The National Health Policy 2017 was notified last week. Coming 15 years after its predecessor, it presented an opportunity to do things differently. First, the recognition that strong state intervention is needed to control the surge of diabetes, heart and respiratory diseases hasn’t come a day too soon. With early screening and diagnosis becoming a public responsibility, the lives of millions of Indians could be saved from debilitating illness and premature death. This shift in emphasis is noteworthy.
Second, establishing a professionally-managed state public healthcare cadre makes eminent sense. A dedicated cadre of healthcare professionals can detect state-specific health hazards and contain them before they spread. The inclusion of professionals from sociology, economics, anthropology, nursing, hospital management and communication is a recognition of a multi-disciplinary approach and an acknowledgment that cultural attitudes must be understood if public health strategies are to gain community acceptance.
The third takeaway is the goal of pushing up male sterilisation “by 30 per cent and, if possible, much higher”. After Sanjay Gandhi’s blighted nasbandi programme, even the mention of male sterilisation made political parties, particularly in North India, squirm. Even after four decades, no politician was prepared to listen, leave alone act. Putting male sterilisation upfront also exhibits concern for the plight of women, who, after dealing with unwanted pregnancies and repeated childbirths, also undergo harrowing tubectomies. Thailand successfully made vasectomies into a routine affair more than 25 years ago. If six Indian states that account for almost half of India’s population and its annual growth, can incentivise (not coerce) men to limit family size by sterilisation, it could be a game changer.
The fourth good idea is piggy-backing medical and paramedical education on service delivery. Generations of health planners have been telling the Medical Council of India to factor in the ground realities that reduce the relevance of even the best medical curriculum. Indeed, students and patients would gain vastly if such facility-based training gets implemented.
The fifth half-positive takeaway is the recognition that AYUSH needs to be integrated into the research, teaching and therapeutic components of health systems; stressing that traditional systems need to back their claims with evidence is equally positive. But by repeating the unsuccessful strategy of appointing contractual AYUSH doctors in primary health facilities, the policy goes into reverse gear. AYUSH practitioners posted in PHCs do precious little traditional medicine and simply function as spare wheels or substitutes for allopathic doctors. That pads up manpower shortfalls but devalues the strength of AYUSH. Had the policy supported recognition of approved district specialty AYUSH centers for a host of chronic problems, lakhs of patients in search of reliable AYUSH treatment could have benefited.
The policy has neatly sidestepped some basic concerns. The Clinical Establishments Act 2010 was passed by Parliament with the aim of regulating clinical standards, both in the private and public health sector, and ending quackery. It has received scant backing from the state governments and was rejected by the Indian Medical Association. Instead of emphasising the importance of oversight of all medical establishments, the policy has soft-peddled by recommending mere “advocacy”.That leaves a hapless public at the receiving end of much care, malpractice and exorbitant treatment costs with no protection. Leaving health regulation up in the air with talk of yet another standard-setting organisation will not insulate consumers from exploitation.
The policy is also hazy about generating resources. One wonders whether the reference to medical tourism earnings and “a high degree of associated hospitality arrangements” implies a desire to tax hospitals that offer frills. This sounds egalitarian but could drive away the relative advantages that Indian medical tourism presents.
The policy places enormous reliance on the eighth standard-pass female volunteer, ASHA — the lynchpin of the National Rural Health Mission. But it does not even allude to how the poor, both in rural and urban areas, are driven by a desperation to overcome acute illnesses (that result in a loss of wages) to seek medical treatment from quacks, RMPs or self-styled doctors with no medical qualifications. Fluff about upgrading sub-centres or providing additional multipurpose workers does not confront the pervasiveness of RMPs or jhola chaap doctors who administer IV fluids, antibiotics and steroid injections with impunity. The policy shows no recognition of the magnitude of what is happening on the ground, even when a WHO report shows that unqualified medical practitioners constitute more than half the “doctors” in India. The WHO’s report is based on data provided by the Census office and the erstwhile Planning Commission. Recognising that they cannot be wished away, the West Bengal government has even embarked on training quacks “to cause less harm”. This problem is too pervasive to be ignored. The policy should have confronted it.
The policy has rightly explained why the time is not ripe to make health into a justiciable right. It is good that symbolism hasn’t held sway as it did with the impractical Right to Education Act. What is more important, however, is for the states to accept the policy and implement the law. It is time that registration, accreditation and regulation of clinical establishments and standards is put in the Constitution’s concurrent list in much the same way as drugs, food and medical education. Too much is at stake to be left to the states that often look the other way when it comes to maintaining critical health standards — this is something that ought to be non-negotiable.
