India Health Policy Change
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Health policy break through in India: by dr joy banerjee; [email protected]
2009
Title of the paper : SARV JAN SWASTH JAN ; going back to past to reengineer the future. Executive summary : Birth, death, old age and disease are the four most inevitable things to any organism starting from the smallest unicellular to the most complex and highly evolved Homo sapiens. But in the race for advanced technological expertise we have enormously lost to understand it lost on the basic front of living. i.e. living a healthy long life. Is all this advancement of any use when the majority of the world’s population has to struggle for the basic bare minimum.? Even an animal manages to carry out 4 basic activities of life and i.e. eating, mating, sleeping and defending with ease but we humans have failed to do so. And in an attempt to gain it we have compromised the health and welfare of masses. Health which is supposedly to be a common wealth to all is increasingly becoming a priced and rare possession and by far everyone is only apparently healthy. Thus there is an urgent need felt of going back to basics and of a policy to make health for all a reality, “SARV JAN SWASTH JAN”. the simple policy we need is to bring health and fitness to the forefront and promote all that directly and indirectly promotes health. Health by definition is spiritual, mental, physical and socio economic well being of an individual and not merely absence of disease. ! Background and Context and importance of the problem : One of the best ways to judge the well being of the people of any nation is by examining the standards of health that ordinary people have attained. Healthy living conditions and access to good quality health care for all citizens are not only basic human rights, but also essential prerequisites for social and economic development. Hence it is high time that people’s health is given priority as a national political issue. But surprisingly the present statistics show some grave signals. : 1) Infant and Child mortality snuffs out the life of 22 lakh children every year, more serious is the fact that the rate of decline in Infant Mortality, which was significant in the 1970s and 80s, has slowed down in the 1990s.Three completely avoidable child deaths occur every minute. If the entire country were to achieve a better level of child health, for example the child mortality levels of Kerala, then 18 lakh deaths of under-five children could be avoided every year. 2) The four major killers (lower respiratory tract infection, diarrheal diseases, perinatal causes and vaccine preventable diseases) accounting for over 60% of deaths under five years of age are entirely preventable through better child health care and supplemental feeding programs. The most recent estimate of complete immunization coverage indicates that only 54% of all children under age three were fully protected.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
3) About 5 lakh people die from tuberculosis every year, and 20 lakh new cases are added each year, to the burgeoning number of TB patients presently estimated at around 1.40 crore Indians ! 4) India is experiencing a resurgence of various communicable diseases including Malaria, Encephalitis, Kala azar, Dengue and Leptospirosis. The number of cases of Malaria has remained at a high level of around 2 million cases annually since the mid eighties. Environmental and social dislocations combined with weakening public health systems have contributed to this resurgence. 5) Diarrhoea, dysentery, acute respiratory infections and asthma continue to take their toll because we are unable to improve environmental health conditions.. 6) Cancer claims over 3 lakh lives per year and tobacco related cancers contribute to 50% of the overall cancer burden, which means that such deaths might be prevented by tobacco control measures. 7) Estimates of mental health show about 10 million people suffering from serious mental illness, 20-30 million having neuroses and 0.5 to 1 percent of all children having mental retardation2 . One Indian commits suicide every 5 minutes. 8) The growing inequalities in health and health care are unjust! The WHO. standard for expenditure on public health is 5% of the GDP. The average spending today by Less Developed Countries is 2.8 % of GDP, but India presently spends only 0.9% of its GDP on public health, which is merely one-third of the less developed countries’ average. Aims and objective of the policy.
To look at health of an individual in a holistic way and wellbeing as all around growth of the society.
To promote all such activities which will involve intensified and regulated physical activity and community brotherhood and partnership.
To bridge the gap between reviving health care and beyond reach expensive medical care.
To gather common consensus and representation from all age group of society and sexes for health related decisions.
To promote community multi religious institutions and encourage liberal discussions to enlighten all sections of society to improve their spiritual quotient and help individuals to realize their important purpose of life.
