GS-1, Social Empowerment, Uncategorized

Cabinet approves Pan-India implementation of Maternity Benefit Program

The Maternity Benefit Program will provide compensation for the wage loss in terms of cash incentives so that the women can take adequate rest before and after delivery and not be deprived of proper nutrition.

Objective of the Scheme
i) To provide partial compensation for the wage loss in terms of cash incentives so that the woman can take adequate rest before and after delivery of the first living child.

ii) The cash incentives provided would lead to improved health seeking behaviour amongst the Pregnant Women and Lactating Mother (PW&LM) to reduce the effects of under-nutrition namely stunting, wasting and other related problems.

Who are the beneficiaries?
All eligible Pregnant Women and Lactating Mothers (PW&LM), excluding the Pregnant Women and Lactating Mothers who are in regular employment with the Central Government or State Government or Public Sector Undertakings or those who are in receipt of similar benefits under any law for the time being.

How much monetary benefit?
All eligible will receive a cash benefit of Rs.5,000/- in three installment

Why is this required?
1- 
Highest number of maternal death due to absence of medical help
2- High maternal mortality rate (167 per 100,000 live births in 2011-13)
3- High Infant mortality rate (41 per 1000 Live birth)

GS-2, Uncategorized

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

Introduction

Prime minister laid the foundation stone for All India Institute of Medical Sciences (AIIMS) inGorakhpur in eastern Uttar Pradesh. The state where medical care is very poor. AIIMS will provide tertiary care for the people. Gorakhpur is a significant area, but always in news for one bad reason that is the Japanese encephalitis which takes many lives.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

  • The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was announced in 2003 with objectives of correctingregional imbalances in the availability of affordable/ reliable tertiary healthcare services and also to augment facilities for quality medical education in the country.
  • Pradhan Mantri Swasthya Suraksha Yojana was approved in March 2006. The first phase in the PMSSY has two components – setting up of six institutions in the line of AIIMS; and up gradation of 13 existing Government medical college institutions.

Importance of AIIMS

  • Health care is a very important dimension of Good Governance. Quality health care has been lacking in Gorakhpur region. Having AIIMS in those area is to take the AIIMS level of quality to those places where previously people from all parts of the country use to come to AIIMS in Delhi.
  • AIIMS was considered the best in terms of what government can provide in terms of public health care. Todaymedical sciences have made lot of improvements and advancements. When it comes to availability to the people, it is the urban people who benefit invariably.
  • So the new project is very important in terms of providing high quality medical facilities to those places where there is no medical attention.
  • We have schemes for Ambulance services, primary health care etc. Having AIIMS in Gorakhpur is important for access to specialist services.
  • Sometimes there are complicated health cases. Providing specialist care along with basic health care facilities is very important. For specialists and diagnostics, people are forced to come to cities for treatment.
  • It is very difficult for poor villagers to come to city and stay for the purpose of availing medical treatment. So having a super speciality hospital with areas of excellence will benefit the people of Gorakhpur.
  • The basic idea of setting up AIIMS at various places was to provide quality and affordable care. Along with this quality medical education is also created.

State of Health care in India

  • In India 10 lakh people die every year due to lack of medical care facilities and 70 crore have no access to medical specialists. 80% specialists are in urban areas.
  • The world average is 3.96 hospitals per 1000 population. In India it is 0.7 hospital beds. 70% of state’s budget goes in paying salaries and wages. This is very dismal situation.
  • Life expectancy has gone up to 66 years as compared to 32 years when India got independence. Health care is going to be more significant aspect. In a country where social welfare and social development indicesare yet to grow, the new project shows some kind of commitment by the government for the welfare of the people.
  • The public funding for health care is 22%, while 78% is going to private hospitals. The share of the richest 20% of the population gets 31% of the total public subsidies. The real intended portion of benefits is not reaching the lower end of the ladder of population. This is a very grim picture.
  • The available medical facilities are not reaching the people who badly need them. In government hospitals there is apathy in terms of attending to patients, availability of facilities and availability of modern technology.
  • India has 0.7 doctors per 1000 population. In the present scenario even 7 doctors per 1000 population may not be sufficient, by looking at the lifestyle diseases (Non Communicable Diseases). The diseases we normally thought would affect only a particular section of the population like obesity is prevalent among low income people. The diseases are striking at every strata of the society. How people cope up with it is a big question.
  • According to Lancent report of 2015, in India 25,300 public health centres have no doctors, 80% of the community health centres do not have a specialist/ surgeon, 76% don’t have access to gynaecologist and 82% don’t have a paediatrician. At one hand we are expanding medical services, while the real staff to treat or diagnose and support staff, we have a long way to go.

