New health policy is ‘preventive’: JP Nadda

New health policy is 'preventive': JP Nadda

Union Health Minister J P Nadda today said the new health policy of the government was “preventive and promotive”, unlike the previous one which was disease-centric.

“The reason to bring in a new health policy was that the previous health policy was focused on disease or it was disease-centric. It was more like working on urgent issues rather than important issues, so we decided to have a policy which will be preventive and promotive,” he said.

He was speaking at opening ceremony of ‘International Conference on Healthcare in a Globalising World’ at Symbiosis International University (SIU) here.

“The new policy is comprehensive and universal. With this new policy we will see to it that we go for early detection (of diseases),” the union minister said. The new policy mandates that all disciplines of medicine should come together, he said.

Homoeopathic treatment can cure allergies, Ayurvedic medicine can be preventive, while Yoga is helpful for living a long life, he said.

Referring to concerns expressed by Dr S B Majumdar, Symbiosis founder and Chancellor of SIU, regarding medical education, Nadda assured that government will try to make the medical education more affordable, accessible and “people- centric”.

No coordination between blood banks and hospitals, 6 lakh litres of blood wasted in five years

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In the last five years, over 28 lakh units of blood and its components were discarded by banks across India , exposing serious loopholes in the nation’s blood banking system.

If calculated in litres, the cumulative wastage of 6% translates to over 6 lakh litres —a volume enough to fill up 53 water tankers.

India faces, on average, a shortfall of 3 million units of blood annually. Lack of blood, plasma or platelets often leads to maternal mortality as well as deaths in cases of accidents involving severe blood loss.

Maharashtra, Uttar Pradesh, Karnataka and Tamil Nadu were among the worst offenders, discarding not just whole blood but even red blood cells and plasma as the life-saving components could not be used before their expiry date.

In 2016-17 alone, over 6.57 lakh units of blood and its products were discarded.

The worrying part is that 50% of the wasted units were of plasma, which has a shelf life of one year, much longer than the 35-day deadline by which whole blood and red blood cells have to be used. The spoilage has been laid bare in data provided by the National Aids Control Organisation (Naco) in response to an RTI query filed by petitioner Chetan Kothari.

Maharashtra, which is the only state to have crossed the one-million mark vis-a-vis collection of blood units, also accounted for the maximum wastage of whole blood, followed by West Bengal and Andhra Pradesh.

Maharashtra, UP and Karnataka bagged the top three positions in the wastage of red blood cells. UP and Karnataka also wasted the maximum units of fresh frozen plasma.

In 2016-17, over 3 lakh units of fresh frozen plasma were discarded, which is surprising given that the product is imported by several pharma companies to produce albumin.

Crusaders for safe blood blamed the crisis on the absence of a robust blood sharing network between banks and hospitals. Donation camps involving thousands of participants have particularly come under fire, with many blaming local politicians for using them as a tool to please constituents.

Dr Zarine Bharucha of the Indian Red Cross Society pointed out that a collection of up to 500 units was acceptable and manageable.

“But we have seen and heard of camps where 1,000 to 3,000 units are collected… Where is the place to store so much blood?” she added, “Why can’t people walk into regular banks and donate once every three months?” she said.

 Dr Satish Pawar, head of the directorate of health services in Maharashtra, said that the wastage could be attributed to a “noble health plan to curtail maternal deaths”.

“We have created more than 200 storage centres in interior areas for emergencies… We would rather be prepared to save a life than worry about unused units of blood,” he said. While Naco officials could not be reached for an official comment, a senior health ministry official told TOI that Naco had allowed banks to transfer units last year. “In 2016-17, there is a near 17% fall in wastage. Also, hospitals have to keep blood in emergency reserve to deal with mass casualties,” the officer said.

