New Delhi: With J.P. Nadda taking charge as Union health minister for the second time, health practitioners are hopeful of much-needed reforms in key areas of the sector. His previous stint, between 2014 and 2019, saw the launch of major initiatives including Ayushman Bharat and a new National Health Policy.
However, the road ahead may not be smooth. Experts highlight continuing challenges in primary healthcare provision, the substantial out-of-pocket expenditure incurred by Ayushman Bharat beneficiaries and the need to fill gaps in health systems that were exposed by the Covid pandemic.
In his other role as minister of chemicals and fertilizers, he also faces the imperative of promoting the pharmaceutical industry while ensuring quality compliance by Indian drugmakers, some of whom have been facing flak for supplying substandard products abroad.
The challenges are serious. But having a “heavyweight” politician — Nadda has been president of the Bharatiya Janata Party (BJP) since 2020 — in charge is the best thing that could have happened to the healthcare sector, according to Dr R.V. Asokan, president of the Indian Medical Association (IMA), the largest network of medical professionals.
“J.P. Nadda has an enormous patience for listening, taking perspectives and grasping things. In addition, his being the BJP head brings a certain heft to the portfolio,” says Asokan, who has interacted with Nadda as a senior IMA office-bearer on multiple occasions.
Rollout of crucial health initiatives
In November 2014, just months after the Narendra Modi government first took office, Harsh Vardhan — a veteran Delhi BJP leader and a doctor himself — was abruptly dropped as health minister. He was replaced by Nadda, who had previously held the health portfolio, among others, in the government of Himachal Pradesh.
In the months and years that followed, Nadda spearheaded the launch of key initiatives such as the National Health Policy (NHP), 2017, the Pradhan Mantri National Dialysis Programme and Mission Indradhanush — an ambitious catch-up programme aimed at ensuring that the universal coverage of various vaccinations for infants and children reaches 90 percent or above.
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“During the drafting of the NHP, which was replacing the previous policy of 2002, the minister had come up with useful suggestions and interventions. There was one point of tussle, though, when a clause declaring health as a right was removed,” says a former health secretary who has worked under Nadda, requesting not to be named.
The 2017 NHP envisages as its goal the “attainment of the highest possible level of health and well-being for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence.”
It also has specific quantitative goals and objectives such as raising life expectancy at birth, reducing maternal and infant mortality rates, expanding the coverage of public health systems and increasing health expenditure by the government as a percentage of gross domestic product to 2.5 percent by 2025.
The health ministry under Nadda also sowed the seeds of one of the Modi government’s most ambitious welfare policies, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which was named Ayushman Bharat – National Health Protection Scheme (AB-NPS) before its rechristening.
“We had prepared an initiative to launch AB-NPS with an insurance coverage of Rs 1 lakh for the poorest people under Nadda’s stewardship. This was later taken over by the Prime Minister’s Office and the coverage amount was raised to Rs 5 lakh,” says the former secretary.
AB-PMJAY aims to provide health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to over 10.74 crore poor and vulnerable families.
Nadda’s term also saw the rollout of Affordable Medicines and Reliable Implants for Treatment (AMRIT), a scheme aimed at providing medicines for critical and chronic illnesses like cancer and cardiovascular diseases at highly subsidised rates.
Another scheme launched during Nadda’s first term at the health ministry was the second component of Ayushman Bharat — the upgradation of primary health centres across India into health and welfare centres (later named Ayushman Arogya Mandir) — to provide crucial primary and preventive healthcare at every level.
Other projects launched during his earlier tenure included the big expansion of All India Institutes of Medical Sciences (AIIMS) across states and the upgradation of district hospitals into medical colleges, especially in aspirational districts.
A senior functionary with a prominent public health organisation that works closely with the government also credits Nadda for being open to “new ideas”, and says it was under his leadership that India embraced the potential of digital health for strengthening health systems.
“He is a big picture guy — interested in big ideas,” adds the functionary.
The former health secretary quoted above agrees, adding that while Nadda had a crucial role in setting the specific NHP goals, the good thing about him is that he lets the administration work without “interfering too much in nitty-gritties”.