Need of the Hour

  • The private health care can fill up that space. In recent times there are issues about quality health care provided by private sector. So government cannot leave healthcare completely to private sector.
  • Private healthcare is equally important because government alone cannot provide health services to the citizens. The government must supplement the services available by creating the centres of excellence.
  • 80% of the medical doctors work in urban centres. Government has tried to correct it by making rural service as compulsory. But things haven’t improved. The other side is doctors find it difficult to stay or have a hospitable living in area where they can move and stay with their family. The facilities for the doctors to stay in rural areas have to be created by the government.
  • In terms of developed countries, the quality medical facility we get in any part of that country is equal to what they get in the bigger cities. India should also aim for the similar system where the super speciality services are available at least at the district level.
  • India has 0.7 doctors per 1000 population, china has 1.5 and Pakistan has 0.8. Recently health minister said India need 7.5 lakh doctors where as the intake of medical colleges are 50,000 students. There is a huge gap in terms of availability of doctors and the need to provide quality medical care. This is to be addressed.

Conclusion

We need to have quality medical facilities at all places. They have to be at affordable prices. Only the government can make the high quality medical care affordable to the people.

38,000 to 45,000 doctors pass out every year. But in terms of post MBBS super specialisation there are not more than 17,000 seats. There is a need to fill this gap. The Medical Council of India and the Government of India have been looking at the issue. The foundation stone of AIIMS at Gorakhpur is a step in the right direction.

GS-2, Social Issue, Uncategorized

With 4 new vaccines, govt to revamp immunisation drive

The health ministry is planning to revamp its flagship immunisation programme ‘Mission Indradhanush‘ to include four new vaccines.

  • The mission, currently providing coverage against seven life-threatening diseases, will soon also include vaccines for rotavirus, measles rubella, inactivated polio vaccine bivalent and Japanese Encephalitis for adults.

Mission Indradhanush:

Mission Indradhanush was launched by the Health & Family Welfare Ministry. The Mission was launched on Good Governance Day to mark the birth anniversary of Bharat Ratna Madan Mohan Malaviya and birthday of Bharat Ratna Atal Bihari Vajpayee.

Aim:

The Mission Indradhanush, depicting seven colours of the rainbow, aims to cover all those children by 2020 who are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B.

Details:

  • The Mission is being implemented in 201 high focus districts in the country in the first phase which have nearly 50% of all unvaccinated or partially vaccinated children (Of the 201 districts, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and nearly 25% of the unvaccinated or partially vaccinated children of India are in these 82 districts of 4 states).
  • These districts will be targeted by intensive efforts to improve the routine immunization coverage.
  • The campaign is part of the Universal Immunisation Programme by 2020 and is being implemented under the National Health Mission across the country.
  • Between 2009-2013 immunization coverage has increased from 61% to 65%, indicating only 1% increase in coverage every year. To accelerate the process of immunization by covering 5% and more children every year, the Mission Mode has been adopted to achieve target of full coverage by 2020.
  • The focused and systematic immunization drive will be through a “catch-up” campaign mode where the aim is to cover all the children who have been left out or missed out for immunization.
  • The learnings from the successful implementation of the polio programme will be applied in planning and implementation of the mission.
  • The Ministry will be technically supported by WHO, UNICEF, Rotary International and other donor partners. Mass media, interpersonal communication, and sturdy mechanisms of monitoring and evaluating the scheme are crucial components of Mission Indradhanush.

Background:

The World Health Organization (WHO) pegs India’s vaccine coverage at less than 80%. The government is targeting to immunise 90% of infants by 2020 under its ambitious nationwide immunisation drive.

Editorials, GS-3, Science & Tech, Uncategorized

Enter the superbug?

Article Link

Summary:

Researchers have found a person in the United States carrying bacteria resistant to antibiotics of last resort. This has caused alarm among public health and infectious disease experts.

  • The person was carrying coli bearing a new gene, mcr-1, which is resistant to even colistin, the last available antibiotic that works against strains that have acquired protection against all other medication.

