Health care has emerged as one of the most challenging sectors as well as one of the largest service sector industries in India. India is working aggressively to achieve the goal of Universal Health Coverage (UHC) for all its citizens in general and those below poverty line (BPL) in particular. With host of government health insurance schemes in offing, it is estimated that about 50% population was covered with some definite amount of health cover. Governments at central and state level are working hard to expand population base to cover majority of population, yet it remains a challenge. While government share in healthcare spending remains around 1.2% of GDP, it is encouraging to note that private sector was pitching in with healthy 3.8% of GDP as investment in healthcare. There is a need for incentivising higher private investments in the healthcare sector and also synergize the efforts of the Government and the Private health care sector to achieve the goal of UHC.
Other key challenge for developing nations is to identify and address to the disease burden of the nation. Non Communicative Diseases have emerged as major concern accounting for 63% of annual death toll in India. We need to work on promotive, preventive and curative aspects of healthcare to counter such a massive disease burden.
Non-Communicable Diseases (NCDs) are now considered as a developmental burden where, out of 56 million global deaths, 38 million deaths were due to NCDs in 2012. Almost three quarters of all NCD deaths (28 million) & the majority of premature deaths (82%) occurred in low-and middle- income countries. (Global Status Report on Non Communicable Diseases, 2014). Cumulatively, NCDs contribute to huge losses in productive years of individuals resulting both in catastrophic health expenditure at individual level and macroeconomic loss at national and international level. Accounting for 63% of the annual global death toll and for untold morbidity and disability, non-communicable diseases (NCDs) have become the dominant public health challenge of the 21st century. NCDs not only have a serious impact on human health, but also on economic growth.
India is experiencing a rapid health transition with a rising burden of NCDs. In 21 century, where India is making marked economic progress, it is confronting an ever increasing burden of NCDs while still continuing to fight against communicable diseases. According to the World Health Organization (WHO), the burden of NCDs has increased alarmingly all over the world and India is a major contributor to this burden. Overall, NCDs are emerging as the leading cause of deaths in India accounting for over 42% of all deaths (Registrar General of India). Most non communicable conditions are chronic and these chronic conditions cause significant morbidity and mortality both in urban and rural population groups, with a huge loss in potentially productive years (aged 35-64 years) of life. Chronic conditions have become the biggest epidemic contributing enormously to the global burden of disease both in developed and developing nations. Combating this problem is one of the most significant challenge for the public health community globally. Although, India's healthcare sector has made impressive strides in recent years, it needs to gear up to tackle the chronic disease epidemic efficiently and effectively.
NCDs contribute to around 5.87 million deaths that account for 60% of all deaths in India. Four types of NCDs-cardiovascular diseases, cancer, chronic respiratory diseases and diabetes make the largest contribution to morbidity and mortality due to NCDs. Cardiovascular diseases (coronary heart disease, stroke, and hypertension) contribute to 45% of all NCD deaths followed by chronic respiratory disease (22%), cancers (12%) and diabetes (3%). (Global Status Report on NCDs-2014). The major behavioural risk factors responsible for significant proportions of these diseases are tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol while the key metabolic risk factors are obesity, raised blood pressure, raised blood glucose and raised blood total cholesterol levels.
Nearly one out of every ten persons aged 18 years and above in India has raised blood glucose, which poses extra financial and service burden on health systems. Every fourth individual in India aged above 18 years has raised blood pressure and the prevalence has increased by 10% from 2010 to 2014.
It is evident that there is lack of focus on life style, diet, physical activity, health communication and other methods of prevention and therefore need for greater emphasis on education, promotion and contemporary management of NCDs. While entry of corporate sector has greatly improved the access to tertiary care in urban India, greater focus on primary care remains the cornerstone in the promotion and prevention and management of chronic conditions. We need to comprehend the various steps and develop road map to address the NCDs through network of PHCs in government sector and on how this can be supplemented by private sector.
Looking at the financial limitations of running such ambitious plan, we need to learn from other service sectors like IT, Hotel etc. and apply innovative approach to make the implementation efficient and effective. We also need to ensure that project outcomes are reliable in long run and for which we can take learning from ISRO, which have impressive track record of reliability and accuracy. The project plan should have built-in mechanism for monitoring and taking corrective measures to achieve defined milestones. Follow-up should be key component to make sure that gains from the project are kept in check and not allowed to slide back.
Proposed National Health Conclave is expected to develop road map to address the issues related to CHRONIC CARE CONDITIONS as outlined above. The CONCLAVE, as the name symbolises, will bring all stake holders including government, research institutions, academia, industry, community and international agencies on one platform to find lasting solution. The conclave as such will be different from regular conferences as here the nominees of stakeholders will come prepared and would share their thought processes and finally will come out with integrated and lasting solution.