The modern way

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The passage of the Mental Healthcare Bill in the Lok Sabha, putting it on course to become law and repealing the Mental Health Act of 1987, will potentially help India catch up with the advances made in the field by other countries. India urgently needs to make a transition from old-fashioned approaches to providing care for those suffering from mental illnesses, something that China, for example, has achieved through state-led policy reform. Even the sketchy studies on the nature of care available to Indians indicate that in terms of population coverage the new law faces a big challenge. The country’s grossly inadequate base of professional resources is evident from its ratio of 0.3 psychiatrists for 100,000 people (with marginally higher numbers taking independent private practitioners into account), compared to China’s 1.7. Then there are massive deficiencies in the availability of trained clinical psychologists and psychiatric social workers. Evidently, the National Mental Health Programme has not been sufficiently funded within the health budget; neither has capability been built in most States to absorb the meagre allocation. Delayed though it is, the new legislation can bring about change with its positive features. The important provisions relate to the recognition of the right to medical treatment, decriminalisation of attempted suicide, explicit acceptance of agency of people with mental illness and their freedom to choose treatments, prohibition of discrimination and regulation of establishments working in the field.

Raising effective primary and district-level coverage of mental health services for the general population, without requiring people to travel long distances to see a specialist and get medicines, should be a priority. Since the base of psychiatrists is low in relation to the need, the use of trained general practitioners as the first line of contact assumes importance. Some studies show many of them are not confident enough with their training to detect, diagnose and manage mental illnesses. With a concerted effort, primary care physicians can be trained to help people with mild and severe problems, ranging from anxiety disorders to depression, psychoses and conditions arising from alcohol and substance abuse. Being able to get professional counselling will reduce the complications arising from extreme stress, often the trigger for suicide. Extending health insurance cover is also a step forward, since out-of-pocket expenditure has risen along with the expansion of the private sector in this sphere, just as for other ailments. The provision in the new legislation prohibiting seclusion of patients, something that is frequently resorted to in asylums, and the general use of electro-convulsive therapy must be welcomed. Modern treatment approaches rely more on family and community support. The new Central and State regulatory authorities should speedily weed out shady non-governmental rehabilitation organisations in this field.

Suicide no more a crime, patients to get cover

The Mental Healthcare Bill, which decriminalises suicide and guarantees the right to better healthcare for people with mental illness, was unanimously passed in the Lok Sabha on Monday.

It mandates that a person attempting suicide shall be presumed to be suffering from “severe stress” and, therefore, shall not be tried or punished by law. Further, the Bill mandates that persons with suicidal tendencies be provided help and rehabilitated.

The Bill was passed after a disruption-free five-hour debate, placing mental health patients at the centre of the legislation. “It was heartening to see parliamentarians discuss for five hours how to improve this Bill. We are, potentially, opening a new chapter in mental healthcare in India. Patients rights have been put at the heart of the legislation and the Bill approaches it from a rights-based perspective,” said Dr Soumitra Pathare, mental health expert who was a member of the drafting committee for the Bill.

This is the first mental health law to take a “rights-based” approach to mental illness by consolidating and safeguarding the rights of fundamental human rights of the patients.

“The Bill empowers the patients for mental healthcare. It gives them the right so that they are not denied [treatment] or discriminated against. The focus is on community mental healthcare … it is a rights-based Bill,” Union Health Minister J.P. Nadda said. While suicides due to insanity declined from 7% in 2010 to 5.4% in 2014, data from the National Crime Records Bureau say nearly 7,000 people killed themselves because of mental disorders in 2014.

Advance directives

The Mental Healthcare Bill was passed by the Rajya Sabha with 134 official amendments last August. A unique feature of the Bill is that it allows adults to make an advance directive on how they wish to be treated in case they got mental illness in the future.

Such a person can chose a nominative representative who would take care of him or her, the Minister said. The Bill also promises free treatment for such persons if they are homeless or fall below the poverty line, even if they do not possess a BPL card. The Bill clearly defines mental illness adding that the earlier definition, under Mental Helath Act 1987 was vague. There are also provisions under which a person cannot be sterilised just because he or she is a mental patient. “As per this law, we cannot separate a child for three years… Also, one cannot chain a mentally-ill person,” Mr Nadda said in Parliament while introducing the Bill. “We tried to see that the patient is protected and no coercive methodology is adopted. Persons who will not adhere to it will be liable to penalty and imprisonment. This is a very progressive bill,” he added.

India is a signatory to the Convention on the Rights of Persons with Disabilities, an international human rights treaty of the United Nations. Around 6-7% of India’s population suffers from some kind of mental illnesses, while 1-2% suffer from acute mental disease.

