India'shealthissuesandchallenges

utterneglectofpopulationstabilizationwhereitmattersmost. Monopolythatanelitistmedicalhierarchyhasexercisedforover60yearson healthmanpowerplanning.>hasgivenasystemwherehightechspecialityservicesare

valuedandrenumeratedfarhigherthanthedeliveryofpublicservices.

Howtomakesuredoctorsservethegrowingneedsofthepublicsectorwhenthe workingconditionsarerotten,meagreinfra...absenceofincentives/dis. Divergentattitudetowardsbirthcontrol. Reversalinattitudecozofemergencydrivensterilizationstakeplace. Thechallengeofreduchinmmrandimr.Innorthernstatealmost60%of marriagesareunderaged.....howcananalreadymalnourishedgirlgivebirthto many...eagstatesandassamaccountfor62%ofmmrdeaths.(~40%ofpop.) MCI,Dentalcouncil,pharmacycouncil,andnursingcounciltoelectfromac.s ofdoctorsandotherhealthproffesionalsdemocraticallyandtoentrustthemthe responsiblityfordesigningandexecutingprofessionalcourses.Butmoney politics.Highlycommercialisedentriesinto...andearningthemback.... questtoproducespecialistsandsuperspecialists.....andutterneglectofpublic health.... thechallengeofestablishingNCHRH seegoalsofhealthmanpowerplanning. Prescriptionofstandards(1.The
agency will also bring about overall transparency,

eliminating the present, allegedly corrupt admission formalities in the field of medical education. From the next academic year, i.e. 2011, onwards there will be a common MBBS entrance test (single PMT) 2.The second major change will be the National Exit Examination (Screening Test ) for students graduating from Indian medical colleges.)

Establishmentofaccreditionmechanisms.
The new draft proposes a National Committee for Accreditation and a National Medical Education and Training Board that will register and accredit medical colleges and prepare curricula for all streams of education in the health sector. The powers of the existing councils, including the

Medical Council of India, will be substantially reduced and they will deal only with licensing, continuing education and ethics. These bodies, though under the general supervision of the NCHRH, will be entirely independent in their structure and functioning

NRHMtriestoimprovethemonitoringandplanningprocessinvolvedwithinhealthcare.NRHMalso
aimstobringprivatesectorstohelpintheruralhealth[3]NationalRuralHealthMission(NRHM)isan IndianhealthprogramforimprovinghealthcaredeliveryacrossruralIndia.Themission,initiallymooted for7years(20052012),isrunbytheMinistryofHealth.Theschemeproposesanumberofnewmechanisms forhealthcaredeliveryincludingtraininglocalresidentsasAccreditedSocialHealthActivists(ASHA),[1] andtheJananiSurakshayYojana(motherhoodprotectionprogram).Italsoaimsatimprovinghygieneand sanitationinfrastructure.)

UNFPA(Theirworkinvolvestheimprovementofreproductivehealth;)reported75%inmpand orissa,50%raj.,bihar,up.Deliverieswereinpublichealthcentres. Worst part is in many talukas of northern states, phc's are bereft of doctors. And state govt. Taking ayush workers to post in phc.... but there level of capability should be settled.

Traditionalnutritionalvalue
coarsegrainslikejowar,bajra,maizealongwithmajorcerealslikericeandwheatusedto balancethenutritionalrequirementsoftheruralfolk. Butwhengreenrevolutionhappened,riceandwheatoccupiedthewholespace,andthislossof balanceddiet,disrupted....... thoughfoodsecuritywasachieved,reallyit'smaterializedonlywhenallthenutritionalneedsare met. Beforetherewere165waystofulfillnutritionalneeds...nowonly25....(ex:fishinodishaand coastalareas,milkinpunjabandharyanaetc.) ragiisanimportantsourceofcalcium.... 57%sufferfromirondefiency. 40%nutrientsshouldcomefromgrainsandremainingfromothersourceslikevegetables,milk, meatetc.,

