Before billionaire jeweller Nirav Modi and the Punjab National Bank scam exploded on to our consciousness, the public issue of the day was the promise of a massive expansion in health insurance through the National Health Protection Scheme, announced in the Union Budget on February 1.
There was a flurry of articles on Scroll.in and elsewhere analysing the scheme, what it claimed but did not represent, the absence of details, that it was not healthcare but health insurance. This was one announcement on which the government soon found itself on the backfoot.
Scroll.in had this piece early on pointing out that public health itself had been ignored in the Budget. Since then we have had contributors further exploring this aspect (here and here) and also discussing the international experience, especially in Thailand, with universal healthcare (as opposed to insurance).
This is a good time to revisit Scroll.in’s coverage of health. Somewhat unusually for an online news publication, it has a separate section, Pulse, which has been reporting on and analysing various aspects of health. In an earlier piece written after the death of 60 infants in a Gorakhpur hospital within a few days in August, I had suggested that while the writing on health was both extensive and intensive, it tended to be episodic and focussed on tragedies like Gorakhpur or the zika virus cases in India. To make an impact, Scroll.in had to look at the more important issues of public and primary health.
I do not want to claim that the comment/advice has had a direct impact, but I do notice that in the past six months or so, the small but very capable team of health reporters has been writing on these very issues of public and primary health. The occasional story on lifestyle diseases or urban outbreaks/events is still there but, deliberate or not, there has been a definite and welcome shift in coverage.
Insight into government policy
This coverage has been of Central government policy, developments in the states and even lower, at the level of the primary health centres.
Thus, we first had these two articles (this and this) on government think tank Niti Aayog’s plans to privatise healthcare in district hospitals and the response of the state governments. We then had a detailed set of two articles (this and this) on the privatisation of healthcare in Rajasthan.
On the positive side, there was this interesting story of bold plans in Kerala to overhaul the state’s public healthcare system. Irrespective of Prime Minister Narendra Modi once comparing Kerala with Somalia and the chief minister of Uttar Pradesh, of all states, decrying health conditions in the southern state, there is much to learn from the public healthcare system in Kerala, and to a somewhat lesser extent in Tamil Nadu and Karnataka.
The Kerala plans apart, this is where Scroll.in has much more to do. We do not as yet have a steady stream of granular accounts of how the primary health centres are working and what afflicts them. The media needs to stress time and again that the health status and healthcare of the population will improve only when primary healthcare systems improve. Tertiary care in the form of large hospitals in the public and private sectors should be the last line of care and not the first and only line as it has become today.
What of primary health centres?
In the past six months, the primary healthcare system has been analysed in this article in Scroll.in. The piece looked at particular shortages that hamper the functioning of sub-centres. But it was really a kind of research summary and, while no doubt important, the dullness of treatment came in the way of conveying an important message.
What we really need are reporters visiting primary health centres in rural areas and writing in depth of the role these centres and sub-centres are supposed to play and why they are unable to do so. Some of this is well-known. The media does occasionally run a series on this topic. But that is what it is – occasional. That does not help, for without the media spotlight being turned on them regularly, the state governments and the Centre (which oversees the National Health Mission) are not going to implement change. Perhaps Scroll.in could take the lead in advocating a repair and overhaul of the primary health centres.
The Budget has announced ambitious plans for overhauling the primary health centres and converting them into “wellness centres”. What this could mean beyond a name change and how the overhaul is to be carried out are important areas for reporting and analysis.
It is not that with the noticeable expansion of coverage of primary and public health, nothing else has been reported on. We have had articles on the medical education Bill, the pricing of drugs and on the very contentious issue of pricing of health services in private hospitals.
The one that attracted my attention had a contra view on all the advice about what we should eat and what we should not. The article, written for the West but relevant for the Indian metropolitan well-heeled as well, aroused my curiosity as it seemed to suggest that we should not deprive ourselves of the pleasures of splurging on food. The piece, syndicated from The Conversation, actually said much more and made some very relevant points about public participation in decision-making and the need for experts to communicate their views more responsibly.
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