But sometimes, Nadda did appear shaky when it came to making big decisions, says the former secretary, adding, “Also, since he listens to everyone, he tends to get confused with multiple opinions.”
Too much focus on tertiary care?
As a former health minister of Himachal Pradesh, Nadda seemed to have developed a keen understanding of the sector and a willingness to strengthen publicly funded health services, says Dr T. Sundararaman, global coordinator of the People’s Health Movement and former executive director of the National Health Systems Resource Centre under the health ministry.
“It could be because the public sector is the main healthcare service provider in the hilly state,” he says.
However, another former health secretary who has worked under Nadda has a differing view.
“I found him inclined towards tertiary care healthcare initiative way more than primary care — but that could also be because of improving basic healthcare parameters,” says the retired civil servant.
But Sundararaman is rather hopeful. “I anticipate him to be more interested in ensuring that Arogya Mandirs achieve their intended target, because it was his idea and initiative. Well-functioning, comprehensive primary healthcare demands more than nomenclature and branding,” he says.
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He adds that AB-PMJAY can also do better, beyond being a “publicity tool” for the government. “On the ground, this has changed little in terms of raising access to quality and affordable healthcare to the most vulnerable,” says the former technocrat.
Several studies show that AB-PMJAY beneficiaries continue to face substantial out-of-pocket healthcare expenditure during the course of their treatment, especially at private hospitals.
A health economist points out: “Also, while the overall healthcare cost [in both public and private sectors] in the country annually is Rs 5 lakh crore, AB-PMJAY has an annual budget of Rs 7,500 crore. It is less than 2 percent of what this country spends on healthcare services every year.”
He adds that a lot of health policy decisions should be seen in the context of a larger political framework.
“It is sometimes not about the individual who heads the ministry; it’s largely about what the government overall wants from the ministry. As such, I do not expect any dramatic shifts in policy, given the government’s near-static expense on healthcare.”
Tough road ahead
According to a public health researcher attached with an international agency in Delhi, despite over two decades of health reforms, such as the launch of the National Health Mission (NHM), the gains have been modest, given India’s demographic and evolving epidemiological transition.
The National Rural Health Mission (NRHM) was launched in 2005 under the Manmohan Singh-led UPA government to address the health needs of the underserved rural population — especially women, children and vulnerable sections of society — and to provide affordable, accessible and quality healthcare.
In 2013, the National Urban Health Mission, (NUHM) was launched and was subsumed alongside the NRHM as sub-missions of the overarching NHM.
“I believe strengthening primary healthcare across the nation should be a key priority for Nadda. Nadda is well positioned to drive the transformation of primary healthcare in India that acts as the first point of contact and brings about a culture of gatekeeping function for efficiency and reducing the burden on secondary and tertiary healthcare establishments,” says the public health researcher.
He adds that the other major challenge ahead of Nadda is addressing the trust deficit that currently exists in the health sector, specifically as a result of health insurance fraud. “PMJAY as the world’s largest health insurance programme has the potential to transform the drawbacks, build back the trust and keep Indians out of poverty linked to health events.”
Dr Anant Bhan, a researcher in global health, bioethics and health policy, says that ensuring coordination with the National Medical Commission to ensure quality medical education, and filling gaps in the health systems that were exposed during the Covid pandemic should be high on Nadda’s agenda.
As Indian firms have been facing flak for supplying substandard pharmaceutical products, mainly cough syrups, to several countries over the past two years, there’s another task ahead for Nadda, something even drugmakers agree with. The Department of Pharmaceuticals comes under Nadda as Minister of Chemicals and Fertilizers.
“Another challenge would be to strike a balance between promoting the drug industry in India but at the same time also ensuring quality compliance by drugmakers,” says a member of the Indian Pharmaceutical Alliance, a group of 23 research-based Indian drugmakers.
In August 2023, Mansukh Mandaviya, Nadda’s predecessor as health minister, had set a deadline for small and medium-scale pharmaceutical companies to mandatorily adopt good manufacturing practices (GMP) within a year.
(Edited by Rohan Manoj)
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