News & Updates

Vol 9 | *|DATE:d M Y|*

Dear *|FNAME|*,

Welcome to The Byte!

With a range of information available on issues across India’s health sector, Learning4impact curates relevant tools, emerging trends and deeper insights for professionals working in the public health space.

In this edition of The Byte, we present to you some of India’s most significant health developments over the past quarter. The newsletter tracks India’s progress towards strengthening health systems, including investments, inclusion efforts, pandemic response, service delivery and healthcare advancements. We also pause to reflect on the impact of one year of the pandemic, as well as the perspective looking ahead.

The newsletter also gives you a sneak peek into our upcoming campaign. We welcome you to engage and share resources or perspectives with us at [email protected].

Enjoy reading!

Budgeting for Recovery: Union Budget 2021-22

The Union Budget 2021-22 has proposed an outlay of ₹2,23,846 crore for health and well-being, an increase of 137% from the previous year, with ₹35,000 crore earmarked for the COVID-19 vaccine. This year, the amount includes the budget for schemes from other ministries as well, such as the POSHAN Abhiyaan and the Jal Jeevan Mission (Urban). While some experts believe that the inclusion of schemes from other ministries skews the budgetary allocation, others view this as a welcome step to approaching healthcare more holistically. Nevertheless, the overall health spend remains at 1.6% of the GDP, far lower than the government’s own target of 2.5% of GDP.

Funds for certain key health institutions remained low; while the allocation for the National Health Mission was ₹36,575.5 crores (a 4.4% increase over last year), the National Urban Health Mission received only a ₹50 crore increase, from ₹950 crores to ₹1,000 crores. Major public health schemes also received insufficient funds; the allocation for the government’s flagship health insurance scheme, Ayushman Bharat-PM Jan Arogya Yojana (PM-JAY), remained unchanged at ₹6,400 crores. Family Welfare schemes, including the budgets for procurement and distribution of contraceptives to states, received just ₹387.15 crores- 35% less than FY2020-21.

The government also announced a new centrally sponsored scheme, PM Atma Nirbhar Swasth Bharat Yojana, to be launched with an outlay of ₹64,180 crores over 6 years to improve primary, secondary, and tertiary care health systems, strengthen existing national institutions and create new institutions to address new and emerging diseases. Under the scheme, more than 17,000 rural and 11,000 urban health and wellness centres will be supported, integrated public health laboratories set up in all districts, and 3,382 block public health units established in 11 states.

1 year of COVID and India’s public health response

March 2021 marks a year since India initiated its response to the COVID-19 pandemic. The toll taken on the health system, in terms of health workers lost, system capacity diverted, essential services and disease surveillance compromised, and reduced health-seeking due to loss of trust and financial constraints- is now widely acknowledged.

A year later, as the vaccination program begins to reach non-medical personnel, significant shifts are becoming visible. There has been a rapid increase in acceptance and uptake of telemedicine approaches, from both demand and supply perspectives, and for both physical and mental healthcare. The evident inequalities in digital and financial resources and healthcare access, has reinforced the need to bolster clinical capacity in the public sector- acknowledged most clearly through the new Atmanirbhar Swasth Bharat Scheme.

From district-level outbreak modelling to panchayat-specific risk messaging, the need for decentralized healthcare management led by local governments is being recognised- and the 15th Finance Commission has now supported this shift with significant resources. Finally, alongside the heroism of clinical professionals, the power of public health approaches like mask-wearing and preventing superspreader events has been acknowledged as key to epidemic control. Together with various other ongoing changes, these shifts create an opportunity and necessity to rebuild trust in health systems from primary to tertiary levels, improve disaster response preparedness, and advance India’s health security going forward.