What’s the main concern now?

Over the long term, experts are very worried that colistin resistance, which can spread easily to other bacteria, could lead to superbugs that could cause untreatable infections. Also, mcr-1 poses a threat of an entirely different order. In this case a small piece of DNA (plasmid) found outside the chromosome carries a gene responsible for antibiotic resistance. Since the gene is found outside the chromosome, it can spread easily among different types of bacteria, as well as among patients. The mcr-1 gene has been reported in other countries, including the United Kingdom in 2008.

Background:

The mcr-1 gene was first identified in China in November 2015, following which there were similar reports from Europe and Canada. The unchecked use of antibiotics in livestock is a major reason for the development of drug resistance. Indeed, given the widespread use of colistin in animals, the connection to the drug-resistant mcr-1 gene appears quite clear.

Also, according to a report, a significantly higher proportion of mcr-1 positive samples was found in animals compared with humans, suggesting that the mcr-1 gene had emerged in animals before spreading to humans. Besides being administered for veterinary purposes, colistin is used in agriculture.

What is a superbug?

A superbug, also called multiresistant, is a bacterium that carries several resistance genes. These are resistant to multiple antibiotics and are able to survive even after exposure to one or more antibiotics.

mcr1

 

What causes them to mutate like that?

Like any living organism, bacteria can mutate as they multiply. Also like any living organism, bacteria have a strong evolutionary drive to survive. So, over time, a select few will mutate in particular ways that make them resistant to antibiotics. Then, when antibiotics are introduced, only the bacteria that can resist that treatment can survive to multiply further, proliferating the line of drug-resistant bugs.

Why is Antibiotic Resistance a Big Deal?

The discovery of antibiotics less than a century ago was a turning point in public health that has saved countless lives. Although antibiotic resistance develops naturally with normal bacterial mutation, humans are speeding it up by using antibiotics improperly. According to a research, now, 2 million people a year in the US develop antibiotic-resistant infections, and 23,000 of them die of those infections.

Why is the medical community worried?

Basically, superbugs are becoming more powerful and widespread than ever. Medical experts are afraid that we’re one step away from deadly, untreatable infections, since the mcr-1 E.coli is resistant to that last-resort antibiotic Colistin. Antibiotic-resistance is passed relatively easily from one bacteria to the next, since it is transmitted by way of loose genetic material that most bacteria have in common.

The World Health Organization (WHO) is afraid of a post-antibiotic world, where loads of bacteria are superbugs. Already, infections like tuberculosis, gonorrhea, and pneumonia are becoming harder to treat with typical antibiotics.

What Can We Do?

First step would be to limit antibiotic use. If a patient has a virus, for instance, an antibiotic won’t work, so doctors shouldn’t prescribe antibiotics even if the patient insists. And when patients do need antibiotics, it’s important to make sure they take the full course to kill off every last infection-causing germ. Otherwise the strong survive, mutate, and spread. As a society, curbing antibiotic use in healthy animals used in human food production is another important step.

Recent developments:

According to few recent studies, nanotechnology holds the key to stopping antibiotic-resistant bacteria and the deadly infections they cause. Scientists have developed light-activated nanoparticles — each roughly 20,000 times smaller than the thickness of a single human hair and have shown in lab tests that these “quantum dots” are more than 90% effective at wiping out antibiotic-resistant germs like Salmonella, E. coli and Staphylococcus. With the emergence of this Colistin-resistant E.coli, the medical community is going to be working harder and faster to contain superbugs and develop new treatments for infections.

Conclusion:

The global community needs to urgently address the indiscriminate use of antibiotics in an actionable manner, and fast-track research on the next generation of drugs.

 

GS-1, Uncategorized

Alcohol prohibition

Recently elected Bihar government banning its sale and consumption to fulfil a key electoral promise.

Issue

  • Prohibition of alcohol

Consequences of alcohol consumption

  • Household impoverishment
  • Domestic violence
  • Premature mortality

Is prohibition of alcohol a sound move?

Prohibition is a very poor policy to address the consequences of alcohol abuse. No evidence.It has major negative implications :

  • Massive loss to the exchequer.
  • Criminalization of a majority of people who drink sensibly.
  • Criminalization of a large section of society right from the manufactures (will resort to illegal manufacturing), dealers (would resort to smuggling) and the consumers (would be forced to buy illegally).
  • This has a potential to result into a big nexus of smugglers, police ,politic. and bootleggers.

