C K Mishra, union health secretary, speaks to Healthpost editor, Gunjan Sharma, about a host of issues, including new health policy, low budgetary allotment for healthcare, generic drugs, the increasing  assaults on doctors, etc. Excerpts:  
 

Recently the government released a new health policy after 15 years. What is its paramount focus? 

There are three critical pillars of this policy: to increase the reach of healthcare, to reduce the cost of treatment, and to improve the quality of healthcare services. 

The main focus of the policy is to provide preventive primary healthcare. It aims to invest two-third of the total budget on primary healthcare —ensuring universal screening, setting up health and wellness centers, increasing the number of  services at PHCs so that we can contain diseases at an an early stage. 

In secondary care, the focus is on strengthening district hospitals. For tertiary care, we would want to have strategic partnerships with the private sector.

The process will be such that the referrals will flow from one level to another. Right now, our major problem is that people go to a tertiary care center such as AIIMS even for basic health needs. 

Also, we need to have more beds for tertiary care; and for more specialized care we need to increase the number of post graduation seats in medical colleges.  

In fact, it is for the first time that our health policy has quantified things. It has set deadlines to achieve the stated objectives. It is ambitious, but it is achievable. In the past we have made policies without mentioning clearly the resources needed to achieve the targets, but in this policy there is a clear mention of the resources we need.

The policy also talks about increasing the health budget to 2.5 per cent of the GDP in a time- bound manner. What is the deadline for that?

We should be able to do it by 2025.
 
The global average is 4.9 per cent of the GDP. Why are we still struggling to achieve 2.5 per cent? Is not 2025 too far?

We definitely need more funds for healthcare. But if you look at our spending, the base is pretty high. The quantum of money available is huge. The states’ and the center’s budget put together is 4 lakhs crore. At 2.5 per cent of the GDP, it will be around 8-9 lakh crore.
It is a huge jump. I am not saying that we don’t need more, but first we need to create a system to absorb this kind of money.

It is for the first time that our health policy has quantified things. It has set deadlines to achieve the stated objectives. It is ambitious, but it is achievable. In the past we have made policies without mentioning clearly the resources needed to achieve the targets, but in this policy there is a clear mention of the resources we need

If there is enough money, why so many people in India die because they can't afford healthcare?

There are two reasons: lack of access and lack of good governance structure.

If we have created a primary health center somewhere but a doctor doesn’t come at this healthcare facility, it is a problem with the governance system.

In a large country like India, unfortunately health-seeking behavior is still very low. Out- of- pocket expenditure on health is high, it accounts for close to 58 per cent.  There is low insurance coverage in the country. 

But with all its inadequacies, the present system has delivered. Look how we have reduced maternal and infant mortality at a faster rate than the global average.

The center has announced more AIIMS- like institutes while the first six are still not fully functional, and are grappling with shortage of doctors.

Yes, I agree. We have presently around 55-60 per cent posts vacant at these institutes, but we have a concrete plan for these new AIIMS. We are going to have recruitment drives and by December 2017, we plan to fill 60-65 percent posts. We also have to ensure the quality of faculty at these AIIMS.
 
Some former directors at the new AIIMS complain that they quit because they didn’t have freedom to run the AIIMS the way they wanted.

I do admit that for initial few years, their administrative system was centralized, and I must say that the ministry has no business running these institutes. But we have delegated a lot of powers to the directors in the last couple of months. Now how to use these powers depends on an individual. I believe that we need to further simplify their governance structure.
 
There have been many reports of assaults on doctors in the last couple of months. Why do you think there is growing mistrust between doctors and patients? The IMA feels that the government has failed to provide affordable healthcare to people, and the doctors are facing the backlash…
 
We are upset about these incidents, but I don’t agree that the government has failed to provide affordable healthcare. Otherwise why so many people would visit government hospitals. 

But, yes, there are a few issues which we need to tackle. People have high expectations and low patience level. People need to understand that there is tremendous load on our public healthcare facilities. About 16,000 patients visit AIIMS in Delhi every day.

Another critical factor is the communication skill, which is more developed in the private sector than the public sector. We will give a two-month induction course in communication to all the doctors who get appointed through UPSC. It will help doctors improve their interpersonal behaviour. We have started the first batch from May 1st. At the same time, we need to create more healthcare facilities for people.

The medical fraternity has raised its concerns over the involvement of AYUSH practitioners in specialised fields. How do you look at it?

I am fully for the integration. I believe that firstly, a patient should be given a choice of treatments. Secondly, and more importantly, we don't have adequate doctors. If there is no MBBS doctor, people have no choice but to go to quacks for health problems. An AYUSH doctor is a trained medical practitioner and AYUSH system has good medicines.

We have started a six-month bridge course at Indira Gandhi National Open University, both for nurses and AYUSH doctors. The course for the nurses started last month and for doctors it will start in September. The idea is to give them some skills in specialised care.
 
The government has recently capped the pricing of stents. Why?

The government regularly reviews the list of essential medicines. We look at the items which are of mass consumption. The ministry of health decides what all medicines/implants should fall into this list. Then it goes to the department of pharma which decides the cost.

We take into account the disease profile of the country, emerging diseases, etc before taking these decisions.

The idea is to make devices and medicines affordable to the extent possible. At the same time, we need to ensure that there is enough supply of necessary medicines and devices. 

Another big decision was to ask doctors to prescribe generic medicines. Don’t you think there is greater need to regulate the quality of drugs first?

India is the biggest manufacturer of generics. PM has also stressed the need to prescribe generic medicines. We will make sure that it happens. It is not a one-time process, it is going to be a continuous process--when we push the generics into the market, we should simultaneously work on ensuring its quality and availability.