The
recent verdict of the Supreme Court to have all state governments and union territories to compulsorily formulate health masterplans is a much needed step towards building a more affordable and robust healthcare system. The order of the court calls for formulation of the masterplans by taking a cue from the already existing Public Health Acts of various States and the
National Health Bill, 2009, and stress on affordability. This move comes after complaints of private hospitals charging exorbitant fees to patients and the issue of unavailability of beds in the public hospitals.
State and city governments across India have been split wide open post COVID-19 exposing its dark underbelly of inadequate infrastructure to support the health crisis put forth by the pandemic. Health infrastructure and services are insufficient and years of inadequate urban health planning has opened the cracks. With an average of
0.55 beds per 1,000 population and public expenditure on healthcare as low as
1.3 per cent of GDP, it is time for India’s health care to be restructured and scaled up.
State and city governments across India have been split wide open post COVID-19 exposing its dark underbelly of inadequate infrastructure to support the health crisis put forth by the pandemic.
While the need for creating a health masterplan from a policy perspective is definitely the need of the hour, supplementing it with adequate urban health spatial planning will give it a complete shape. One of the indicators of adequate health planning is the availability of a public primary healthcare centre, a secondary and tertiary care centre within one square kilometer of one’s house. The answer for most of Indians for this question lies in the negative.
Most health budgets of states and urban local bodies indicate the complete neglect of fund allocations — especially in case of health asset creation. Take the case of Maharashtra and Mumbai. In the past four years, the state has allocated less than
4 percent of its budget towards health. In the case of the Mumbai civic body this is consistently 17 percent of
the budget with almost 13 percent dedicated to administration and maintenance. A lot of these allocations is to do with what is the built infrastructure on ground and how we are planning it for the future. Thus, changing the ground reality will be imperative.
It is important we also bring about some changes in the very responsibility pattern of medical healthcare and decide the division of healthcare — primary, secondary and tertiary across the levels of the government, with the civic bodies having to look after only primary health care, although allocations in the city could be extended to all types. Similarly, clarity needs to be sought on budget allocations alongside the health provisions made in urban spatial plans, else the provision of specialty hospitals or healthcare only remain on paper for years and we see no change in the ground reality.
Clarity needs to be sought on budget allocations alongside the health provisions made in urban spatial plans.
A spatial health plan would comprise of planning norms, standards and phase-wise strategies aimed at welfare of the healthcare sector in a stipulated time frame. Currently, the
Urban and Regional Development Plan Formulation and Implementation Guidelines of India and the Indian Public Health Standards which are a part of the National Health Mission constitute to be the planning guidelines in the healthcare facilities’ planning across the nation. Using the same benchmarks and the standards set by
WHO, the states and ULBs can prepare the city specific norms and standards.
This could be an opportunity to get into micro-planning of urban geographies and bringing in local area planning as a mandatory mechanism to plan health. Several civic bodies have been preparing other sector specific plans such as city sanitation plan, comprehensive mobility plan, and health could be a much-needed extension of this micro sectoral planning. The demographic analyses and mappings such as age wise population distribution, the gender distribution, distribution of vulnerable sections of the society if integrated with the analysis of common type of diseases in the city, can formulate the strategic front of the masterplan.
Globally, Singapore, Sri Lanka, Nigeria and Afghanistan are examples where the preparation of a healthcare masterplan is a regular practice.
Singapore has been stressing on affordability and workforce development. The 2020 masterplan strategises to ensure affordable healthcare through which the citizens will have to pay 40% less for specialist care in public hospitals and 50% less for the medical drugs as compared to 2012. The setting up of new medical infrastructure generates the employment opportunities as well. On the lines of the masterplan, by 2015, the nursing intakes were increased by 17% and medical staff by 29%. Making employment generation in health sector an integral part of the masterplan. This planned increase in medical staff, today in 2020, has helped Singaporeans to avail enough human resource amid the battle against COVID-19.
Globally, Singapore, Sri Lanka, Nigeria and Afghanistan are examples where the preparation of a healthcare masterplan is a regular practice.
Sri Lanka, has been on the forefront of mapping populations through GIS and accessibility. The latest edition of masterplan has principles such as human resource management, financing and accessible information pertaining to health sector. Along with identifying the issues the plan includes gap analyses and a detailed VMOSA toolkit. Interestingly, the fusion of GIS technology with health sector, that can help in disease mapping, epidemiological trend analysis is one of the features of the plan as well. The other provisions of the plan are establishing a drug availability index, preparation of health performance matrix and integration of the masterplan with Sri Lankan national health policy.
Nigeria has set up a National Health Information System (NHIS) for disease and medical facilities availability analysis. This way, the access to information can help in analysing the areas of improvement and needed amount of infrastructure. For the health financing, the plan identifies potential areas for foreign investment. The plan emphasises upon building public-private partnership models for the betterment of inadequate health infrastructure in the country.
Afghanistan on the other hand looks at the assessment of health impact indicators that impact national development. The plan devises regional integration and cooperation for harmonise regional regulations in pharmaceuticals and medical tourism practices. The identification of cross-cutting areas, achieving gender balance and the capacity building are a few steps that add up to make this plan inclusive and comprehensive.
While India has some of the finest healthcare professionals — from medical specialists, doctors, nurses and even para-medics — the sector which has the potential to be India’s sunshine sector is not supported through adequate infrastructure of land and built structures. Picking the right leaves from global examples and incorporating regional challenges would be the way to move ahead. The Supreme Court has set the ball rolling for state masterplans. It is time that we get all levels of government including local urban bodies involved in this process, to make it full-proof.
Sayli Udas⎯Mankikar is Senior Fellow and Piyush Girgaonkar is Research Intern at ORF.
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