Report of the National Commission on Macroeconomics and Health Report of the National Commission on Macroeconomics and Health Report of the National Commission on Macroeconomics and Health Report of the Report of the National Commission on Macroeconomics and Health Report of the National Commission on Macroeconomics and Health National Commission on Report of the Macroeconomics and Health National Commission on Macroeconomics and Health MINISTRY OF HEALTH AND FAMILY WELFARE GOVERNMENT OF INDIA, 2005 EQUITABLE DEVELOPMENT • HEALTHY FUTURE Report of the National Commission on Macroeconomics and Health National Commission on Macroeconomics and Health Ministry of Health & Family Welfare Government of India, New Delhi August 2005 © Ministry of Health & Family Welfare, Government of India September 2005 ISBN 81-7525-633-8 This Report does not address tertiary care and related areas such as super speciality hospital development in the public or private sector, telemedicine, medical tourism, environmental pollution or food safety etc. though they are all equally important. The Commission Report is based on background papers which can be accessed from the NCMH website www.mohfw.nic.in. They have also been published in two companion volumes. This report was written during the period April 1, 2004 - March 31, 2005. Printed at: Cirrus Graphics Private Limited B 261, Phase I, Naraina Industrial Area, New Delhi 110 028 Tel: + 91 11 51411507/1508 Fax: +91 11 51417575 email: [email protected] Editors: Pranay G. Lal and Byword Editorial Consultants Cover design: Quote Design Studio ii REPORT OF THE NATIONAL COMMISSION ON MACROECONOMICS AND HEALTH Members of the National Commission on Macroeconomics & Health Shri P. Chidambaram, Chair Finance Minister Dr. A. Ramadoss, Chair Health Minister Dr. Rakesh Mohan, Member Secretary, Finance Shri Rajeeva Ratna Shah, Member Secretary, Planning Commission Shri P.K. Hota, Member Secretary, Health & Family Welfare Smt. Uma Pillai, Member Secretary, Ayush Dr. S.P. Agarwal, Member Director General of Health Services Dr. Ashok Kumar Lahiri, Member Chief Economic Adviser, Ministry of Finance Dr. V.R. Panchmukhi, Member Former Director General, Research and Information System for the Non Aligned and other developing countries Shri Bharat Jhunjhunwala, Member Columnist Dr. Anil Chaturvedi, Member Sr. Consultant, Internal Medicine, Shanti Mukund Hospital & Indraprastha Apollo Hospital Dr. Harshvardhan, Member Former Health and Education Minister, Govt. of Delhi Shri Abhay Bang, Member Director, Society for Education, Action and Research in Community Health Dr. Alok Mukhopadhyay, Member Chief Executive, Voluntary Health Association of India Prof. Ranjit Roy Chaudhury, Member Emeritus Scientist, National Institute of Immunology. Mr. Michael F. Carter, Member Country Director, World Bank Dr. S.J. Habayeb, Member WR, World Health Organisation Ms. Sujatha Rao, Secretary IAS REPORT OF THE NATIONAL COMMISSION ON MACROECONOMICS AND HEALTH iii iv REPORT OF THE NATIONAL COMMISSION ON MACROECONOMICS AND HEALTH Preface THERE IS A GROWING REALIZATION THAT THE HEALTH OF THE PEOPLE OF A NATION SIGNIFICANTLY contributes to its economic growth. Assuring a minimal level of physical and mental well-being is a critical constituent of the development process. Our commitment to the goal of reforms with a human face entails priority attention to the social aspects of development, in particular, education and health. It is for this reason that the National Common Minimum Programme accords such high priority to these two sectors. The terms of reference of the National Commission on Macroeconomics & Health, included among others, a critical appraisal of the present health system — both in the public and the private sector — and suggesting ways and means of further strengthening it with the specific objective of improving access to a minimum set of essential health interventions to all. It was also intended that the Commission would look into the issue of improving the efficiency of the delivery system and encouraging public-private partnerships in providing comprehensive health care. The health system in India is at the cross roads — dramatically changed from what it was a few decades ago. Liberalization of the economy has expanded opportunities for additional employment and generation of additional incomes which, in turn, have helped reduce poverty levels. Such a development process has however also caused changes in lifestyles, increased urbanization and connectivity and enhanced access to information and services not available earlier. These and other factors, in one way or another, have profoundly impacted on the epidemiological and health seeking behavior patterns of the people. With rising demand for health