A new frontier for TB diagnosis

In a marked departure from the current methods for active TB diagnosis that are based on the presence of live bacteria in sputum samples, a rapid blood test that relies on two proteins for diagnosis and quantification of the severity of active TB has shown promise.

The blood test accurately detects minute levels of two biomarkers — CFP-10 and ESAT-6 — that TB bacteria release only during active infections. In a pilot study, the new blood test was able to diagnose active TB cases with “high sensitivity and specificity”. It was able to diagnose active TB even in people co-infected with HIV.

It was able to diagnose both pulmonary and extra-pulmonary TB cases with high sensitivity — over 91% in the case of culture-positive pulmonary TB (PTB) and above 92% extra-pulmonary TB (EPTB), and 82% in culture-negative PTB and 75% in EPTB in HIV-positive patients. In the case of HIV coinfected cases, the sensitivity was 87.5% for PTB and 85.7% for EPTB cases.

Obtaining sputum samples is not always easy. Biopsy samples are needed in the case of EPTB cases. Even Gene Xpert, introduced a few years ago to improve sensitivity and specificity, relies on sputum samples, and as per a 2014 WHO update, Xpert has “very low quality evidence” for EPTB diagnosis.

As per the results of the study published on Monday in the Proceedings of the National Academy of Sciences, the two peptides that are actively secreted by virulent Mycobacterium help in early diagnosis of active TB.

For the first time, quantitative results can be obtained that will help knowing the severity of active TB and in monitoring treatment outcomes.

It takes about four hours for the NanoDisk-MS assay to accurately detect the presence of the two peptides in the blood.

Building a healthy India: The government’s National Health Policy will improve health outcomes and reduce out of pocket expenses

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By JP Nadda, MOHFW, Govt. of India

Over the last decade, India has made noteworthy strides in health. We built an extensive, sophisticated system to deliver multiple doses of polio vaccine to every child in this vast country, eradicating the disease. Nationwide, our infant and maternal mortality rates have declined by more than one-third. We have learnt to manufacture high quality drugs that are exported to the rest of the globe; an estimated 20% of generic drugs supplied globally are produced in India.

While we have much to be proud of, we know that we can do much better. Health outcomes can improve further and out of pocket expenses on health can reduce, to better protect citizens from financial risk. We can build on our progress to reach the goal of an India in which every citizen lives a healthy and productive life.

The National Health Policy, developed after extensive consultations with state governments and other stakeholders, aims to shape our health system in all its dimensions – by investment in prevention of diseases and promotion of good health; by access to technologies; developing human resources; encouraging medical pluralism; and by building knowledge for better health, financial protection and regulation. The Policy is aimed at reaching healthcare in an assured manner to all, particularly to the underserved and underprivileged.

Fortunately, we have made significant advances, which puts us in an excellent position to address the needs the health system isn’t meeting yet – starting with strengthening and delivering good quality maternal and child healthcare and ensuring availability of emergency care, and moving on eventually to create robust infrastructure and capabilities to deliver universal health coverage. We have clearly prioritised four investments, through which we can build the Indian health system of the future.

The first is our focus on prevention of diseases, promoting good health and assuring quality comprehensive primary care to all. The emphasis, therefore, is to move away from sick care to wellness. Seven areas for inter-sectoral action and peoples’ campaign under ‘Swasth Nagrik Abhiyan’ have been identified so that people stay healthy and rely less on hospital care.

The need is also to shift from selective primary healthcare services to assured comprehensive primary healthcare with two-way referrals, which include care for major non-communicable diseases (NCDs), mental health, geriatric care, palliative care and rehabilitative care. As a critical element, the Policy proposes to raise public health expenditure to 2.5% of the GDP in a time-bound manner with allocation of a major proportion (two-thirds or more) of resources to primary care.

The second critical focus of this Policy is strengthening and designing our health systems such that affordable healthcare is made available to all. Chiefly, through free access to universal comprehensive primary healthcare, free drugs, diagnostics and essential emergency services in government hospitals as well as strategic purchasing through government financed insurance programmes. To facilitate access within the ‘golden hour’, the Policy aims to ensure availability of 2,000 beds per million population across all geographies.

Empowering citizens and providing quality patient care is our third critical pillar. Hospitals will undergo periodic measurements and will be certified on level of quality.

