of various “Yojanas” and “Missions” have been inadequate. Of course our health indicators have improved over last 75 years, but compared Sri Lanka, Thailand, China or Vietnam we are far behind. We have fallen behind even Bangladesh and Nepal.

The current public expenditure of 1.3 per cent of GDP on health is far short of policy objectives of 3 per cent. Given the pandemic shock society and politicians are all willing to spend more on public health. Unless we invest more in health system now we will not be prepared for the next pandemic. Here are some suggestions for the new Budget.

India lacks a well-organised public health cadre. This was very apparent in the pandemic. Our public health actions were ad hoc rather than nuanced. We had to depend on studies in UK and Israel on various aspects of the pandemic. The Budget must propose formation of a public health learning from Tamil Nadu. Each district should have 3-6 public health cadre offices from the Centre on lines of IAS or IPS. They will ensure all public health functions at the district and state level.

Research opportunity

India’s huge population provides a unique opportunity for research. Israel, UK and South Africa with their small populations have produced excellent studies on Covid which helped guide the global strategy. India needs scientific outlook, funds and technical expertise. ICMR’s isolation of Covid virus paved way for Bharat Biotech’s indigenous Covaxin. We need to at least double ICMR budget each year for next three years and fund universities to do research.

Primary care and public health services are needed to stop the spread of the pandemic. Most of the testing, tracing and treatment was done by our primary care providers and public health staff. In the pandemic we also realised the value of diagnostic services including rapid test, RTPCR and X ray and HR CT examination. The Budget needs to really ramp up primary care and diagnostic capacity 3-4 folds. Primary health services will help us fight against other infectious diseases such as diarrheas, pneumonia, TB, Malaria and dengue after the pandemic.

Given the concentration of Covid cases in major cities we need to strengthen city health departments. Cities do not employ adequate number of public health officers, statisticians, epidemiologists and demographers. One measure of this is the controversy on total Covid deaths. The Budget must provide substantial resources to strengthen city health departments with public health professionals. At least one public health professional for 1,00,000 people is needed.

The major interventions in Covid prevention were social distancing, masks, personal hygiene, ventilation. The government’s job is to provide evidence based guidance. Hence health communicators become very important in such pandemics. Unfortunately, India did not build a good health communication cadre in the health department. This Budget should create a health communication division.

We had great difficulty in collecting and analysing Covid data. Even simple data like Covid hospitalisations and deaths were not reliable. Hence many decisions had to be taken on expert advice without data. This Budget must invest in data systems improvement. India has good institutions and experts who should be consulted to develop good data systems. The Digital Health Mission is a step in right direction.

Recently many new medical and nursing colleges have opened. We need highly skilled and experience HR managers in health departments. We must pay the health staff well. The frequent strikes by various levels of health staff in past two years is indicator of the discontent among themf. Good HR systems are not expensive. On the contrary they will save substantial funds by rationalising the workforce and increasing their productivity.

This pandemic is once in 100 years’ opportunity to invest in health. We must not miss it.

The writer is Director, Indian Institute of Public Health, Gandhinagar