To promote that spirituality without scientific stand is fanatic and scientific understanding without spiritual understanding is madness.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
To effectively remove health related myths and inculcate health as a dynamic and continuous response of the body and mind from the intense and ongoing continuous interaction between the internal and external environment of the body.
To institutionalise other systems of medicines which have been holistic cost effective n stood the test of time and different types of disease.
To bring about increasing awareness on primary health services and involve community in Continuous Community Health Care Education at neighbourhood level.
To bring under law all medical and paramedical practioners by auditing and introducing renewable Medical Practioner’s licenced every 5 years.
Recommendations including strategies and mechanism of implementation. : The policy has to be laid in 3 steps. Education, Motivation, Application. Education : will come when inter personal myths will go. This can be removed by organizing functional clusters of different people for a single cause. Launching a 3 stage plan at the level of school, neighbour hood community and work place.
At school : compulsory health and hygiene education from nursery to class 10 th and encouragement to community work. All the schools should dedicate fixed hours to the neighbour hood work and encourage parent guardian partnership to mobilize people n bring awareness.
At neighbourhood : HAMARA SAATH DO, an elected body comprising compulsory of 10% senior citizen, 10% teenagers, 20% women and a flexible but compulsory percentage of SC/ ST. This body will look into mainly proper sanitation and organize neighbourhood
health camps
and educations camps by inviting
lecturers / professionals from field of health. The idea is to convey the long lost valuable possession of health knowledge to the common people. The elected body will be re-elected on six monthly basis. And will be receiving community health funds partly from local government and part from generous voluntary contribution from the neighbourhood. At the end of three months a tri monthly letter should be published consisting of the present statistics and audit of the team.
At work-place : positive incentive be given to those who are physically fit and maintain a regular check up. Organization should encourage vertical and horizontal association among employees. The government should recognise such work stations with maximum number of healthy people. In regards to hazardous work the employer should mandatorily increase the health insurance and give benefits on yearly basis with rotation of job if possible.
Motivation :
Health policy break through in India: by dr joy banerjee; [email protected]
2009
Launching of health insurance at neighbourhood level will take care of the person’s in need and such people be given naming it as JEEVAN RAKSHA.
Pan health insurance for geriadritic and paediatric group. The neighbour hood to take the responsibility for the welfare of senior citizen and toddlers by pooling of resources with proportionate contribution from the beholders and the able ones.
Sports a missing event from our present life should be actively be introduced and all sorts of games should be encouraged among people. This would require immense investments from the government but can be maintained on PPP basis naming it as KHEL KHEL MEIN.
The local government should create service enthusiasm amongst medical staff by appreciating all those who can create a rapport outside the hospital with the probable patients. The staff should perform such exercise during duty hours and be encouraged by authorities. Best performing hospitals to receive higher recognition.
APkE SAATH APkE HATH an initiative to train on short term basis the young adults to learn certain important health and supportive care methods and they be maintained by the community. To bring homogeneousness they should go to nearest big public hospital n be trained under special teaching staff assigned for the purpose.
Application : This will take care of the main issues in hand. The idea is to converge and decentralize the health care from being a doctor centric institutionalized industry to community based free for all effort. PRAN .i.e. Primary Resurrection and Application Network. The major parts of aims and objectives will see the light of the day through this PRAN. Not only this will hold the medical staff responsible for re mewing their licence but make sure the doctor’s in private practice give regular community service. PAY or PLAY will extract a % contribution from the doctor adding to the community health fund in case he misses out his service. The community in return should provide the doctor with area and assistance to carry out his work. Also community should visit the nearest doctor and register. The quacks are not always harmful and should be considered as a strategic pawn in this initiative. The hospitals should have all three systems department and in case of absence the private prctioners should be allowed to help in. A governing body under the CMO should not only be the source of providing technical and administrative assistance but should also be a regulator to avoid mal practices. The statistics of different communities should be collected and authentic zed by him. Critique of the policy :
Health policy break through in India: by dr joy banerjee; [email protected]
2009
This policy is a long term and has to be implemented in stages. The education and motivations should begin first and has to be constantly maintained .