Prohibition of alcohol surprisingly has a serious ramification even on public health as poor people would resort to illegally brewed alcohol which is often poisonous and frequently results in deaths.

Prohibition in its true sense is rejected by most public health scientists who know this field, even the World Health Organisation does not recommend it.

There is lack of public health approach in India:

  • Government has permitted the shameless substitute advertising of alcohol by corporations, for example, through selling “bottled water” under the same brand names as their much better known alcoholic beverages.
  • Airline named after the most popular alcoholic beverage (Kingfisher)

What to do then if not prohibition?

India must not follow these archaic models of de-addiction. There are many other steps that could be taken:

  • Effective counselling interventions for those who wish to control their drinking.
  • Keeping a strong check on the proliferation of bootlegging and illegal manufacturing units.
  • Spreading awareness right from the schools and colleges about the problem of alcohol abuse

Conclusion

Though prohibition may appear to be a one stop solution to the problem of alcohol abuse

In fact there is no evidence to show that prohibition has ever had its intended impact.

Yes it will reduce alcohol consumption but it can do very little for domestic violence and premature mortality. It might pose more serious problems than it would tackle.

Editorials, Uncategorized

Cure for high medicine bills: A generics prescription law

Context

  • The central government is considering the introduction of a law to make it mandatory for the doctors to prescribe generic drugs

Why

  • So that everyone can access affordable medicines
  • from state-run Jan Aushadhi stores.

What is Jan Aushadhi stores?

  • ‘Jan Aushadhi’ is a campaign launched by the Department of Pharmaceuticals in association with Central Pharma Public Sector Undertakings, to provide quality medicines at affordable prices to the masses.
  • Jan Aushadhi stores have been set up to provide generic drugs, which are available at lesser prices but are equivalent in quality and efficacy as expensive branded drugs.
  • Generic medicines are unbranded medicines which are equally safe and having the same efficacy as that of branded medicines in terms of their therapeutic value.
  • The prices of generic medicines are much cheaper than their branded equivalent.

What is the future plan?

  • To set up 3,000 Jan Aushadhi stores across the country this year, current Union Budget promise.

Main issue.

  • A good chunk of Indian population is not able to afford the branded medicines which are priced very high.
  • Doctors doe not prescribe generic medicines and instead refer the branded counterparts.

Government proposed an ordinance or Act of Parliament

  • To ensure that doctors prescribe generic drugs or include a clause ‘or equivalent generic drug,’ when doctors prescribe a branded drug

The BPPI is responsible for implementing the Jan Aushadhi programme which was launched in 2008.

What is BPPI?

  • BPPI (Bureau of Pharma Public Sector Undertakings of India) has been established under the Department of Pharmaceuticals, Govt. of India, with the support of all the CPSUs for co-coordinating procurement, supply and marketing of generic drugs through the Jan Aushadhi Stores.

Main focus is accessibility, affordability and availability.

But if doctors will not prescribe generic drugs sales won’t take place.

Pharmacists should have the option to give the generic substitute

Reason for building jan Aushadhi stores?

  • Ex-factory cost of medicines are low
  • People get the drugs which are marked up multiple times owing to supply chain costs and incentives for medical representatives.
  • The Jan Aushadhi stores will be able to provide drugs at Rs. 19, if the ex-factory cost is Rs. 10. For which people are giving 100 rupees.

Solutions

  • Remembering a generic drug for combination drugs like PCM gets a little tricky.
    • create an IT-enabled prescription system that automatically includes the formulation of such drugs when a doctor prescribes a branded drug out of habit or because they don’t know the exact formulation
  • A law will be more effective than directives from the Medical Council of India asking doctors to write generic drug names.
  • State governments should asked to focus on buying generics drugs rather than expensive branded alternatives

Current position

  • Jan Aushadhi stores had opened in 16 States, and there are 283 stores in 22 States and Union Territories at present.
  • BPPI will set up ten times the existing number of stores this year.
  • Over 100 private pharma firms have enlisted to supply generic drugs.

