Story behind Modi-care: Plan initiated by PM in Jan 2016, took two years in making; not knee-jerk poll sop

New Delhi: The process to implement ‘Modi-Care’ — tagged by the NDA regime as the big takeaway of the 2018 Budget — had begun two years ago when Prime Minister Narendra Modi gave a presentation in his South Block office to 11 senior bureaucrats drawn from different ministries. Contrary to perceptions in some quarters, the prime minister’s healthcare plan wasn’t a populist measure aimed at garnering support ahead of the 2019 Lok Sabha elections. The meeting in 2016 was a unique occasion that saw the prime minister make a PowerPoint presentation to the bureaucrats, flagging his expectations from them in the health sector. At the core, was his desire to have a health protection scheme for the poor and bring about structural change in the way healthcare is delivered in India. [caption id=“attachment_4337893” align=“alignleft” width=“380”] File image of Narendra Modi. PTI[/caption] Finance Secretary Hasmukh Adhia, then serving in the department of revenue of the finance ministry, acted as a rapporteur of the group that included then health secretary BP Sharma and scientist Soumya Swaminathan working in the field of health research. With the help of 30 joint secretaries sourced from Central government departments, Adhia and team held nine meetings in early 2016 to brainstorm around the issue and examine suggestions from eminent personalities in the health sector, including Dr Abhay Bang, Dr Devi Shetty and Dr Namperumalasamy Sometime in mid-2016, the bureaucrats equipped with a roadmap comprising feasible policy actions returned to Modi with a suggestion to launch the world’s largest healthcare scheme. The 28-page report on the health and education sector titled Universal Access and Quality signed by Adhia, then health secretary BP Sharma, AYUSH Secretary Ajith M Sharan, Women and Child Development Secretary V Somasundaran, Food and Public Distribution Secretary Vrinda Sarup, Social Justice and Empowerment Secretary Anita Agnihotri, School Education Secretary Subash C Khuntia and Additional Secretary in the Ministry of External Affairs Mukta Tomar had examined the flaws and potential in the system to craft a credible policy mechanism for inclusiveness and quality in healthcare. The proposal, reviewed by Firstpost clearly stated that the government must provide health protection to 10 crore deprived families as per the Socio-Economic Caste Census (SECC) absolutely free of cost. Two years on, the proposal is set to turn into reality. According to the report, “It (the scheme) should provide universal coverage to all citizens. For 10 crore deprived families (as per SECC), this scheme should be provided free of cost; for other citizens, it should be open on payment basis.” As far deliverables are concerned, the report said, “Quality standards of services to be provided should be defined and widely-publicised. The scheme should be implemented through empanelled private and public health service providers. State-level health society and trust to implement it directly. There should be an online record of beneficiaries who will be given cashless service. There will be a facility for biometric authentication of beneficiaries with listed health providers and the state health society.” The report recommended a Centre-state expenditure ratio of 60:40 and noted that the total estimated cost us around Rs 10,000 crore. In the report to the prime minister, the bureaucrats had suggested various steps to implement the scheme. Before the rollout, the suggestion was to make available the SECC data of 10 crore families, which can be accessed by all health providers and state health societies. One of the suggestions was that state health societies may invite applications from private and public hospitals and persons covered under the scheme can go to any of the empanelled public or private sector hospital to get his treatment by presenting a cashless card, after being referred by primary health centre unit. The officials had felt that solving the problems of shortage of doctors was the second-biggest challenge for the health sector. The bureaucrats told the prime minister, “We have around seven lakh AYUSH doctors available in the country. With a six-month bridge course for these AYUSH doctors to enable them to dispense common allopathic medicines, several primary health centres can benefit from the presence of these AYUSH doctors, who are in any case attached to these centres. Suitable skilling-up gradation courses may also be designed for ASHA workers to be trained to diagnose and dispense allopathic medicines for common illnesses. This will augment the human resource deficit in far-flung areas. For other allied health workers, there is scope for skilling a large number of them, which will not only improve patient care but also generate employment.” The new National Medical Commission Bill of 2017 tabled in the Lok Sabha during the Winter Session of Parliament in December last year had a taken a cue from the recommendation of top bureaucrats and health experts. The bill, that seeks to replace the Medical Council of India with a new medical education regulator, proposes to allow Ayurveda and Homeopathy doctors to practice allopathy after completing a bridge course. The report that admitted absence of doctors and unavailability of drugs for poorer sections of the population, had further suggested that to leverage the advancements in technology and to overcome the shortage of doctors in rural areas, it was proposed that call-centres manned by few doctors may be established in each state to augment the existing capabilities of local health personnel by providing guidance to them over the phone. Besides authoring the game-changing scheme, the bureaucrats minced no words in informing the prime minister about the problems ailing the healthcare sector:

BOX: Major issues raised with the prime minister Infogram

They said the delivery mechanism of healthcare in India is predominantly private. They argued government-driven delivery mechanisms in most states lack quality and are characterised by hospitals being flooded with patients, while primary healthcare facilities remain underutilised. The report drafted by Adhia and team said, “Diagnostics along with drugs, constitute a major part of health expenditures. The present arrangement in government hospitals for diagnostics suffers from various malaise such as (a) non-operational machines, (b) non-availability of technicians and (c) non-availability of consumables. The absence of even preliminary diagnostics facilities of blood and urine testing at the primary health unit compels people to go to cities for normal requirements also. The vision should be that universal life and health assurance be provided to all citizens with defined standards of services and at affordable rates.” While announcing the scheme, the government followed the blueprint prepared by the team of bureaucrats and experts. Finance Minister Arun Jaitley said the National Health Protection Scheme will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. He termed this as the world’s largest government-funded healthcare programme and provided assurances that adequate funds would be provided for smooth implementation.