The clear demarcation of funds in community and different temperaments of community(s) is subject to thought.
There is great requirement of changes to be made at higher levels in health policy to incorporate PRAN and Community Insurance Scheme JEEVAN RAKSHA.
Changing the mind set, getting common consensus, preventing ulterior motives and trying to bring religious and socio cultural equilibrium will be a daunting task and shall always be a burning issue in Indian context.
Sources:
1. SRS Bulletin. Government of India.1998. 2. Planning Commission, Government of India. Tenth Five Year Plan 2002-2007. Volume II. 3. International Institute for Population Sciences and ORC Macro. National Family Health Survey (NFHS-II) 1998-99. India. 4. International Institute for Population Sciences. RCH-RHS India 1998-1999. 5. National Crime Records Bureau. Ministry of Home Affairs. Accidental Deaths and suicides In India 2000. 6. World Health Organization. The World Health Report 2003. 7. International Institute for Population Sciences. Facility Survey.1999. 8.
Misra, Chatterjee, Rao. India Health Report.Oxford University Press, New Delhi.2003 9.
Morbidity and Treatment of Ailments. NSS Fifty second round. Government of India. 1998. 10. Changing the Indian Health System – Draft Report, ICRIER, 2001 11. Shariff Abusaleh. India Human Development Report.Oxford University Press New Delhi. 12. Duggal,Ravi. Operationalizing Right to Healthcare in India. Right to Healthcare, Moving from Idea to Reality. CEHAT Mumbai.2003. 13. National Coordination Committee for the Jana Swasthya Sabha. Health for All NOW. 2004.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
14. Central Bureau of Health Intelligence.Directorate General of Health Services, Ministry of Health and Family Welfare. Health Information of India 2000 &2001. 15. National Sample Survey Organization. Department of Statistics.GOI.42nd and 52nd Round. 16. Census of India 2001: Provisional Population Totals.Registrar General and Census Commissioner GOI.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
2009
Title of the paper : SARV JAN SWASTH JAN ; going back to past to reengineer the future. Executive summary : Birth, death, old age and disease are the four most inevitable things to any organism starting from the smallest unicellular to the most complex and highly evolved Homo sapiens. But in the race for advanced technological expertise we have enormously lost to understand it lost on the basic front of living. i.e. living a healthy long life. Is all this advancement of any use when the majority of the world’s population has to struggle for the basic bare minimum.? Even an animal manages to carry out 4 basic activities of life and i.e. eating, mating, sleeping and defending with ease but we humans have failed to do so. And in an attempt to gain it we have compromised the health and welfare of masses. Health which is supposedly to be a common wealth to all is increasingly becoming a priced and rare possession and by far everyone is only apparently healthy. Thus there is an urgent need felt of going back to basics and of a policy to make health for all a reality, “SARV JAN SWASTH JAN”. the simple policy we need is to bring health and fitness to the forefront and promote all that directly and indirectly promotes health. Health by definition is spiritual, mental, physical and socio economic well being of an individual and not merely absence of disease. ! Background and Context and importance of the problem : One of the best ways to judge the well being of the people of any nation is by examining the standards of health that ordinary people have attained. Healthy living conditions and access to good quality health care for all citizens are not only basic human rights, but also essential prerequisites for social and economic development. Hence it is high time that people’s health is given priority as a national political issue. But surprisingly the present statistics show some grave signals. : 1) Infant and Child mortality snuffs out the life of 22 lakh children every year, more serious is the fact that the rate of decline in Infant Mortality, which was significant in the 1970s and 80s, has slowed down in the 1990s.Three completely avoidable child deaths occur every minute. If the entire country were to achieve a better level of child health, for example the child mortality levels of Kerala, then 18 lakh deaths of under-five children could be avoided every year. 2) The four major killers (lower respiratory tract infection, diarrheal diseases, perinatal causes and vaccine preventable diseases) accounting for over 60% of deaths under five years of age are entirely preventable through better child health care and supplemental feeding programs. The most recent estimate of complete immunization coverage indicates that only 54% of all children under age three were fully protected.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
