Affordable healthcare for all
Author: Dr Naresh Trehan
Health is an essential pillar. Literally! If we project India’s growth story over the next 25 years, this adage would help chart what the government and private healthcare players must focus on for the world’s most populous nation to also become the most prosperous one – ensuring timely access to quality, affordable healthcare to lower morbidity, mortality, and improve well-being of its 1.43 billion people.
There is no contesting the link between an individual’s good health, their ability to create wealth, and a country’s economic prosperity. As India works to grow into a $25-trillion economy, built on equitable development, it must adopt a multi-pronged approach to address the health challenges posed and deepened by changing demographics, lifestyle, mutating viruses, pandemics like COVID-19, and the climate crisis.
It must also find ways to tackle India’s traditional healthcare challenges such as inter-state and urban-rural disparities, below-average ratio of healthcare workers to patients, and gaps in hospital services between Tier-I, II and III cities. In this context, universal access to affordable healthcare takes on a new level of significance for India.
In this direction, India has made great strides in improving healthcare access and affordability with newer schemes under the National Health Policy, 2017. The government has launched a range of initiatives aimed at taking healthcare to the last mile, with a particular focus on and fillip from digital health technology.
For example, it set up more than 1.5 lakh Ayushman Bharat Health and Wellness Centres and created a network of over 9,000 Jan Aushadhi Kendras servicing 700 plus districts with quality generic medicines. But among the most significant initiatives taken towards ensuring universal coverage has been the Ayushman Bharat PM-Jan Arogya Yojana that covers close to 55 crore people, including India’s poorest 40 per cent by meeting hospital costs up to Rs 5 lakh per family per year.
While we may have seen the back of the COVID-19 pandemic, its ghosts of added-healthcare-burden are likely to continue haunting us. Long Covid, increase in non-communicable diseases, treatment deferral and worsened symptoms of existing conditions because of Covid – all these factors will likely add to become a source of economic burden in the near future. This is particularly worrying as a large chunk of our population is still concentrated in villages where, despite the network of primary and secondary healthcare centres, increased medical colleges and seats, doctor-patient ratio remains a work in progress.
This is where digital innovation – in play much before the start of the pandemic – is helping. The Government’s telemedicine app, eSanjeevani, has eliminated distance as a barrier to consult specialist doctors and bridged the urban-rural divide. In under three years of its launch, it has been able to help more than 10 crore people. The private sector too has taken several initiatives to bridge the last-mile gap and remove distance as an access barrier. In addition to telemedicine, which it is using to connect with patients even in the farthest corners and oversee their treatment, large-scale healthcare providers have even started remote critical care services (e-ICUs).
The government initiatives such as the National Health Stack and the National Digital Health Mission have created a robust foundation for the development of an integrated and seamless healthcare delivery system that greatly helps tertiary care providers deliver effective, efficient, and personalised care. With the rising number of smartphone users and proactive adoption of the digital health system, affordable solutions are reducing disparities in healthcare access and quality, especially among underserved and marginalised communities. These tools are also enabling promotion of disease prevention and early detection, which can help reduce the long-term burden of disease and associated costs, and ultimately improve the overall well-being of the population.
Moreover, digital health solutions can facilitate the collection and analysis of large-scale data that can inform public health interventions and policies. This can enable public and private sector healthcare providers to develop evidence-based strategies for disease control, outbreak management, and health promotion. For example, it can support the tracking of disease incidence and prevalence, which can help identify emerging health threats and develop appropriate interventions.
The government programmes, ingenuity of the private healthcare sector and adoption of digital health solutions are together redefining ‘universal affordable healthcare’ to represent an integrated system that not only ensures access but actively evolves to further reduce treatment costs and play an active role in disease prevention. /BI/
(The author is Chairman and Managing Director, Medanta Heart Institute, Gurugram)
More In Public Affairs
NEP-2020 aspires for inclusive excellence in school education
Rajeev Ranjan Roy
The New Education Policy-2020 (NEP-2020), unveiled recently, aims at achieving excellence in school learning by imparting quality, affordable and inclusive education to all, with an extra emphasis on those children coming from socially and educationally disadvantaged groups of the society. It is a futuristic endeavour towards building Ek Bharat, Shrestha Bharat. The previous education policies largely focussed on the issues of access and equity in giving school education, while the NEP-2020 commits to laying the foundation of a vibrant Bharat where no one is devoid of a kind of school education, which helps every student become an asset for the nation in a true sense. The unfinished agenda of the National Policy on Education 1986, which was modified in 1992, has been effectively dealt with in the NEP-2020 along with the vision behind the Right to the Free and Compulsory Education Act, 2009, which “laid down legal underpinnings for achieving universal elementary education.”
