Context: The Fifteenth Finance Commission has called for a greater role for public-private partnerships to ramp up the health infrastructure and scale up public spending on health from 0.95% of GDP to 2.5% by 2024.

Concerns raised by the 15th Finance Commission

  • Poor health spending: The total spending of around 0.95% of GDP is not adequate in relation to the commitments under the National Health Policy of 2017. 
  • Skewed health infra: While India doesn’t have adequate health infrastructure but the poorest States have the worst health infrastructure. 
  • Contractual jobs for doctors: Doctors in many States are engaged on a contract basis and there is a need to improve their working conditions. 

Recommendations by the Finance Commission

  • A working PPP relationship with the private sector: To achieve better healthcare parameters, public-private partnerships must be considered “in a holistic way” instead of the current situation where the government only turns to the private sector in times of emergency.
    • A working relationship can be built only if the trust deficit that exists [between industry and government] now is bridged. 
    • Public expenditure should focus on primary health care at the panchayat and municipality level.

Public private partnership (PPP) refers to an arrangement between the government and the private sector, with the principal objective of providing public infrastructure, community facilities and other related services.

  • Improving doctors’ conditions: Substantial improvements needed in the working conditions for doctors in government hospitals.
  • The creation of an Indian Medical Service cadre as envisaged in the Civil Services Act of 1951.
  • The govt. must raise public spending on health from 0.95% of GDP to 2.5% of GDP by 2024.
  • Greater attention on the role of paramedics and frontline health workers in countering the pandemic

The primary health centres must be the central focus of public outlay. The private sector participation can be at other levels of speciality and at levels where they are better placed due to their innovative skills.

The National Health Policy, 2017 (NHP, 2017) 

  • It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.

Specific Quantitative Goals and Objectives

  • Increase Life Expectancy at birth from 67.5 to 70 by 2025.
  • Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.
  • Reduction of TFR to 2.1 at national and sub-national level by 2025.
  • Reduce Under Five Mortality Rate to 23 by 2025 and MMR from current levels to 100 by 2020.
  • Reduce infant mortality rate to 28 by 2019.
  • Reduce neonatal mortality to 16 and still birth rate to “single digit” by 2025.
  • Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i.e, - 90% of all people living with HIV know their HIV status, - 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
  • Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic pockets by 2017.
  • TB: To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new cases, to reach elimination status by 2025.
  • To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.
  • To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025.
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