3) About 5 lakh people die from tuberculosis every year, and 20 lakh new cases are added each year, to the burgeoning number of TB patients presently estimated at around 1.40 crore Indians ! 4) India is experiencing a resurgence of various communicable diseases including Malaria, Encephalitis, Kala azar, Dengue and Leptospirosis. The number of cases of Malaria has remained at a high level of around 2 million cases annually since the mid eighties. Environmental and social dislocations combined with weakening public health systems have contributed to this resurgence. 5) Diarrhoea, dysentery, acute respiratory infections and asthma continue to take their toll because we are unable to improve environmental health conditions.. 6) Cancer claims over 3 lakh lives per year and tobacco related cancers contribute to 50% of the overall cancer burden, which means that such deaths might be prevented by tobacco control measures. 7) Estimates of mental health show about 10 million people suffering from serious mental illness, 20-30 million having neuroses and 0.5 to 1 percent of all children having mental retardation2 . One Indian commits suicide every 5 minutes. 8) The growing inequalities in health and health care are unjust! The WHO. standard for expenditure on public health is 5% of the GDP. The average spending today by Less Developed Countries is 2.8 % of GDP, but India presently spends only 0.9% of its GDP on public health, which is merely one-third of the less developed countries’ average. Aims and objective of the policy.
To look at health of an individual in a holistic way and wellbeing as all around growth of the society.
To promote all such activities which will involve intensified and regulated physical activity and community brotherhood and partnership.
To bridge the gap between reviving health care and beyond reach expensive medical care.
To gather common consensus and representation from all age group of society and sexes for health related decisions.
To promote community multi religious institutions and encourage liberal discussions to enlighten all sections of society to improve their spiritual quotient and help individuals to realize their important purpose of life.
To promote that spirituality without scientific stand is fanatic and scientific understanding without spiritual understanding is madness.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
To effectively remove health related myths and inculcate health as a dynamic and continuous response of the body and mind from the intense and ongoing continuous interaction between the internal and external environment of the body.
To institutionalise other systems of medicines which have been holistic cost effective n stood the test of time and different types of disease.
To bring about increasing awareness on primary health services and involve community in Continuous Community Health Care Education at neighbourhood level.
To bring under law all medical and paramedical practioners by auditing and introducing renewable Medical Practioner’s licenced every 5 years.
Recommendations including strategies and mechanism of implementation. : The policy has to be laid in 3 steps. Education, Motivation, Application. Education : will come when inter personal myths will go. This can be removed by organizing functional clusters of different people for a single cause. Launching a 3 stage plan at the level of school, neighbour hood community and work place.
At school : compulsory health and hygiene education from nursery to class 10 th and encouragement to community work. All the schools should dedicate fixed hours to the neighbour hood work and encourage parent guardian partnership to mobilize people n bring awareness.
At neighbourhood : HAMARA SAATH DO, an elected body comprising compulsory of 10% senior citizen, 10% teenagers, 20% women and a flexible but compulsory percentage of SC/ ST. This body will look into mainly proper sanitation and organize neighbourhood
health camps
and educations camps by inviting
lecturers / professionals from field of health. The idea is to convey the long lost valuable possession of health knowledge to the common people. The elected body will be re-elected on six monthly basis. And will be receiving community health funds partly from local government and part from generous voluntary contribution from the neighbourhood. At the end of three months a tri monthly letter should be published consisting of the present statistics and audit of the team.
At work-place : positive incentive be given to those who are physically fit and maintain a regular check up. Organization should encourage vertical and horizontal association among employees. The government should recognise such work stations with maximum number of healthy people. In regards to hazardous work the employer should mandatorily increase the health insurance and give benefits on yearly basis with rotation of job if possible.
Motivation :
Health policy break through in India: by dr joy banerjee; [email protected]
2009
Launching of health insurance at neighbourhood level will take care of the person’s in need and such people be given naming it as JEEVAN RAKSHA.
