Tuesday, September 22, 2015

Access denied

                                           Sopan Correspondent
India lags behind on health goals such as maternal and infant mortality and
sanitation, the basic premise for prevention of communicable diseases

Many in the country believed that India's economic progress so far has failed to bring about the desired improvement in health services in the country. The gap between the rich and the poor in terms of access to health services is most glaring, even bigger than that in the field of education. This reality to some extent has been accepted even by member of the newly constituted NITI Aayog Bibek Debroy, who had recently remarked that the country had lagged behind on health goals like maternal and infant mortality, as well as sanitation, which is the basic premise for prevention of communicable diseases. The communicable diseases account for more than 50 per cent of the total illness in the country.
Surveys reveal that India lags behind even Sri Lanka, Bangladesh and Nepal on many fronts including infant mortality rate, child immunisation rate and even life expectancy. Even as private urban tertiary care centres vie for global medical tourism, the stark failure of basic public health services profiles the paradox of India's health system.
 Even as India is considered to be a global pharmacy hub for inexpensive generic drugs, the draft National Health Policy put out recently informs that over 63 million Indians face the threat of poverty each year due to unaffordable health care expenditure. Huge inter-state disparities in health indicators testify to the widely varying quality of health services across India.
 The 2015 deadline for meeting the Millennium Development Goals (MDG) targets turned the spotlight on the poorly performing health system. So there is an urgent need to resolutely revamp the health system to make it capable of delivering the targets set by the new health goal. So it is rightly said, "If we do not create the future, the present extends itself."
 Targets are desired to be achieved by 2030, which include reduction in maternal mortality to less than 70 per 100,000 live births (India is at 178 now); end preventable deaths of newborns and under-five children; end the epidemics of HIV, TB, malaria and neglected tropical diseases; reduce by one-third premature mortality from non-communicable diseases (deaths before 70 years from cardiovascular and chronic respiratory diseases, cancers and diabetes); halve deaths and injuries from road traffic accidents; provide universal health coverage, including financial risk protection, and access to essential medicines and vaccines to all; universal access to sexual and reproductive health services; substantially reduce harm from hazardous chemicals and pollution of air, water and soil.
 Thus the target as desired by the goal set by the UN, sets the agenda to make health as the core of the development efforts. Even as India's aspirational draft national health policy document of 2015 awaits an uncertain fate, with health remaining at the fringe of budgetary priorities, the SDG for health provides a road map of what a caring society must aim to achieve for its people.
 Can India do it? Yes India can do with the right mix of investment, innovation and integrity. Public financing of health
must rise, in central and state budgets, to invigorate primary health services, strengthen district hospitals and expand the health work force. Essential health services, drugs and diagnostics must be provided without financial burden, through a system of universal coverage. Different streams of health financing must be channelled into a single payer system that procures quality care as a cashless service from a mix of providers.  Several successful models exist across the world to show that a fine balance of economy, efficiency and equity can be achieved by health systems which are configured for universal health coverage. The broad framework has to be common across states, with enough room for context-specific modifications. No Indian should be denied needed health care wherever he or she may reside, work or travel in the country.
Innovation, in the face of physician non-availability in many rural areas and disorganised urban primary health services, calls for technology-enabled nurse practitioners and community health workers to provide frontline services and chronic continuous care in community settings. Auxiliary nurse midwives, armed with android tablets configured with an array of diagnostic tests and decision support systems, are now working in six districts of Jammu and Kashmir to transform maternal and child health services. Mobile phones have become powerful tools in the home management of diabetes and hypertension. Telemedicine and mobile medical units are bridging distance to improve access. As the role of allied health professionals is expanded, millions of young persons, especially women, can be gainfully employed, invigorating both health and the economy. Indian systems of healing too can help to reduce unmet health care needs.
This action agenda requires political commitment to a vision that values health as a societal imperative for accelerated, sustainable and equitable development. It also calls for integrity in delivering that vision through good governance which optimally utilises health system resources. This involves rational and transparent priority setting, corruption free procurement processes, standard management guidelines, robust regulatory systems and timely monitoring and evaluation. The malaise of purchased seats in medical colleges and the dubious role of councils that regulate health professional education has been debated for long, even before Vyapam shocked the nation. It calls for grit and guts on the part of policymakers to clean these Augean stables.
Moreover, India has rightly been defined as a nation which lives in its villages and thus it mirrors its economy and well being. Nation's development is essentially the development of its people and so it is imperative for the government to make human development an inseparable component of the overall well-being of mankind.
India bears the load of roughly 17.5 percent of the global population and one-fifth of the world's share of all diseases and nutritional disorders.  Apart from this, one cannot deny the fact that India has achieved truckloads in advancing healthcare and overall health standards over the past six decades.
Public financing of healthcare sector and budgeting schemes for a healthy rural India is paramount. After all, access to healthcare is essentially dependent on how healthcare has been financed. The Union budget for 2015-16 allocated no more than Rs33,152 crores to finance the health sector. It is not that enough as it is only about one percent of GDP.
The policy makers now need to realise that the greater the proportion of public investments, the greater the access provided to crucial healthcare services. It comes off as no surprise that a nation that spends only a minuscule proportion of its total social sector expenditure on healthcare is failing equity in access to very basic healthcare services vis-à-vis other developing countries developing nations.
However, the recent initiatives for developing our healthcare have been satisfactory. The "Swachch Bharat Abhiyan" launched with much fanfare on October 2, 2014, which aims at attaining an open-defecation-free India by October 2, 2019 is quite a welcome idea. It aims at providing hassle free access to toilet facilities to all households in villages as also initiating solid waste management activities at Panchayat level to augment hygiene.
Thus, there needs to be a calibrated focus to address disparities in budgetary allocations, disparities within and among states and regions, there is an inevitable need to bring health services under the umbrella of universal health coverage.

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