The Policy recommends establishing mechanisms for speedy resolution of disputes, and of National Healthcare Standards Organisation to develop evidence-based standard guidelines for care. Resource allocation to government hospitals will be made responsive to quantity, diversity and quality of caseloads.

The fourth pillar of our Policy is focussed on leveraging the power of India’s innovation, technology and ICT capability. The Policy advocates the need to incentivise local manufacturing to promote customised indigenous products such that healthcare is made more accessible and affordable for our citizens, while simultaneously generating employment.

The Policy recommends establishing federated national health information architecture, consistent with Metadata and Data Standards (MDDS), introduces use of Electronic Health Records (EHR), use of digital tools for AYUSH services by AYUSH practitioners, for traditional community level healthcare providers and for household level preventive, promotive and curative practices.

Additionally, to address the shortage of specialised care especially in some states, besides upgrading district hospitals to medical colleges, use of technology to scale initiatives such as tele-consultation, which will link tertiary care institutions (medical colleges) to district and sub-district hospitals with secondary care facilities, will ensure that excellent medical care reaches the remotest locations. To build capacity and knowledge at the last mile, the policy promotes utilisation of National Knowledge Network for Tele-education, Tele-CME, Tele-consultations and access to the digital library.

Holding ourselves accountable to meet a clear set of measurable health sector goals relating to mortality and morbidity on life expectancy and a healthy life, on reducing mortality and disease prevention and incidence, the government of India is committed to a healthy future of all its citizens.

By recognising and prioritising the role of the government in shaping and delivering equitable quality health to all, we have announced the National Health Policy 2017, and are committed to implementing it in close cooperation with the state governments, in a time-bound manner with clear deliverables and milestones, so that Indians stay healthy and reach their full potential.

TB time bomb: the price of policy inertia

A crumbling health system, slashed budgets and an overcrowded country — these factors make India the perfect playground for one of the world’s oldest diseases, tuberculosis.

In the past year, the global public health community, led by World Health Organization (WHO), has been looking at India with trepidation. In 2015 alone, 4.8 lakh Indians died of the airborne disease. In fact, India’s leading chest physician Dr. Zarir Udwadia called it “Ebola with wings” earlier this week during a TED Talk to mark World Tuberculosis Day, which fell on Friday, March 24.

 Thousands without access

Two new TB drugs, Bedaquiline and Delamanid, being used in Europe and the United States for several years, are yet to be made available in India’s national health-care system. In January, an 18-year-old Patna girl took the government to court after she was refused Bedaquiline on the grounds that she was not a resident of Delhi. The drug is available only in six sites across the country and, according to Health Ministry’s annual TB report released on Friday, only 207 patients have access to the drug needed by at least 79,000 patients. Herein lies the crux of the matter, making India’s bureaucratic inertia the world’s problem: TB does not respect geographical boundaries and these patients continue to transmit drug-resistant forms of the disease due to the poor access to medicines. Not only does India shoulder the highest TB burden in the world with over 2 million of the 10 million cases reported here, it also accounts for the most drug-resistant patients — nearly 1.3 lakh people who do not respond to first-line drugs. “Transmission of drug-resistant TB will continue unabated unless patients get early diagnosis and the right treatment. India has to invest extensively and urgently if it has to expand the testing facilities and get the drugs to the patients. Currently, there is a mismatch between the urgency with which the government is talking and the resources we are committing,” says Chapal Mehra, a public health specialist on TB.

In a major embarrassment for the government, WHO had to revise global TB estimates last year after India informed that it had been under-reporting TB cases from 2000 to 2015. The global estimates were revised upwards to 10.4 million people infected with TB — a jump of 5,00,000 from 2014. In its annual TB report, the Health Ministry explained that “this apparent increase in the disease burden reflects the incorporation of more accurate data. With backward calculations, both tuberculosis incidence and mortality rates are decreasing from 2000 to 2015”.

 The intent-action deficit

While the global spotlight for urgent action has sent the government back to the drawing board, experts maintain that it is not putting its money where its mouth is. The budget estimates in the annual TB report are in fact lower than that of 2014-15. As against ₹1,358 crore requested, the government approved ₹710 crore in 2014-15. In 2016, however, in the face of trenchant criticism, the budget requested actually went down to ₹1,000 crore and the approved budget was a measly ₹640 crore. “By no means is this enough to expand the programme. For the strategic plan to show impact, we must allocate enough resources,” says Mr. Mehra.