Pan health insurance for geriadritic and paediatric group. The neighbour hood to take the responsibility for the welfare of senior citizen and toddlers by pooling of resources with proportionate contribution from the beholders and the able ones.
Sports a missing event from our present life should be actively be introduced and all sorts of games should be encouraged among people. This would require immense investments from the government but can be maintained on PPP basis naming it as KHEL KHEL MEIN.
The local government should create service enthusiasm amongst medical staff by appreciating all those who can create a rapport outside the hospital with the probable patients. The staff should perform such exercise during duty hours and be encouraged by authorities. Best performing hospitals to receive higher recognition.
APkE SAATH APkE HATH an initiative to train on short term basis the young adults to learn certain important health and supportive care methods and they be maintained by the community. To bring homogeneousness they should go to nearest big public hospital n be trained under special teaching staff assigned for the purpose.
Application : This will take care of the main issues in hand. The idea is to converge and decentralize the health care from being a doctor centric institutionalized industry to community based free for all effort. PRAN .i.e. Primary Resurrection and Application Network. The major parts of aims and objectives will see the light of the day through this PRAN. Not only this will hold the medical staff responsible for re mewing their licence but make sure the doctor’s in private practice give regular community service. PAY or PLAY will extract a % contribution from the doctor adding to the community health fund in case he misses out his service. The community in return should provide the doctor with area and assistance to carry out his work. Also community should visit the nearest doctor and register. The quacks are not always harmful and should be considered as a strategic pawn in this initiative. The hospitals should have all three systems department and in case of absence the private prctioners should be allowed to help in. A governing body under the CMO should not only be the source of providing technical and administrative assistance but should also be a regulator to avoid mal practices. The statistics of different communities should be collected and authentic zed by him. Critique of the policy :
Health policy break through in India: by dr joy banerjee; [email protected]
2009
This policy is a long term and has to be implemented in stages. The education and motivations should begin first and has to be constantly maintained .
The clear demarcation of funds in community and different temperaments of community(s) is subject to thought.
There is great requirement of changes to be made at higher levels in health policy to incorporate PRAN and Community Insurance Scheme JEEVAN RAKSHA.
Changing the mind set, getting common consensus, preventing ulterior motives and trying to bring religious and socio cultural equilibrium will be a daunting task and shall always be a burning issue in Indian context.
Sources:
1. SRS Bulletin. Government of India.1998. 2. Planning Commission, Government of India. Tenth Five Year Plan 2002-2007. Volume II. 3. International Institute for Population Sciences and ORC Macro. National Family Health Survey (NFHS-II) 1998-99. India. 4. International Institute for Population Sciences. RCH-RHS India 1998-1999. 5. National Crime Records Bureau. Ministry of Home Affairs. Accidental Deaths and suicides In India 2000. 6. World Health Organization. The World Health Report 2003. 7. International Institute for Population Sciences. Facility Survey.1999. 8.
Misra, Chatterjee, Rao. India Health Report.Oxford University Press, New Delhi.2003 9.
Morbidity and Treatment of Ailments. NSS Fifty second round. Government of India. 1998. 10. Changing the Indian Health System – Draft Report, ICRIER, 2001 11. Shariff Abusaleh. India Human Development Report.Oxford University Press New Delhi. 12. Duggal,Ravi. Operationalizing Right to Healthcare in India. Right to Healthcare, Moving from Idea to Reality. CEHAT Mumbai.2003. 13. National Coordination Committee for the Jana Swasthya Sabha. Health for All NOW. 2004.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
14. Central Bureau of Health Intelligence.Directorate General of Health Services, Ministry of Health and Family Welfare. Health Information of India 2000 &2001. 15. National Sample Survey Organization. Department of Statistics.GOI.42nd and 52nd Round. 16. Census of India 2001: Provisional Population Totals.Registrar General and Census Commissioner GOI.
Health policy break through in India: by dr joy banerjee; [email protected]
2009
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