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India will need to do more than Ayushman Bharat for an Arab Spring in Healthcare

“Protecting the health of those who have no wealth will require an iron will from a governance perspective. This also means an inclusive approach with all stakeholders and not a top down model which will really work. If India’s people must win, convergence remains the starting point for an Arab Spring in Healthcare.” 

Back in 2008 when I first joined medical school, I had a dream which is still burning inside me. Entering a hospital as a medical student and entering the same corridors as a patient carries different feelings, which often cannot be described in words, but rather only felt by those who are carried by that very feeling.

We had different types of patients, some rich, some rich in heart and others who were poor, but all hopeful that the hospital will relieve them of their human suffering and also prolong the inevitable.

During my case taking session prior to presentation before a staff, we would often go to interact with the patient and the patient party, in-order to understand the name and the condition beyond an otherwise bed number.

A human life teaches us many things: to feel suffering, to discover hope, to re-discover our values and also to remind us of who we are and who we may be.

It used to raise many questions in my mind as to what is our inherent value of life on earth. If God loved us so much, then why all this suffering, shame and pain combined into a package more often than not.

Doctors, after all, are only mortal human beings trained by a very human system, governed by a council which pre-determines what it means to do right and wrong based on certain ideas & notions. But in all of it, every patient is unique, every circumstance that brings the patient there is different and every outcome has its own course. In the best of worlds, it remains a complex puzzle putting together the dots and mystery to diagnose disease by understanding symptoms and then eliciting signs.

In a country like India where millions fall below poverty line only because of lack of access to healthcare and inability to afford the same, Ayushman Bharat becomes a life saver should it reach the right places & be implemented powerfully.

However, Ayushman Bharat as a corporation will have to look beyond New Delhi to strike a connect at India’s healthcare heart-lands. Ayushman Bharat will have to engage with more regional civil society institutions and hospitals than look at big players whom they envision to bail out India’s healthcare ills.

Having a look back at history, we come to realize that India has been built brick by brick by the imaginary yet powerful Indian middle class. This very middle class will need to be the link on which Ayushman Bharat must leap-frog. Ayushman Bharat will benefit over 10 crore poor in India and will cover families with Rs 5 lakh per family per year.

However, it will cost the exchequer over Rs 5,000 crore each year. The modality of execution will however remain the prerogative of the State given the background that Health in India is a state subject.

The bottleneck with most schemes today is the return of un-utilized funds due to lack of visionary decision making, indifference to work with new partners and the atmosphere of suspicion for every ambitious effort.

The case in point I am trying to make is not what we do, it is how we do it. Since 1947, India has been gifted with number of schemes which benefit the poor and many of them have in many ways.

The Bhore Committee envisioned Primary Health Care much before Alma Ata Declaration came by. Yet today in 2018, we are battling what I call a triple burden of disease.

While investment insufficiency has been our primary concern, investment inefficiency has been a bigger problem. Many field level NGOs have also misled the system thereby breeding mistrust and hatred among communities.

Long term impact-centric programmes in healthcare cannot work by confusing systems and dodging officials. No one expects miracles, but commitment to the cause is the starting point of hope.

As an example, in my field level evaluation with regard to Rashtriya Swasthya Bima Yojana scheme, many r-urban families had no clue about what it was and for whom it was meant.

Ayushman Bharat must seek to connect the threads delicately through historical schemes which didn’t work the way it should have and it needs to factor in the leadership which is both young and young in heart to make this work.

India’s billion beats will need more than an Ayushman Bharat, but for now it appears as a policy decision in the right direction and has the potential to impact if tabled with sincerity.



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