Healthcare Sector Management And Governance: An Indian Perspective

Event Report
Samprikta Banerjee

The Center for the Study of Finance and Economics, at IMPRI Impact and Policy Research Institute, New Delhi conducted a one-month immersive Online Introductory Certificate Training Course on ‘Health Sector Management and Governance: An Indian Perspective’ from June 22 to July 13, 2024.

The chair of the program was Prof Mukul Asher, Former Professor, Lee Kuan Yew School of Public Policy, National University of Singapore; Visiting Distinguished Professor, IMPRI.

Convenors for the event were Dr Simi Mehta, CEO & Editorial Director, IMPRI and Dr Arjun Kumar, Director, IMPRI.

Day 1| Analytical Concepts and Frameworks Relevant to Assessing the Health Sector

Prof Mukul Asher began the session by discussing the universal principles of any discipline, including economics, and emphasized the importance of understanding and applying these principles in a local or domestic context. He highlighted India’s need to develop more expertise in health sector management and governance, as professionalization in this area has not been prioritized sufficiently in the past.

Prof. Mukul pointed out that health systems are complex and require continuous trade-offs among accessibility, affordability, and evolving healthcare technology. No country is wealthy enough to provide the best healthcare for all its citizens. He stressed the role of digital technology, such as telemedicine, in transforming the healthcare sector and acknowledged the growing recognition of mental health issues, which were not as prominent in previous generations.

The session encompassed the emphasizing the importance of not taking good health for granted and being proactive about one’s health, the discussion, and concept of the Satvik Lifestyle, the importance of Statistics in the field of Healthcare, the importance of local context in healthcare, the need for self-reliance in healthcare and the various challenges related to healthcare. Therefore, Prof Mukul emphasized the importance of affordable medicines and medical equipment for better treatment.

Prof. Mukul Asher took the session forward by emphasizing the importance of a sound and appropriate framework, stating that “there is nothing more practical than a sound, appropriate framework.” He noted that a framework is not a blueprint but an aid to thinking.

The session was centered on analytical frameworks and concepts designed to assess health sector outcomes effectively. Prof Asher stressed that the health sector needs to be governed and managed with a keen focus on outcomes. He identified the key tradeoffs in the health sector and discussed the desired outcomes for a healthy population. He also provided an analysis of health expenditure to GDP ratios in demographically mature countries and discussed the significant impact of unhealthy lifestyles and poor environmental conditions on premature deaths.

The session concluded with a discussion of funding and financing in healthcare along with a brief overview of the Ayushman Bharat Scheme.

Day 2 | An Overview of India’s Health Sector: Key Issues in Health Governance in India

Ms Urvashi Prasad introduced the shift from curative to preventive healthcare and how digital wearable devices can identify signs of possible mental ailments. She said that the Government is incentivizing the setting up of hospitals in Public Private Partnership (PPP) mode in Tier2 & Tier3 urban centers as well as rural areas.

She highlighted the need to bring in virtual healthcare as a prospective beneficial healthcare system, like telemedicine, and focused on women’s health and maternity in India. She touched on the aspect of domestic violence faced by women and the need for proper and inclusive healthcare owing to such problems. Her session also had a portion where she spoke about the elderly’s need for healthcare and the current scenario of the epidemiological transition from infectious diseases to non-communicable diseases (NCDs).

Her session concluded by highlighting the need for expanding healthcare to a gendered lens thereby making it gender neutral and also spoke about effective policies that need to be in focus regarding improving the healthcare system of India.

Prof Pradeep K. Panda took the session forward by discussing various initiatives aimed at strengthening the Department of Ayurveda, Yoga, and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) sector and highlighting the impressive growth of the AYUSH manufacturing sector. He explained how the policy landscape for AYUSH has evolved significantly, transitioning from the National Rural Health Mission (NRHM) to the National AYUSH Mission (NAM). His session focused on the impact of the AYUSH integration justifying the evidence with relevant statistics along with relevant statewide integration to show its impact across States.

His session also dealt with the National Ayush Mission(NAM) and Prof Pradeep emphasized that NAM aims to promote cost-effective AYUSH services, strengthen educational systems, enforce quality control, and ensure sustainable raw material supply. He highlighted the several benefits of AYUSH in public health which include holistic care, accessibility, cost-effectiveness, cultural relevance, and reduced side effects.

