Ever since he took charge, Union health minister Mansukh Mandaviya has virtually inaugurated two Pressure Swing Adsorption (PSA) plants in a Gujarat hospital. This is to meet India’s oxygen demand, especially when the third wave of Pandemic is looming like a Damocles sword on a billion plus population.
Mandaviya took charge as the nation’s health minister on July 7, 2021.
Mandaviya knows he must upgrade overall medical infrastructure to meet future challenges, especially ensuring funds in every district of India for buying critical care medical requirements in an emergency. India has a ₹23,000 crore package for Covid-19 emergency response.
But that is not enough.
India’s healthcare system is battling various issues, including the low number of institutions and less-than-adequate human resources. The healthcare structure is split into three – primary, secondary and tertiary – care services. The Indian Public Health Standards (IPHS) says delivery of primary health care is provided to those in the hinterland through sub-centre, primary health centre (PHC), and community health centre (CHC). Secondary care is delivered through district and sub-district hospitals and tertiary care is extended at regional/central level institutions or through super specialty hospitals.
The minister knows it’s important to improve primary health care as a public good, especially when India continues to struggle with deficient infrastructure (read well-equipped medical institutes) for quite some time. And then, the rate of building such medical teaching or training facilities remains awfully less. Once, the government said private medical colleges must be built on at least five acres of land. A few private colleges were built in rural areas, and doctors refused to work full time. It is only now that the newly-constituted National Medical Commission (NMC) scrapped the five acre requirement for setting up a medical college and curtailed the minimum number of beds required as a proportion of the number of seats in the college.
Mandaviya is aware that India does not have enough trained manpower – doctors, nurses, paramedics and primary healthcare workers – in the medical stream. The situation is worse in the hinterland, home to 66 per cent of India’s population.
I am sure the minister is aware that in India, the doctor-patient ratio remains abysmally low, merely 0.7 doctors per 1,000 people. The World Health Organisation (WHO) average is 2.5 doctors per 1,000 people. Mandaviya knows serving a population of 1.4 billion remains a gigantic task in itself. He must rise to the occasion.
But the biggest challenge for the minister is to quickly adapt new technologies for operational and clinical processes for healthcare facilities. It will help India manage efficient patient flow. He must think out of the box and push virtual care protocols, and telehealth services. It will be a great way to reduce the patient-load burden to a large extent.
The minister must also work hard on the latest National Health Policy (NHP) 2017, focussing it towards proactive healthcare, not reactive healthcare. Mandaviya must work on the high out-of-pocket expenditure which continues to be a stress factor for millions in India. Public hospitals are free but understaffed, poorly equipped, and located mainly in urban areas. The minister must push accessible and affordable healthcare in the public sector, it can easily reduce the rise in dependence on private institutions. Some of his bureaucrats must show his reasons why 65 percent of medical expenses in India are paid out of pocket by patients..
And then the minister must look at harm reduction technologies to enable people to cut harm and reduce dependence on products like beedis, gutka and cigarettes. Mandaviya must help create profound public health shifts in the world’s second most populated nation, India. The world has over 1 billion smokers and a bulk of them are in India, and parts of Asia.
I read in a recent copy which quoted Michael Russell, the late pioneer in the study of tobacco dependence and harm reduction, saying: “People smoke for the nicotine but die from the tar.” Mandaviya must push regulations that can save millions from tobacco-linked deaths in India, and end combustible smoking. The minister must know that the WHO has, time and again, failed to significantly reduce the number of adult smokers, and an estimated 8 million die each year from combustible tobacco-related diseases.
Mandaviya is the health minister of the world’s second most populated nation and he must be in the thick of the debates over tobacco and all that comes with the product, including the fact that can people quit smoking overnight and if not, what is the way forward. The minister must make harm reduction a part of his new agenda. He must blend modern health science with loads of commonsense and compassion, only because he is the health minister of India. Mandaviya must take time out to hear the stakeholders and break all blind assumptions which continue to derail conversations over nicotine, tobacco and all tobacco-based products, and of course, the e-cigarettes that continue to remain banned in India. He must make the laws more inclusive and more transparent. Someone must brief the Mandaviya that high excise taxes and horrific photographs on cigar and cigarette packages does not help the cause, nor does WHO’s unscientific call for boycotts.
India’s health ministry must work with those who believe in the benefits of harm reduction and create one of the most profound public health shifts for people in India.
Two Covid waves have wreaked havoc, killed millions and destroyed lives. The Indian health minister must put in place a constructive health policy and routinely share information so that the stakeholders can engage with the ministry and offer their side of the story. Mandaviya must not look at solutions for India and Indians, his ministry must also concentrate on global health issues and global health challenges.
Views expressed above are the author’s own.
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