The government will soon be launching a new strategy, and Union Health Minister J.P. Nadda has announced that his Ministry will aim to “eliminate TB” by 2025. “Ensuring affordable and quality health care to the population is a priority for the government and we are committed to achieving zero TB deaths and therefore we need to re-strategise, think afresh and have to be aggressive in our approach to end TB by 2025,” he said on World Tuberculosis Day.

During the TED Talk, Dr. Udwadia, one of the first doctors to make Bedaquiline available in India, called tuberculosis patients “therapeutic destitutes”, adding, “Drug-resistant TB represents a collective indictment of all of us as a society. Of the tests too slow. The drugs too toxic. Of the government programme that’s underfunded and inefficient. Of the private practitioners who’ll dole out the drugs but not compassion. Of the public policy failure.”

For taking on government inertia, Dr. Udwadia was profiled by The New York Times in September 2016 in a report titled “Battling Drug-Resistant TB, and the Indian Government”.

The battle, for him, for patients and for caregivers is far from over.

The TB time bomb

Disease control in India is a story of contradictions and tuberculosis (TB) is no exception. Earlier this week, India’s Health Minister, J.P. Nadda, spoke at the World Health Organisation (WHO) Regional Health Ministers’ meeting in Delhi — on TB — stating his government’s intention to address the disease aggressively. Not too long ago, India’s Finance Minister too spoke of TB elimination.

Welcome and well-intentioned, these claims are at odds with India’s full-blown epidemic of TB and drug-resistant (DR) TB — a crisis that is decades in the making, from benign neglect by successive administrations. TB is a staggering epidemic that affects 2.8 million and kills 485,000 Indians, pushing individuals, families and communities into poverty, suffering and debt. Such claims then must be borne out by thoughtful strategy, commitment backed by sufficient funding. However, these seem to be missing. India recently released a draft of its latest strategic five-year plan to control TB which takes the approach to find, treat, prevent and build for TB control on a massive scale. However, the plan ignores the fact that most Indians affected by TB do not seek care under the government programme. It is usually their last choice. Even the poorest prefer to pay and go to the private sector because it is efficient and accessible. They land up in the public sector penniless and much sicker. That most TB-affected need efficient care with dignity and respect has escaped India’s health programme planners.

Glossed over

TB’s institutionalised neglect is not limited to the government alone. In its recently released first ever priority list of antibiotic-resistant bacteria, the WHO didn’t include DR-TB. The list is supposed to provide direction globally to government priorities for research on bacteria for which we need new antibiotics. There is already shrinking support for research into new TB antibiotics primarily because TB is a disease with a large market at the base of the pyramid. This is borne by the fact that despite its massive human costs, only two drugs have been developed in four decades and remain expensive and inaccessible to most. Such omissions let the pharmaceutical sector and government off the hook from pressure to invest in research for new drugs.

Why is TB ignored? Perhaps because its fundamentals are beyond the capacity of the health establishment. A lack of preventive strategies, poor nutrition, and rapid urbanisation with limited public awareness all feed India’s epidemic. Many of these are domains traditionally outside of disease control programmes though they have an impact on disease control.

Mr. Nadda listed numerous achievements among which were mandatory case notification from the private sector, inclusion of new Cartridge Based Nucleic Acid Amplification Test (CB NAAT) machines for early detection, and the introduction of new drugs such as Bedaquiline. What missed mention was that the increased case notification is but only a fraction of the cases detected and treated privately. The government has failed to implement TB notification successfully. India does have 500 new CB NAAT machines but they remain underutilised, highly rationed and of limited reach to most of the TB-affected. We still don’t know the government’s forecasting mechanism for procuring cartridges to make these tests accessible. What’s more, most TB patients rarely get tested upfront for drug resistance. As a result, numerous cases of DR-TB remain undiagnosed, poorly treated and often lost or what the WHO terms “missing”.