He touched upon two important case studies to depict the various ways in which the AYUSH mission has been beneficial and the way forward for this mission.

Day 3 | Health Economics and Governance

Prof Mukul Asher presented an introduction to the Economics of the Health Sector, he began his presentation by introducing healthcare as an important economic concept that examines and finds system-based solutions to make healthcare more accessible, equitable, and affordable to all. He explained the funding and financing of healthcare services and how each health system will have to develop a financing mix that consists of a combination of these instruments.

He highlighted the need for effective governance, which is seen as a critical part of the whole approach to health systems development, thereby pointing out the governance failures denoting that governance failures in healthcare are marked by both market and government failures.

He concluded the session by suggesting regulatory tools that need to be implemented to ensure proper targeting of healthcare needs and smooth access. The underlying premise is that the health sector needs to be governed and managed well, focusing on health outcomes and not just health expenditure.

The day was furthered with an enriching panel discussion by Prof Mukul Asher, Mr V. Ramakrishnan, Dr Parashram Patil, and Dr Manorama Bakshi. The session started with Dr. Manorama Bakshi, who emphasized medical tourism’s benefits in improving patient outcomes and boosting economic growth in destination countries, thereby highlighting the various advantages of the same along with the impending challenges that need to be addressed. She also suggested numerous methods and strategic initiatives to advance India’s medical tourism sector across key markets.

Mr V Ramakrishnan took up next and shared his extensive healthcare experiences in India, noting numerous surgeries and expressing disappointment in hygiene standards and governance compared to what he expected at home. He highlighted AI’s potential to improve healthcare governance, likening its current state to a densely packed train. He questioned the effectiveness of COVID-19 data collection efforts and stressed the ongoing need for community care, traditional medicine, and robust public health facilities. Mr. Ramakrishnan highlighted initiatives such as the National Health Mission and Ayushman Bharat Yojna for standardizing data collection to enhance healthcare services through AI applications.

Then the session was handed over to Dr Parashram Patil, who emphasized the need for agricultural policies promoting diversity with horticulture, meats, and dairy alongside cereals to address nutritional deficiencies. Mr Ramakrishnan added to the discussion and discussed milk’s nutritional role and its historical promotion alongside staples like rice and wheat, contributing to India’s high diabetes rates due to insulin-like growth factors. He cautioned against yogurt’s potential to increase body weight linearly when substituting milk with other dairy products.

The entire session concluded with remarks from the Chair, Prof Mukul Asher, who stressed adapting technology to local contexts and highlighted the link between agriculture, food, and health in healthcare systems. He advocated for decentralized education to promote healthier eating habits through local leadership involvement.

Day 4 | Challenges in Healthcare Services

On the final day of Health Sector Management and Governance: an Indian Perspective, Prof Sanghamitra S. Acharya held a panel on “Challenges in Achieving Better Access, Adequacy and Affordability of Healthcare Services within India’”. Her session focused on two important aspects inclusive data and climate change.

She touched on various facets of inclusive data like the challenges to data inclusivity, the impact of exclusion, the process of policy and data collection, the act of ensuring social inclusion, and the Environment, Social, and Governance (ESG) framework. Her focus on climate change included major topics of discussion like how climate change is a healthcare challenge, the health impacts of heat waves, how sustainable development goals (SDGs) are beneficial to battle heat waves, the community and policy responses required in relation to climate change, and the important long term strategies needed to battle climate change.

The concluding session of this course was taken forward by the chair, Prof Mukul Asher, who touched upon the major aspects required to improve health outcomes in India. His focus was on integrated urban planning, urban finance mechanisms, health as a State subject, urban health infrastructure, and addressing urban challenges. His session highlighted the urban sector by suggesting ways to improve the infrastructure and accessibility of healthcare outcomes in that sector.

He concluded his session with the thought that by integrating holistic urban planning, efficient resource use, innovative financing models, and inclusive policies, cities can become more sustainable and livable.

Acknowledgment – Written by Samprikta Banerjee, Visiting Researcher at IMPRI. The author would like to thank Vaishali Singh for the valuable comments and suggestions.