services, the inadequacies of the present health system — both in the public and private domains — are increasingly becoming evident. The responsibility of the government in providing an efficient and purposeful health system, covering all aspects such as health education, preventive programmes and curative services, has considerably increased. Further, the government, besides strengthening the current public health system has also the challenge of fruitfully utilizing the widespread private health system to address public health goals and make it accessible to the poor at affordable prices. It is in this background that the Commission's Report assumes special importance and significance. The Report seeks to boldly address many critical issues confronting the health sector such as inequitable access to basic services resulting in welfare loss for the poor, the inefficiencies in the system resulting in waste and suboptimal utilization of existing resources, the poor quality and declining values, ethical norms etc. The absence of patient rights and citizens-entitlements to a basic package of health services — preventive, promotive and curative — has disturbed and provoked us to throw up some specific recommendations for the way forward. REPORT OF THE NATIONAL COMMISSION ON MACROECONOMICS AND HEALTH v It is quite clear that setting up a universally applicable health care system of acceptable quality, that is commensurate with the present and future levels of demand, will take more than a decade to realize if we initiate the process today. We need more research, better skilled human resources in adequate numbers, better-designed policies that are aligned to this aspiration, and effective debate and widespread discussion on the challenges that are facing the health system of the country. We believe that an equitable and efficient health system will enable us to ensure the realization of the various goals laid down in our policies and, in particular, the Millennium Development Goals by 2015 to which we stand committed. The Report is based on extensive consultations with experts. Over 30 meetings were held and 34 papers/surveys commissioned. We take this opportunity to express our thanks to all the contributors, reviewers and experts who took time off to attend the consultations. We also thank the ministries, departments and organizations of the Central and State governments, special invitees, officials, researchers and experts for their help and assistance. We would like to thank Dr. Ranjit Roy Chaudhury, Chair of the Sub Commission, and the members and technical consultants of the Sub Commission for shouldering the onerous responsibility of deliberating the various issues confronting our health system and submitting a useful policy- oriented Report for our consideration. We would also like to record our special appreciation of the tireless efforts put in and the commendable services rendered by Ms. Sujatha Rao, Secretary of the Commission in assembling the voluminous material and giving form and shape to the Report. We eagerly look forward to the prospects of considering the various recommendations of the Report, for effective implementation, with the objective of improving the welfare of the common person in the country. Dr. Anbumani Ramadoss Shri P. Chidambaram Union Minister for Health & Family Welfare Union Minister Finance vi REPORT OF THE NATIONAL COMMISSION ON MACROECONOMICS AND HEALTH Acknowledgements The Commission would like to place on record its gratitude to all those who shared their thoughts and ideas with us - researchers, academicians, professionals, private providers, representatives of the health industry and officials, particularly those working at the cutting edge. Their views and experiences helped us understand the complexity of the issues being faced in the health sector. We have tried our best to reflect in this report their frustrations, hopes and aspirations. Such persons are far too many to name individually. Our special thanks to the WHO which provided the stimulation, technical support and above all funds. We also thank the UNICEF, UNFPA and the Columbia University for their technical and financial support. The Commission would like to make a special mention of the help and unstinted support extended to us by Shri C. S. Rao, Chairman of the Insurance Regulatory Development Authority, Dr. N. Vijayaditya, Director General, National Informatics Center, National Sample Survey Organization, Registrar General of India, Central Statistical Organization, and also thank all the contributors, reviewers and researchers. Their inputs were invaluable and helped form the basis of the Report. REPORT OF THE NATIONAL COMMISSION ON MACROECONOMICS AND HEALTH vii viii REPORT OF THE NATIONAL COMMISSION