The challenge now is to translate the policy’s stated noble intentions into schemes and programmes supported by the requisite financial backing. It is accountability that needs early deliverance.
The writer is former secretary, Department of AYUSH, government of India, and former chief secretary, government of Delhi
The recent decision to scrap the Public Health Foundation of India (PHFI)’s Foreign Contribution Regulation Act (FCRA) licence has stunned the public health community. Although the Foundation has had its share of detractors, it received patronage from the government, some of India’s richest industrialist-philanthropists and foreign organisations such as the Bill & Melinda Gates Foundation. Over the years, PHFI has also benefited from allotment of vast tracts of land and government support to establish state chapters.
The denial of FCRA permission to PHFI signifies a sudden fall from grace. While it is curtains for future foreign funding, it is important to examine what soured the milk. If, as has been reported, PHFI was cutting corners on FCRA conditions, it must get just deserts. However it seems that was not the primary reason for the retribution meted out by the ministry of home affairs, which grants FCRA clearances. The objection was: “[PHFI] used the contributions to lobby parliamentarians, the media and the government on tobacco control issues.”
How can doing tobacco control advocacy and that too at the behest of the ministry of health invite reprisal? Didn’t the MHA talk to the ministry of health before taking the step? Interdepartmental co-ordination is sacrosanct in the functioning of the government. Unfortunately, the fallout of PHFI’s FCRA cancellation has been an all-round perception that big tobacco has won. This exposes us to international criticism.
For decades the anti-tobacco movement has been spearheaded by the ministry of health and the World Health Organization (WHO). India is a signatory to the WHO Framework Convention on Tobacco Control. Despite incremental gains, India’s track record of controlling tobacco consumption has been abysmal. Tobacco deaths are rising and the sad part is that around half of those dying are among the illiterate.
The Indian Council of Medical Research data shows that 50% of cancers in men and 20% in women is due to tobacco use. India has another problem. Non-smoking tobacco is the greater cause of mortality and children and adolescents are falling prey to tobacco addiction. When every avenue should be pursued to build maximum awareness about tobacco use, we pride ourselves on being the second-largest consumer (275 million users) of tobacco products.
The government must clarify that it is dead against smoking and tobacco consumption by proactively encouraging anti-tobacco advocacy. And then to back it with fiscal and administrative measures that hurt enough to make a big difference.
Shailaja Chandra is former chief secretary, Delhi The views expressed are personal
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Guests: Siddharth Mishra, Consulting Editor, Millennium Post; Anil Verma, Head, ADR; Shailja Chandra, Former Chief Secretary of Delhi; RM Sinha, Advocate, Delhi Court
Anchor- Frank Pereira
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Desh Deshantar: Attacks on Doctors: gaps and issues in Heath care system
Guest: Shailja Chandra ,Former Secretary, Ministry of Health & Family Welfare GOI; Rajib Dasgupta, Professor, Centre of social Medicine And Community Health Social Sciences JNU; M. Wali, Sr Physician; Rakesh Kumar Gupta, President, Delhi Medical Association
Anchor: Arfa Khanum Sherwani
Air Date: March 30, 2017
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National Health Policy: what does it entail?
Guest: Abhijit Das, Director, Centre for Health and Social Justice;T.K.Rajalakshmi, Dy. Editor Frontline;Shailja Chandra -Former Secretary Ministry of Health & Family Welfare GOI;Rajib Dasgupta, Professor, Centre of social Medicine And Community Health Social Sciences, JNU;Abhijit Das, Director, Centre for Health and Social Justice
Anchor: Arfa Khanum
Air Date: March 17, 2017
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Published on 1 Jan 2017
Thanking people for their support and co-operation to his demonetisation drive, Prime Minister Narendra Modi on December 31 made a series of announcements reiterating his government’s focus on the welfare of farmers and the poor.
He was making a televised address to the nation on New Year’s eve and said he was grateful for the patience that people had shown amid a cash crunch that followed the ban on Rs 500 and Rs 1000 notes that he announced on November 8.
The decision was aimed at combating tax evasion and money laundering and the Prime Minister praised the people for working shoulder to shoulder with the government to defeat corruption.