Additional Points

Other initiatives taken by BPPI (Bureau of Pharma Public Sector Undertakings of India) to control the drug pricing are:

  • Price control of Scheduled Drugs through the National Pharmaceutical pricing authority (NPPA):Under the Drug Price Control Order, 1995, NPPA): Under the Drug Price Control Order, 1995, NPPA has been given the mandate to control and fix the maximum retail prices of a number of scheduled/listed bulk drugs and their formulations, in accordance with well defined criteria and methods of accounting, relating to costs of production and marketing .Notably therefore, the prices of these medicines have remained quite stable and affordable.
  • Price regulation of Non-Scheduled Drugs: Apart from the scheduled medicines under DPCO, 1995, the NPPA monitors the prices of other medicines not listed in the DPCO schedule, such that they do not have a price variation of more than 10% per annum. This has further helped in keeping the prices of most of the non-scheduled medicines stable and affordable.
GS-3, Uncategorized

Patents over patients

The U.S.-India Business Council (USIBC) to the U.S. Trade Representative (USTR) recently revealed that India has given private assurances to the US that it will not grant licences allowing local firms to override patents and make cheap copies of drugs by big Western drug makers.

Background:

It should be noted here that the USTR has placed India on its “priority watch” list for two years in a row saying the country’s patent laws unfairly favour local drug makers. A bone of contention has been a legal provision that allows the overriding of patents on original drugs and granting of ‘compulsory licences’ to local firms to make cheaper copycat medicines.

What is Compulsory Licensing (CL)?

CL is the grant of permission by the government to entities to use, manufacture, import or sell a patented invention without the patent-owner’s consent. Such licenses permit a third party to make, use, or sell a patented invention without the patent owner’s consent.

Laws governing such licenses:

India can grant such licences under certain conditions, such as public health emergencies, to ensure access to affordable medicines.

  • Under Indian Patent Act, 1970, the provision with regard to compulsory licensing is specifically given under Chapter XVI. The conditions which need to be fulfilled in order for a compulsory licence to be granted are also laid down under Sections 84 and 92 of the Act.
  • Under Section 84 (1) of the Indian Patent Act, any person may request a compulsory license if, after three years from the date of the grant of a patent, the needs of the public to be covered by the invention have not been satisfied; the invention is not available to the public at an affordable price; or the patented invention is not “worked in,” or manufactured in the country, to the fullest extent possible.
  • India’s National Manufacturing Policy (NMP) also supports the application of CL across different manufacturing sectors, more specifically to ensure access to the latest green technologies that are patented.
  • The NMP provides the “option” to entities such as the Technology Acquisition and Development Fund “to approach the government for issue of a CL for the technology which is not being provided by the patent holder at reasonable rates or is not being ‘worked in India’ to meet the domestic demand in a satisfactory manner.”
  • CL is also permitted under the WTO’s TRIPS (IPR) Agreement provided conditions such as ‘national emergencies, other circumstances of extreme urgency and anti-competitive practices’ are fulfilled.

Concerns over the recent assurance:

The disturbing word in the recent communication from the USIBC to the US Trade Representative is “privately”. This is related to Track II Diplomacy (Track II diplomacy refers to “non-governmental, informal and unofficial contacts and activities between private citizens or groups of individuals, sometimes called ‘non-state actors’. It contrasts with track I diplomacy, which can be defined as official, governmental diplomacy that occur inside official government channels).

  • Track II flourishes in diplomacy, but the idea of Track II policy is problematic. Policy must always be created and operated transparently, or government runs the risk of losing credibility.
  • Yet, the government appears to have offered a verbal, Track II-like reassurance on drug patents, which has found its way into the official record.
  • Technically, private assurance suggests that India is willing to pay heed to multinational requests to respect intellectual property and to protect incomes accruing from it, even if it amounts to disrespecting the right of its citizens to life and health.
  • Such an assurance also goes against the main spirit of Patents Act and the public health safeguards enshrined in it.

Natco’s case:

Based on section 84, Natco, an Indian generic manufacturer, applied for India’s first compulsory licence some years ago and convinced the patent office that Bayer’s patented drug for kidney cancer, Sorafenib Tosylate, was excessively priced and available to hardly 2% of patients.