Drugpricingandpharmapolicy
withinhealthcarethecostofmedicineisthemajorcostdriverwhichconstitutes nearly6070%oftotalhealthcarecost.
DepartmentofPharmaceuticals
The cabinet Secretariat on 2 July 2008, has notified creation of a new Department under Ministry of Chemicals and Fertilisers with the objective to give greater focus and thrust on the development of Pharmaceutical Sector in the country and to regulate various complex issues related to pricing and availability of medicines at affordable prices, research & development, protection of intellectual property rights and international commitments related to pharmaceutical sector which require integration of work with other ministries. There is also need for better coordination in the areas of pharmaceutical R&D and education and for international cooperation in these areas AllmattersrelatingtoNPPAincludingitsfunctionsofpricecontrolandmonitoring.
NPPA is an organization of the Government of India which was established, inter alia, to fix/ revise the prices of controlled bulk drugs and formulations and to enforce prices and availability of the medicines in the country, under the Drugs (Prices Control) Order, 1995. The organization is also entrusted with the task of recovering amounts overcharged by manufacturers for the controlled drugs from the consumers. It also monitors the prices of decontrolled drugs in order to keep them at reasonable leve

http://wcd.nic.in/ veryimportantinformationonnutritionandagoodknowledge
bank.

UniversalHealthCoverage

 Around70%oftotalhealthspendingisoutofpocket,andaround70%ofthatisondrugs. Poorpeoplegolessandlesstopublicfacilitiestowhichtheywouldgoearlierbecausethey almostneverhavethefreedrugstheyaresupposedtoprovide.Thisisagreatironyfora countrythathasgainedrespectinAfricaformakingdrugsaffordablethroughourexport ofgenericstothem.

UNIVERSALHEALTH PrimeMinisterManmohanSinghdeclaredinhisIndependenceDay addresson15August2011thathealthwouldbeaccordedthehighest priorityintheTwelfthFiveYearPlanwhichwouldbecomeoperationalinApril2012. Inthis,thereisanexpressionofintentthatthegovernmentwillincreasepublicspend ingonhealthto2.5%ofIndiasGDP. Thevisiontoprovideeverycitizenessentialprimary,secondaryandtertiary careservicesthatwillbeguaranteedbythecentralgovernmentunderthenational healthpackage(NHP)whichwillgivecovertoallcommonconditionsiswelcome. Therecommendationtoearmarkatleast70%oftheexpenditureforpreventive,promotiveand primaryhealthcarewillbeaverybeneficialstepforthepopulationofthecountry.
Creatingspecificpurpose,quasigovernmental,autonomousagenciesliketheTamilNaduMedicalServices Corporationwhichhasbeenprovidingefficientservicedeliveryatthe statelevelcanalsobelookedatasapossiblemodelatthenationallevel.Integrat ingallgovernentfundedhealthinsuranceschemesintotheUHCsystemalong withthestateruninsuranceprogrammesisinthecorrectdirection.
ThehealthcareservicescoveredundertheUHCareproposedtobeavailablethroughpublicsectorandcontractedinprivatefacilities, includingthoseprovidedbynonprofitorganisations.Twodifferentoptionsareproposed.

Thefirstoptionis:

1.toincludetheprivateprovidersintheUHCsystemandtoseethattheyprovideatleast75%of outpatientcareand50%ofinpatientcareonastandardisedrateandareimbursed mode.Suchserviceswillbeofferedcashlesstothecitizens.Howthissystemcanbemonitored, regulatedandqualityassuredirrespectiveofthelocation,caste,creedandeconomicstatusofthe deservingisaquestion. 2.ThesecondoptionseemstobeafacilitywhichwillprovideonlycashlessservicesundertheNHP andwillbefundedunderthescheme. Integratingpublichospitalsandtheprivateforprofitandnotforprofithospitalsto deliverasimilarqualityofcareinourcountrywillnotbeeasy.Whatwillhappen