Given the undisputed role of education in nation building, the NEP-2020 rightly lays the stress on standardization and accreditation of school infrastructure and teachers as well, since education with accountability, transparency and affordability is the need of the hour, and hence the need to “empower schools, teachers with trust, enabling them to strive for excellence and perform at their very best, while ensuring the integrity of the system through the enforcement of complete transparency and full public disclosure of all finances, procedures and outcomes.” Since private sector is significantly present in the field of school education, the idea to promote ‘not-for-profit’ entities is a unique feature of NEP-2020, which at the same time intends to promote private philanthropic efforts for quality education, thereby affirming the public-good nature of education, while protecting parents and communities from arbitrary increase in tuition fees.
An equally important area, which has got due attention in the NEP-2020 is the need for efficient resourcing and effective governance through school complexes and clusters, a significant initiative in view of the fact that nearly 28 per cent of India’s public primary schools and 14.8 per cent of upper primary schools have less than 30 students. The average number of students per grade in the elementary schooling system – Grades 1 to 8 – is about 14, with a notable proportion having below six students during 2016-17, the year which also had 1,08,017 single-teacher schools, and majority of them – 85,743 – being primary schools taking care of Grades 1-5 children. It was, therefore, a pressing need to evolve a mechanism for establishing a grouping structure, say, school complexes, consisting of one secondary school together with all other schools, which lead to greater resource efficiency and more effective functioning, coordination, leadership, governance, and management of schools in the cluster. This will not only ensure optimum utilisation of resources, but will also foster the sense of oneness and togetherness among the school children, who are the future of the nation.
What further makes the New Education Policy-2020 uniquely special is its pledge for equitable and inclusive education for all, one of the great dreams of our founding fathers. Education, as the NEP-2020 rightly envisions, is “the single greatest tool for achieving social justice and quality.” Inclusive and equitable education, indeed an essential goal in its own right, is also critical to achieving a social order where every citizen has “the opportunity to dream, thrive, and contribute to the nation.” Quality, affordable and ethical education to all is the first move to break multiple social and economic barriers, which sow the seeds of exclusion, discrimination and exploitation against our own people on different parochial considerations.
Needless to say efforts were made in the past as well to bridge the educational chasm between socially and educationally disadvantaged groups (SEDGs) and the children of top social strata, but the desired results remained elusive. SEDGs account for the country’s overwhelming population, but their children’s share in quality school educational institutions has been minimal over the years. Early childhood care and education (ECCE) needs to be handled more comprehensively. According to the Unified-District Information System for Education (U-DISE) 2016-17 data, about 19.6 per cent of students belonged to Scheduled Castes (SCs) at the primary level, but this fraction fell to 17.3 per cent at the higher secondary level. These enrollment drop-outs were more severe for ST students (10.6 per cent to 6.8 per cent), and differently-abled children (1.1 per cent to 0.25 per cent), with even greater declines for female students within each of these categories. Thus, there is no scope for any complacency on the part of the government. A series of interventions including better facilities, more and more hostels, scholarships and other enabling support have been provisioned in the NEP-2020 so that the idea of ‘learning for all’ is realised in a more comprehensive manner.
Teachers are not only an integral part of an education system, but the most important stakeholder in the entire gamut of things. Their quality and ability to teach school students, when they are in their formative age, become something of paramount importance. From their recruitment to training, every precaution needs to be taken to ensure that school education is not rendered to a mere formality, but becomes a game changer. The New Education Policy-2020 comes with a basket full of tools and parameters to ensure holistic training and upgradation of teachers and their teaching skills in a sustainable manner. From continuous professional development (CPD) to career management and progression (CMP), the NEP-2020 vouches for a set of common guidelines – National Professional Standards for Teachers (NPST), which will be put in place by the National Council for Teacher Education (NCTE) in its restructured new form as the Professional Standard Setting Body (PSSB) under the General Education Council. This exercise will be carried out in consultation with National Council Educational Research and Training (NCERT), SCERTs, teachers from across levels and regions.
