New Delhi: When the Modi government launched its ambitious national healthcare scheme Ayushman Bharat in September last year, it garnered a lot of attention for its move to address one of the most pressing issues India faces today — public health.
This World Health Day Sunday, with the World Health Organisation (WHO) celebrating the theme of ‘Universal Health Care’ and the Modi government pushing for re-election on the eve of Lok Sabha polls, ThePrint takes stock of at what ails India and the status of Ayushman Bharat.
What is Ayushman Bharat?
Ayushman Bharat, or Pradhan Mantri Jan Arogya Yojana (PMJAY), is the largest healthcare scheme in India under which the Modi government seeks to provide insurance health cover up to Rs 5 lakh to 10 crore families falling below the poverty line.
Over 18.35 lakh beneficiaries have been admitted, 2.89 crore e-cards issued and 15,291 hospitals empanelled under the scheme as of 3 April, showed official data.
“Ayushman Bharat is a big leap to the Universal Healthcare primarily with an increased number of people being provided financial assistance to eliminate the health crisis. This scheme is aiming at 50 crore Indians,” Indu Bhushan, PMJAY’s chief executive officer, told ThePrint.
“I would say Ayushman Bharat has the potential to cover all those who come under its umbrella.”
Bhushan said the supply and accessibility are a challenge at many places in India but he was still “quite optimistic” with the achievements of the scheme.
“Like Rome was not built in a day, this is not going to bring key changes over night. There are roadblocks like lack of hospitals in rural parts but eventually they (blocks) will also be removed,” Bhushan added.
Disease Burden
Diabetes, ischemic heart diseases (damage in the heart’s major blood vessels), respiratory disorders, suicides and malnutrition are some of the major diseases ailing Indians.
The Lancet’s Global Health Journal, released in September 2018, underlined India’s increasing disease burden from 1990 to 2016 in a series of studies.
Titled Global Burden of Disease Study 1990-2016, the journal reportedly highlighted that India’s diabetes burden more than doubled in over two decades with the total number of cases rising from 26 million (1990) to 65 million (2016).
With 18 per cent of the global population, India also bore 32 per cent of the global burden of respiratory disease, and 23 per cent of the burden of ischemic heart disease.
The Lancet report also found a shocking 50 per cent increase in heart diseases. Deaths due to heart ailments increased from 1.3 million in 1990 to 2.8 million in 2016, and more than half the deaths caused by heart ailments in 2016 were in persons less than 70 years of age, according to the study, The Changing Patterns of Cardiovascular Diseases and Their Risk Factors in the States of India: the Global burden of Disease Study 1990-2016.
Ischemic heart disease contributed 17.8 per cent of total deaths (19.6 per cent among men and 15.6 per cent among women), while strokes contributed 7.1 per cent of total deaths (6.9 per cent among men and 7.3 per cent among women).
The study also showed that 37 per cent women who commit suicide across the world are Indian. It further revealed that India accounts for 24 per cent of suicide deaths in the world among men.
India also faces a huge challenge in providing proper nutrition to its children. Recently, a study underlined that children were malnourished, even in the ‘prestigious’ constituencies represented by leaders like Prime Minister Narendra Modi and Congress president Rahul Gandhi. According to the Global Nutrition Report released in 2018, India accounted for almost a third of the world’s stunting. The country also accounted for 25.5 million children who are wasted, followed by Nigeria and Indonesia.
Also read: Diabetes type-3, 4, 5? Indian study looks to break down disease & find targeted treatment
‘Development’ transition
India also faces a huge challenge of other communicable and non-communicable diseases. Every year, with escalation in cases of swine flu, dengue, chikungunya and malaria, the medical facilities in the country come to a standstill.
However, experts say India is going through a “transition” vis-à-vis economic development, so diseases of such nature can occur.
“Every country, at some point, goes through a different type of developmental phase. Same is for India, there are underdeveloped parts with water and sanitation problems suffering with malnutrition, while some parts of the same country is full of rich people who eat and live lavishly and get hit by lifestyle diseases like the diabetes,” Dileep Mavalankar, director of Indian Institute of Public Health, told ThePrint.
“Not just this, environmental pollution caused mainly by industries and construction — part of development — is also responsible for chronic diseases,” Mavalankar said.
Lifestyle issues
Experts also say achieving good health is a goal for both the policy makers as well as the citizens themselves.
The eating choices and alteration of lifestyle lie at the heart of this.
“Indian lifestyle is a combination of four things — smoking, alcohol consumption, unhealthy eating habits and lack of exercise. People are moving from rural areas to urban areas and their lifestyle is changing as there is more a sedentary lifestyle in the cities and less physical activity, said Dr Manoj Sharma, senior consultant, internal medicine, Fortis Escorts Heart Institute.
“For children who are raised in cities, sedentary lifestyles have become a norm as a result of which obesity is on the rise,” said Sharma.
Other factors, like environment, water contamination, nutrition and lack of health care services, also weigh on public health.
Also read: Modicare CEO wants wellness centres to be one-stop shop for healthcare in rural India
‘Major step’
With all these factors playing a role, the IIPH director called Ayushman Bharat a major step towards universal health care, but “it will only cater to indoor patients, those who need hospitalisation”.
“There is a growing burden of outdoor patients too. Suppose, patients with asthma, diabetes, heart ailments, tuberculosis need medical care on a routine basis. We know how crowded and time consuming are our government facilities,” said Mavalankar.
“The universal health care means health care for all, including delivery care and childcare.”
However, Malvalankar remained optimistic about the prospects of improving healthcare in India.
“When Swachh Bharat started (in 2014), it changed things only because of political will. In the 1990s, there were no toilets and it has taken so long to work out things. Similarly, political will can transform the public healthcare system,” he said.