  • In sharp contrast to Bayer’s Rs 2.8 lakh per month price tag, Natco offered to sell its version of the drug at Rs 8,800 per month.
  • The controller of patents granted a licence upon the payment of a 6% royalty rate to Bayer, ensuring this was not a zero-sum game but one that could potentially benefit the patent owner as well, given Natco’s knack of selling in markets beyond the ordinary purview of the high-priced patented drug.
  • Upon appeal by Bayer, the patent office decision was validated, with some minor modifications in royalty rates.

Unfortunately, despite this excellent start to the invocation of an important public health safeguard, no other licence has been granted since.

WTO’s view:

The WTO’s fourth ministerial conference in Doha in 2001 had adopted a declaration which balanced the imperative of national health against the transnational rights to intellectual property.

  • It established the primacy of the right of member nations to protect public health and promote access to medicines for all. It further clarified that each member has the sovereign right to decide the grounds for granting compulsory licences according to national interests, and implicitly did away with the need for an emergency or a situation of urgency, which are listed both in Trips and in the IPA.
  • The Indian government is, therefore, under no compulsion to put multinational interest ahead of the imperative of public health. It only needs to be fair in its policy — and transparent.

What needs to be done now?

World over, compulsory licensing is largely a matter of government discretion to be invoked at the government’s pleasure. However, in India, Section 84 makes clear it’s a legal entitlement that cannot be pimped away through private assurances to foreign friends. Rather, the government is obliged to adjudicate each application on merit, donning its robe as a quasi-judicial authority. The patent office must, therefore, be equipped with personnel vested with a fair degree of adjudicatory competence and independence.

  • If serious about its constitutional commitment to good health, the government must immediately formulate a legal framework to compel private parties to disclose drug and disease data.
  • Also, it must ensure quasi-judicial authorities (the patent office) remain relatively independent and are infused with sufficient training to ensure a fair, impartial and competent dispensation of justice.
GS-2, Social Issue, Uncategorized

A healthcare prescription

India’s economy is posting among the fastest growth rates globally

Without Aarogya Bharat, the benefits from faster growth will be seriously compromised.

 Morbidity cost to India:

  • Is estimated at $6 trillion between now and 2030
  • Three times today’s gross domestic product (GDP).

 Public health spending

  •  Around 1% (1.2 %)of GDP while overall
  • The country spends over 4% (~3.9%)~

Health system is geared towards secondary and tertiary care.

Primary care, which is significantly less costly, is unorganized and largely not covered by insurance.

Pathetic Situation

  • Out of pocket expenditure is health in nearly 60% of health expenditure, three times the global average.
  • Insurance penetration is just 25% overall.
  • short of 2 million beds and doctors and 4 million nurses.
  • Urban India accounts for around 30% of the population but has 80% of healthcare infrastructure.
  • The average Indian’s life expectancy is only 66 years versus 75 in China and 74 in Brazil.
  • Some states such as Kerala, where outcomes are five times better today, learning can be taken from there and from international best practices.

Points to focus:

  • Increase health care spending from 1% of GDP to atleast 2.5–3%.
  •  Focus on 100% vaccination.
  •  Government, nongovernment and the private sector—must declare war on NCDs.
  •  Citizens must be supported with universal health insurance for primary care.
  • Improve healthcare quality. The way ahead is through institutionalizing minimum standards for healthcare.
  •  unleash technology to increase access and affordability. Example are Swasthya Slate and 3nethra.
  • Telehealth can expand reach and help scale scarce clinical talent, while mobile health can engage the population and improve adherence.
  • The private sector should also be key in enhancing the effectiveness of public infrastructure via public-private partnerships.
GS-2, Social Issue, Uncategorized

Why India’s healthcare system needs an overhaul

1) A weak primary healthcare sector-

In 2015, there was one government hospital bed for every 1,833 people compared with 2,336 persons a decade earlier but its not uniformally distributed. For instance, there is one government hospital bed for every 614 people in Goa compared with one every 8,789 people in Bihar.

web_plainfacts_chart_1

2) Unequally distributed skilled human resources-

In community health centres in rural areas of many states, ranging from Gujarat to West Bengal, the shortfall of specialists exceeds 80%.

web_plainfacts_chart_2

3) Large unregulated private sector-

The National Sample Survey Office (NSSO) numbers show a decrease in the use of public hospitals over the past two decades—only 32% of urban Indians use them now, compared with 43% in 1995-96.