The teacher education will also undergo a sea-change. By 2030, the minimum degree qualification for teaching will be a 4-year integrated B.Ed. that teaches a range of knowledge content. Today B.Ed. teaching is most poorly regulated in our country ever since the standalone B.Ed. colleges were allowed to be opened up in the private sector. It is high time to take B.Ed. teaching more than seriously. The NEP-2020 stipulates that by 2021, a new and comprehensive National Curriculum Framework for Teacher Education (NCFTE-2021) will be formulated by the NCTE. NCFTE, which will also factor in the requirements of teacher education curricula for vocational education, will be revised once every 5-10 years.
In conclusion, the NEP-2020 visualizes to impart a school education which lays the foundation of a self-reliant India and also to help our country emerge as a knowledge hub. From the foundation of learning to foundational literacy and numeracy to checking drop outs and ensuring universal access to education for all and at all levels to the restructuring of school curriculum, India is in for a metamorphosis in the field of school education, recognizing, identifying and fostering the unique capabilities of each student. Tools such as multi disciplinarity, emphasis on conceptual understanding, creativity and critical thinking, ethics and human and constitutional values, full equity and inclusion, and light but tight regulatory framework are bound to do wonders. Education is a public service, a rare pursuit in nation building, which should be holistic and inclusive and must make one take pride in India and its rich, diverse, ancient and modern culture and knowledge systems and tradition. The NEP-2020 aspires so, indeed!
( The writer is a senior journalist and author. The views expressed are strictly personal.)
NEP-2020 aspires for inclusive excellence in school education
Rajeev Ranjan Roy
The New Education Policy-2020 (NEP-2020), unveiled recently, aims at achieving excellence in school learning by imparting quality, affordable and inclusive education to all, with an extra emphasis on those children coming from socially and educationally disadvantaged groups of the society. It is a futuristic endeavour towards building Ek Bharat, Shrestha Bharat. The previous education policies largely focussed on the issues of access and equity in giving school education, while the NEP-2020 commits to laying the foundation of a vibrant Bharat where no one is devoid of a kind of school education, which helps every student become an asset for the nation in a true sense. The unfinished agenda of the National Policy on Education 1986, which was modified in 1992, has been effectively dealt with in the NEP-2020 along with the vision behind the Right to the Free and Compulsory Education Act, 2009, which “laid down legal underpinnings for achieving universal elementary education.”
Given the undisputed role of education in nation building, the NEP-2020 rightly lays the stress on standardization and accreditation of school infrastructure and teachers as well, since education with accountability, transparency and affordability is the need of the hour, and hence the need to “empower schools, teachers with trust, enabling them to strive for excellence and perform at their very best, while ensuring the integrity of the system through the enforcement of complete transparency and full public disclosure of all finances, procedures and outcomes.” Since private sector is significantly present in the field of school education, the idea to promote ‘not-for-profit’ entities is a unique feature of NEP-2020, which at the same time intends to promote private philanthropic efforts for quality education, thereby affirming the public-good nature of education, while protecting parents and communities from arbitrary increase in tuition fees.
An equally important area, which has got due attention in the NEP-2020 is the need for efficient resourcing and effective governance through school complexes and clusters, a significant initiative in view of the fact that nearly 28 per cent of India’s public primary schools and 14.8 per cent of upper primary schools have less than 30 students. The average number of students per grade in the elementary schooling system – Grades 1 to 8 – is about 14, with a notable proportion having below six students during 2016-17, the year which also had 1,08,017 single-teacher schools, and majority of them – 85,743 – being primary schools taking care of Grades 1-5 children. It was, therefore, a pressing need to evolve a mechanism for establishing a grouping structure, say, school complexes, consisting of one secondary school together with all other schools, which lead to greater resource efficiency and more effective functioning, coordination, leadership, governance, and management of schools in the cluster. This will not only ensure optimum utilisation of resources, but will also foster the sense of oneness and togetherness among the school children, who are the future of the nation.