Developments in Tribal health

A joint team of Piramal Swasthya and The Bridgespan Group recently undertook a research study on tribal health challenges confronting India, focussing on 25 NITI Aayog-mentored Aspirational Districts. The study, like India's first comprehensive tribal health focussed report created by the Government of India’s expert committee on tribal health, unsurprisingly finds that compared to India’s overall population, tribal communities suffer from higher maternal and under-five mortality; have more stunted, wasted, and underweight children; higher incidence of malaria and tuberculosis; and a high and growing burden of diabetes, cardiovascular diseases, and hypertension. The report also includes a call to action focussing on delivering quality healthcare services to its tribal populations given the recent renewed focus on SDG 2 and SDG 3 on hunger, health and well-being as a part of India's budget. The main findings include physical barriers to access healthcare services in remote locations, insufficient access to updated healthcare practices and inadequate healthcare facilities as well as a shortage of trained health workers. In addition it focuses on the need for better data and a comprehensive evidence-based strategy in order to deliver healthcare to these vulnerable populations.

View district-wise data on tribal health here.

Vaccination progress in India

In India, the COVID-19 vaccination program was launched on 16th January, 2021. Healthcare and frontline workers will receive the COVID 19 vaccine in the first phase, followed by persons over 50 years of age and those under 50 with comorbidities in the second phase, which begins from March 1. As of the third week of February, over 10.8 million people have received the COVID-19 vaccine in India, which amounts to 11.4 million doses administered, and 1.12 million people fully vaccinated with both doses (0.08% of the population).

India’s drug regulator has approved two coronavirus vaccines for emergency use in India, Covaxin developed by Bharat Biotech and Covishield from the Oxford/AstraZeneca stable being manufactured by the Serum Institute of India (SII). All persons who receive the vaccine need the second dose to be administered within 28 days of receiving the first. Both vaccines are being administered despite not having completed all three phases of clinical trials, with one vaccine (Covaxin) being administered in “clinical-trial” mode. Consequently, a comprehensive Adverse Events Tracking System (AETS) to track adverse reactions to the vaccines is operational as part of the vaccination effort. MoHFW guidelines also clearly state that taking the vaccine is completely voluntary (See the FAQs here).

In terms of progress, India has administered one dose of COVID-19 vaccine to 3.4% of its target group (health care workers and the elderly), and has 5.5 months to cover the rest--and administer a second dose--to meet its target of vaccinating 250 million people by July 2021. At the current rate of vaccination, India stands at the fourth place globally in achieving vaccination targets. Meanwhile, an intensified vaccine drive focussing on mandatory vaccines for children and women, 'Indradhanush 3.0', has also been launched given that several segments of the population missed regular vaccinations owing to the pandemic. Further details on Indradhanush 3.0 are available here.

Kicking India’s burgeoning tobacco habit

The Government has proposed amendments to existing tobacco control legislation in India, affecting both India’s 268 million tobacco users (the second highest in the world) as well as its 46 million people currently engaged in tobacco production. The proposed Amendment Bill, which was shared with the public for inputs in January, contains provisions to raise the legal age of smoking, end the sale of loose cigarettes, penalise illicit cigarette production, and ban all public smoking, with increased penalties.

While the amendments continue to be debated, they provide an opportunity to reflect on why India’s anti-tobacco legislation has failed to reduce tobacco consumption, particularly among the youth. Each year, tobacco use is linked to 7 million deaths, and with the second largest population of tobacco users in the world, effective tobacco control policies in India are the need of the hour.

Read the analysis here.

Women’s Day - Health care workers #ActionForHeroes

The pandemic response has brought home the need to better support, protect, motivate and equip health workers-- a need acknowledged by the WHO in designating 2021 as the International Year of Health and Care Workers, with the theme – Protect. Invest. Together.

Globally, women comprise 75% of the health workforce, and over 90% of nurses and midwives are women. As the representation of women in the health workforce grows across cadres, the wage gap is also growing, with female health workers earning on average 28% less than men, and 11% less for the same work. According to the WHO, the ‘pay differential of 11.2% could be attributable to a wide array of factors, including women’s underrepresentation in senior positions, fewer opportunities for career advancement, and gender discrimination’. It is estimated that just 17% of Indian doctors are women, as compared to over 80% of nurses, and even these doctors are concentrated in a few states and in urban areas.

This year on International Women’s Day, as we consider the theme ‘Women in Leadership: Achieving an equal future in a COVID-19 world’, Learning4impact will be focusing on the specific challenges faced by women health workers, and ways to ensure they are able to perform to their full potential, saving lives and leading us out of the pandemic.

Join us by sharing your experiences, insights and resources with the hashtag #Action4Heroes.