Moreover, “the many new institutions set up in the past decade… encouraged by commercial incentives, have often fuelled corrupt practices and failed to offer quality education”,

4) Low public spending on health-

Even though real state expenditure on health has increased by 7% annually in recent years, central government expenditure has plateaued. Economically weaker states are particularly susceptible to low public health investments.

The 14th finance commission recommendations, which will transfer a greater share of central taxes to states, offers an opportunity for the latter to increase investments in health.web_plainfacts_chart_4

5) Fragmented health information systems- 

Data is incomplete (in many cases it excludes the private sector) and many a time, it’s duplicated.

6) Weak governance and accountability-

“In the past 5 years, the government has introduced several new laws to strengthen governance of the health system, but many of these laws have not been widely implemented,” said Lancet. In some instances, the “scope of (some) regulations is still unclear, and there are fears that these laws have hindered public health trials led by non-commercial entities”.

“At the heart of these constraints is the apparent unwillingness on the part of the state to prioritize health as a fundamental public good, central to India’s developmental aspirations, on par with education. Put simply, there is no clear ownership of the idea of universal health coverage within the government,”

web_plainfacts_chart_7

 

GS-2, Social Issue, Uncategorized

Invest in health

A recently conducted study highlighted that India spends very little on health: $215 in terms of purchasing power parity per person, which is lower than comparable middle-income countries such as China, Brazil and South Africa. The study also notes that the majority of this spending is made directly by Indian households. Such out-of-pocket payments for healthcare can cause severe financial hardship and impoverishment.

  • In recent years, there has been a strong political commitment to treating health as a social goal either through legislation or mandating and prioritizing expenditure on health. The push by the Indian government for universal health coverage in this regard is commendable.

But while spending more on health is essential in India, value for money also needs to be demonstrated. According to OECD, additional expenditure places pressure on already scarce resources. Then, how can we tackle this problem?

  • Some of the most successful examples of expanding coverage among middle-income countries in recent years have addressed this challenge by defining a limited set of essential, cost-effective services.
  • For example, Mexico’s Seguro Popular programme provided an explicit package of cost-effective interventions, including pharmaceuticals. Chile identifies about 70 essential services that are fully covered by public and private insurance.
  • This problem can also be tackled by allocating resources across geographic localities based on need. A number of OECD countries have been using this.
  • For example, in the UK, a weighted capitation formula that accounts for a locality’s socio-economic characteristics is used to equitably allocate funds to clinical commissioning groups (the units responsible for health services in specific localities).
  • Government can also resort to cost-effective interventions, such as preventive and primary care activities, rather than less cost-effective interventions, such as construction of new hospitals.

The underlying principle of the weighted capitation formula as demonstrated in the National Health Service is to distribute resources based on the relative needs of each area. This is to enable similar levels of healthcare for populations with similar needs, with the further objective of helping to reduce avoidable health inequalities.

g_chart5_web

Role of state governments:

Given India’s federal structure, special attention needs to be given to ensure that health remains a priority for states and Union territories.

  • In the backdrop of the 14th Finance Commission’s recommendation wherein the state’s share in the central divisible pool has been enhanced from 32% to 42%, a key challenge is to ensure that a sufficient level of funds transferred from the centre to states and Union territories is spent on health.
  • To this end, state governments should be incentivized to expand health coverage to the poor, focusing on cost-effective interventions.
  • State Governments also need to work closely together with the Centre so that minimum quality standards are maintained, and specialist resources are used efficiently.
  • Effective policies, which ensure that states and Union territories’ incremental spending goes to health, should be put in place.
  • Higher financial allocation will ease some of the chronic shortages but additionally government health care staff will have to do a lot better. This will require a significant improvement in the quality of state administrations which are responsible for the entire public-facing structure from the primary health centre to the district hospital.

Role of the Central Government:

The central government plays a stewardship role, and has a key planning and oversight role, with a consolidated national information infrastructure necessary to adequately monitor health outcomes, while the states are responsible for the implementation of programmes.

Conclusion:

Investing in the health system not only saves lives, it is also a crucial investment in the wider economy. This is because ill-health impairs productivity, hinders job prospects and adversely affects human capital development. The central government defining the minimum standards of care is an important first step in this direction. However, the implementation of minimum standards requires coordinated political will at both the central and state levels. Accountability mechanisms for healthcare outcomes and balancing responsibilities across central and local authorities are few steps which can be adopted in this regard.