What further makes the New Education Policy-2020 uniquely special is its pledge for equitable and inclusive education for all, one of the great dreams of our founding fathers. Education, as the NEP-2020 rightly envisions, is “the single greatest tool for achieving social justice and quality.” Inclusive and equitable education, indeed an essential goal in its own right, is also critical to achieving a social order where every citizen has “the opportunity to dream, thrive, and contribute to the nation.” Quality, affordable and ethical education to all is the first move to break multiple social and economic barriers, which sow the seeds of exclusion, discrimination and exploitation against our own people on different parochial considerations.
Needless to say efforts were made in the past as well to bridge the educational chasm between socially and educationally disadvantaged groups (SEDGs) and the children of top social strata, but the desired results remained elusive. SEDGs account for the country’s overwhelming population, but their children’s share in quality school educational institutions has been minimal over the years. Early childhood care and education (ECCE) needs to be handled more comprehensively. According to the Unified-District Information System for Education (U-DISE) 2016-17 data, about 19.6 per cent of students belonged to Scheduled Castes (SCs) at the primary level, but this fraction fell to 17.3 per cent at the higher secondary level. These enrollment drop-outs were more severe for ST students (10.6 per cent to 6.8 per cent), and differently-abled children (1.1 per cent to 0.25 per cent), with even greater declines for female students within each of these categories. Thus, there is no scope for any complacency on the part of the government. A series of interventions including better facilities, more and more hostels, scholarships and other enabling support have been provisioned in the NEP-2020 so that the idea of ‘learning for all’ is realised in a more comprehensive manner.
Teachers are not only an integral part of an education system, but the most important stakeholder in the entire gamut of things. Their quality and ability to teach school students, when they are in their formative age, become something of paramount importance. From their recruitment to training, every precaution needs to be taken to ensure that school education is not rendered to a mere formality, but becomes a game changer. The New Education Policy-2020 comes with a basket full of tools and parameters to ensure holistic training and upgradation of teachers and their teaching skills in a sustainable manner. From continuous professional development (CPD) to career management and progression (CMP), the NEP-2020 vouches for a set of common guidelines – National Professional Standards for Teachers (NPST), which will be put in place by the National Council for Teacher Education (NCTE) in its restructured new form as the Professional Standard Setting Body (PSSB) under the General Education Council. This exercise will be carried out in consultation with National Council Educational Research and Training (NCERT), SCERTs, teachers from across levels and regions.
The teacher education will also undergo a sea-change. By 2030, the minimum degree qualification for teaching will be a 4-year integrated B.Ed. that teaches a range of knowledge content. Today B.Ed. teaching is most poorly regulated in our country ever since the standalone B.Ed. colleges were allowed to be opened up in the private sector. It is high time to take B.Ed. teaching more than seriously. The NEP-2020 stipulates that by 2021, a new and comprehensive National Curriculum Framework for Teacher Education (NCFTE-2021) will be formulated by the NCTE. NCFTE, which will also factor in the requirements of teacher education curricula for vocational education, will be revised once every 5-10 years.
In conclusion, the NEP-2020 visualizes to impart a school education which lays the foundation of a self-reliant India and also to help our country emerge as a knowledge hub. From the foundation of learning to foundational literacy and numeracy to checking drop outs and ensuring universal access to education for all and at all levels to the restructuring of school curriculum, India is in for a metamorphosis in the field of school education, recognizing, identifying and fostering the unique capabilities of each student. Tools such as multi disciplinarity, emphasis on conceptual understanding, creativity and critical thinking, ethics and human and constitutional values, full equity and inclusion, and light but tight regulatory framework are bound to do wonders. Education is a public service, a rare pursuit in nation building, which should be holistic and inclusive and must make one take pride in India and its rich, diverse, ancient and modern culture and knowledge systems and tradition. The NEP-2020 aspires so, indeed!
( The writer is a senior journalist and author. The views expressed are strictly personal.)