ifprivatehealthcareproviderswhorender70%ofthecare,especiallyatthetertiary level,refusetoparticipateintheprogramme?Thiswillleavetheprogrammetobehandled entirelybythepublichospitals.Morethan60%oftheinpatientservicesinIndiaarenowprovided bytheprivatesector,moresoatthesecondaryandtertiarycarelevels. Manystatestodatedonothaveanylegislationwhichwouldmakeitmandatoryforprivate medicalestablishmentstoobtainalicencetofunction.Thelegislationthatisinexistenceis outdatedandirrelevantforcontemporaryconditions. Theminimumstandardsneededininfrastructure,humanresources, technology,theservicestoberenderedandthepricingofsuchserviceshavetobe addressedthroughlegislationthatwouldmakethemmandatoryforallmedical establishments. Thishastobedoneacrossthecountryinauniformmanner.Thegov ernmentshouldcomeoutwithalegislationtomakeallsuchstandardisedhospi talsintheprivatesectoracceptpatientsundertheNHPandmakeitmandatoryto allocateacertainpercentageofbedsfortheprogramme.Ifviablepackagesare offeredforprivateestablishmentsthenitwillbepossibletoimplementtheNHP. Theneedforcountryspecifictechnologyfromaviewpointofcost,qualityand efficacyiscompletelyabsentinthereport. Theuseofmedicaltechnologyofthewesternworldatcurrentlyavailablecostswill makemedicalcarephenomenallyexpensive.Weneedtohavetechnologywhichis relevantandservesthepurposeinanobjectivemanner,andcostsneedtobemuch lowerthaninthewesternworldmodels. . Thedreamofreducingoutofpocketspendingonhealthfromaround67%todaytoaround33%by 2022isagoalworthstrivingfor. Indiaisoneamongthedevelopingcountrieswherehouseholdsspend adisproportionateshareoftheirconsumptionexpenditureonhealthcare,withthe governmentscontributionbeingminimal. Almost75%ofexpenditureisoutofthepocketondrugs,whichdrawsattention tothecostcomponentandsuccessivegovernmentsfailuretoputinplacea systemofprovidingasolutioninthisdirectionandminimisingthecostofessential drugsespecially,throughregulatorymechanisms.Todate,thegovernment doesnothaveaclearpolicyofhowtoeliminatethemiddlemanbeteenthe manufacturerandthebuyerwheremuchofthecostescalationstakeplace. Simplesolutionsofpropagatinggenericdrugs,avoidingirrationalcombinations

andsettingupasystemofethicaluseofappropriatemedicinesbythemedical fraternityhavenotbeenconsidered. Spending70%ofthebudgetofUHConsuchactivitiesandprimaryhealthcare isacceptable.Theroleofpublicprivatepartnerships,nongovernmentalandnot forprofitorganisationsandcivilsocietycanbeverypromisingespeciallywhen corporatisationofhealthcarecanleadtoartificialcostescalationandundesirable healthpractices.Theemphasisoninvestingintheprimarycarenetworkalong withdevelopingacommunityawarenessofhealthandsanitation,holdingthe providersresponsibleforoutcomesathepopulationlevelanddevelopingnet workswiththesecondaryandtertiaryfacilitiesisintherightdirection. UHCcanbeachievedonlywhensufficientandsimultaneousattentionispaidtoat leastthefollowinghealthrelatedareas: (i)nutritionandfoodsecurity,(ii)water andsanitation,(iii)socialinclusion,and cleanenvironmentandhousing. ThirtyonepercentofurbanIndiansareestimatedtobeeitheroverweightorobese. Owingtothelargereproductivelyactivepopulationitisvitalthatinvestmentsin maternalandneonatalcareareplannedfor,asthisislikelytolastforseveral moredecadesbecauseofthesheersizeofthepopulation.Immunisationespecially becauseIndiaisatropicalcountryhasphenomenalbenefitsifvaccinepreventable diseasesaretakencareof. Tosumup, Theimplementationstrategyhasnotbeenclearlydefined. (3)IncreasinggovernmenthealthspendasapercentageofGDPfromthepresent1%to2.5% willmakeasignificantdifferenceonlyifthemodelofdeliveryismadeaccount ableand, transparent,andtherightkindofmonitorymechanismsareputinplace. (4)Increasinghumanresourcesinhealthsectoronawarfooting,notcompromising onthequalityofprofessionalsfromsuchinstitutions,minimisingtheruralurban, andtheregionaldifferencesindistributionofmedicalcollegesacrossthecountrywill increasethestandardofhealthcaredeliverymultifold. (5)Thestakeholdersrolesindeliveryofcareandmonitoringmecha nismshavenotbeenelaboratedintheHLEGreport. Usinggenericdrugsandhavingatightcontrolonpricingwillminimisehealthcarecosts. Lowcosttechno logy inmedicalindustryshouldbeencoured;thiswillindirectlyhavean impactontertiarycarecostswheretechnologycostsarehigh.

Eliminatinginsuranceinhealthcareotherthanforuniversalhealthcarewillbetheideal situation. Emphasisingupgradationofmedicalknowledgeregularlyandinculcatingethicalpractices throughproperpracticeguidelinesandprotocoldrivencarewillalsoaddtobetteroutcomes especiallyintertiarycarefacilities. (10)Ifthenationalhealthentitlementcardisgoingtoensurecashlesstransactionanywherein thecountry,adramaticimpactonthehealthofthemostvulnerablethenomadicclass(mi grantpopulationworkinginunorganisedsector)willbeseen. (11)TheHLEGreportisdevoidofanydisruptiveinnovations,withreferencetoaccountability, qualityofcareandoutcomes. consideredthediabetescapital