India’s reputation for dramatic contrasts was reinforced by the performance of its health sector in 2014.

The year began with the world celebrating India’s success in becoming polio free but ended with tragic sterilisation-related deaths in Chhattisgarh and blinding of patients at cataract surgery camps in Punjab, signifying the failure of the country’s public health system.

Campaign mode Despite decline, infant and maternal mortality rates are high, while low rates of routine immunisation remain a concern. All point to the health system’s ability to act effectively in a campaign mode, while steady state function is sub-optimal.

Earlier this year, the health policy was paralysed by the electoral process. Major changes in the Central and state governments, since May, gave the green signal for developing a new Health Policy and a redesigned National Health Assurance Mission (NAHM).

These will be unveiled after a Prime Ministerial review. A flurry of early announcements by the new Government brought forth the AYUSH Mission, Mental Health Policy and an expanded immunisation programme. The Union budget saw increased funding for the establishment of new AIIMSs across the country, but the overall allocation for health did not see a significant rise. A 5 per cent tax on sugary drinks was welcome, though a larger tax is needed to drive down the consumption of these beverages to stall the rising incidence of diabetes. While taxes on cigarettes were raised, the more frequently consumed bidis escaped with a light touch.

Surveillance weakness Governmental intent to prominently position AYUSH in the health system was underscored as a Minister was allocated exclusively for that department. India hosted the World Ayurveda Congress in November and the United Nations declared that June 21 would be the World Yoga Day.

The threat of Ebola activated a Government response which included airport and seaport screening as well as a decision to rapidly expand laboratory capacity for viral diagnostics.

However, the fundamental weaknesses in disease surveillance, health information systems and primary health service capacity for early and effective outbreak response are yet to be addressed.

The pharmaceutical sector has seen challenges from the US and European regulators. While these are more to do with data reporting systems than drug quality, it is a reminder that Indian manufacturers must eliminate all weak links if their global expansion is to be unimpeded. At the same time, the Indian Government’s plans to provide essential drugs for free in public facilities would provide a boost to generic drug production. The Telangana government’s decision to develop a Pharma City in Hyderabad would provide a fillip to the sector.

Mixed signals At the political level, mixed signals were sent on policy priorities, including tobacco control and reform of the Medical Council of India, when the new Health Minister, JP Nadda came into power in November. Change of government in many states also opens the road for new initiatives.

The Prime Minister’s Swachh Bharat Abhiyan for improved sanitation will uplift health if the campaign translates from a political resolution to a cultural change. If clean drinking water and control of air pollution also climb higher on the policy agenda, that will spell well for health in the coming years.

The writer is President, Public Health Foundation of India. Views are personal.

Correction

The headline has been changed online to reflect the main thrust of the article.

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