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First, the government has an opportunity to issue a clarion call for universal health

insurance (UHI). UHI will free the current out-of-pocket spending and channel funds toward
far more productive uses.
While strengthening the public health-care system, the government could concurrently adopt a
few bold, high-impact interventions within three years to improve health care. In India, around
1.5 million children continue to die before their fifth birthday, mostly due to conditions that are
avoidable. Thus, a second priority should be to include a rapid scale-up of the introduction of
new vaccines against diarrhoea and pneumonia among children.
Smoking kills about 1 million Indians every year. All cigarettes must be taxed on their tobacco
content and not length. The Asian Development Bank has found that tripling the tax rate can save
about 8 million lives.
Preventing vascular deaths
Controlling malaria
TB
Finally, a major effort should be made to improve health reporting. The Census should be
strengthened, expanded and paired with the economic census and other surveys. This new
central information hub will help track and report on development and progress.
GOVT SPENDING MORE ON TERTIARY HEALTH CARE THAN ON PRIMARY. IS IT
JUSTIFIED?
1. The ministry of health is reportedly planning to open 10 more AIIMS-like institutes

as well as cancer centres in different states. Creating new cancer centres is
desirable, given the burden of the disease and the inadequate number of
treatment centres. Today, cancer is one of the main causes of premature
mortality in our country, and the 25 regional cancer centres are not being able to
cope with the high load of patients. Additional cancer centres would definitely be
meeting a badly felt need.
2. However, it is not clear why the government is planning to establish more AIIMS-

like hospitals. The health ministry may wrongly believe that India needs more
such centres of excellence to train doctors as well as to provide high quality
healthcare services to people.
3. However, such a move has serious implications for the rest of the health system.

The government spends about 1.3 per cent of the GDP on healthcare — among
the lowest in the world. As per the ministry’s own report, the government spent
less than Rs 1,000 per Indian in 2012-13. Of this, more than 10 per cent already

5. The government spends just about Rs 5 per person on medicines. primary health centres (PHCs) and referral hospitals are severely understaffed and under-equipped. 7. New Delhi. 9. In Brazil. If the money that would be spent on these AIIMS-like centres were used to increase the budgetary allocation for PHCs. Also. State of Primary health care centres in India 4. Patients are asked to purchase medicine from private pharmacies. 6. where patients come from neighbouring states and crowd the outpatient and inpatient services. incur out-of- pocket expenses at a time of illness. a comparable centre has four doctors for every 10. Apart from the economics of building more AIIMS-like centres.000 people. patients may bypass the existing facilities to seek care directly at the AIIMS-like centres. This compromises the quality and effectiveness of the centre. Currently. because of their iconic stature. thereby further depleting the human resource pool for district and referral hospitals. This is evident in the original AIIMS.goes towards medical education. If more scarce resources are diverted to tertiary care and medical colleges. Patients’ trust in government facilities would be enhanced and there would be a corresponding increase in their utilisation. One PHC with a single doctor is responsible for the health of 30. It would be a step in the right direction if we were able to achieve universal health coverage in the near future. the allocation for primary and secondary healthcare may be reduced. . in most states. Negative effects on spending more on tertiary health care sectors 8. there could be more staff and medicines at these centres. They will attract specialists from existing health centres. This is so inadequate that most PHCs do not have medicines beyond the first few months of a year. such institutions have other effects. This creates a significant financial barrier and prevents patients from accessing healthcare at the PHC.000 people. Primary healthcare is the centre of any health system — be it in India or in the United Kingdom.

On the other hand. More than 50 per cent of these graduates went on to serve in rural areas in the US and UK. was spending Rs 98 lakh on a single medical graduate. rather than tertiary healthcare for a few. However.000 live births. for every 1. It is a fallacy to expect all graduates from these centres of excellence to work for our country. good quality antenatal care. Our country needs to provide quality outpatient services and round-the-clock emergency services at facilities that are close to the people. . So what sould be our priority Today. If India is to ensure that all people have access to quality healthcare. investment in the three-year BSc in rural health course would increase the probability of having clinical staff at the PHC level. On the other hand. more infants die in India than in countries like Nepal and Bangladesh. if PHCs and referral hospitals are strengthened. We need to catch up with these countries. patients can be provided good quality care closer to their residence. New Delhi. Chhattisgarh has shown the way and we can definitely learn from it. and the main way to do this is to increase investment in preventive services like routine immunisation. screening for cancers and promoting healthy lifestyles. In 2009. not only at district headquarters. existing evidence proves otherwise. we need to provide quality primary and secondary healthcare for all. This is beneficial both for the patient and for the health services. 11.10. it has been hypothesised that these centres will create more doctors who can then work for the country. AIIMS. And finally. 12.