Access to new drugs like Bedaquiline is best explained in the struggle of an 18-year-old girl who desperately needed the drug and went to the Supreme Court to get it. Had she got this treatment sooner, she may not have died.

India’s spending per TB patient is the least among BRICS countries. The answers lie in expanding the capacity of the public sector, aggressively engaging the private sector, increasing budgets, and creating a massive campaign to ensure awareness and empowerment among those most severely affected. We need access to a free and reliable TB test, counselling, free high-quality treatment, and economic and nutritional support. Until then, TB will continue to devastate the foundations of this aspirational superpower.

It would be catastrophic to follow high-cost healthcare model of US: Sujatha Rao

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Private hospitals have been in the news for all the wrong reasons lately. Sujatha Rao, former Union health secretary and author of the book, Do We Care? India’s Health System, tells Rema Nagarajan that the recent exposés underscore the need for greater investment in public healthcare delivery as well as better systems to regulate the private sector

You say in your book that the government has an ambivalent policy towards the overwhelming private sector. Why?
The recent exposes in the media regarding the overpricing of cardiac stents and establishing fake colleges by the private sector show what happens in the absence of regulations. Fraud on such a large scale cannot happen otherwise. As traced in my book, the evolution of public policy in health clearly shows how the private sector in India grew by default and the persistent failure of the political system to articulate a consistent and coherent policy to manage this elephant in the room. This is a serious omission since the health sector has severe market failures making government intervention an imperative, not a choice. Such indifference to develop an appropriate framework of laws, systems, protocols and the institutional architecture to regulate the sector is a failure of governance.

Does the government have any option but to purchase healthcare from the private sector?
As the private sector provides three quarters of outpatient treatment and two thirds of hospitalisation, options to ignore it are limited and the perception that government can provide all health services is impractical. The government still has room to bring in a balance in two ways. One, by creating the fiscal space to step up public investment with at least 1% of GDP only for building the health infrastructure, particularly in areas where government is the sole provider. Two, by keeping its dominance in primary and secondary care markets that address over 95% of medical ailments, prevent disease, promote wellness, and in the long run, reduce costs for government and households. Every country tries to keep control over healthcare expenses, either by controlling primary care so that the push to more expensive hospitalisation is regulated, or by regulating secondary and tertiary care with protocols and price caps so that there are no runaway surgeries and unnecessary care. If the whole chain is privatised and unregulated as it is now, then it can become unaffordable. In any case, government’s first charge is to ensure universal access to public goods like basic healthcare, clean air, water, environmental hygiene and nutrition. In my opinion, this is an obligation the state cannot abdicate. This alone will reduce a substantial burden of disease and out-of-pocket expenditure.

You say public policymaking is trending towards greater reliance on consultants than building institutional capacity. Why?
If you take a historical view, you will see a transition from reliance on classical public health experts to commercial consulting companies like Ernst Young or McKinsey, in helping draft public policy. This is not a stable solution. What is needed, and government does not do adequately enough, is investing in institutionalised research and promoting knowledge to anchor policy on evidence. Our success in reducing the incidence of communicable diseases like malaria, guinea worm, polio or HIV/AIDS is largely on account of good quality evidence that helped guide policy and implementation strategy. Health falls in the realm of behavioural economics and regulating that requires policies to be rooted in our own cultural and behavioural preferences, social realities and political and administrative contexts. Besides, such accounting firms also have conflicts of interest as many are also consultants to private companies in the health sector and carry a bias against government intervention and public health.

Budget 2017 does give a lot more to public healthcare delivery, doesn’t it?
It’s not the 28% increase that should concern us but the quality of spending proposed. More worrying is the absence of a clear vision. In this context I am glad to see the recently released National Health Policy embedding a vision. One may disagree with it and there may be some contradictions, yet at least there is a vision that will now enable bringing in required regulations to mitigate any harm. The challenge today, rather than spelling out schemes, is articulating a vision for the next decade and an implementation plan that has a national consensus to ensure it is placed above partisan politics. Public health goals have been stated but realising them would need huge investments in terms of trained people, and appropriate infrastructure, particularly at the level of primary care. Primary care is not just about polio drops and institutional delivery. It’s about averting diseases that are expensive to treat. For example, there would be no need for too many dialysis centres if we can control hypertension and diabetes. Neglecting primary care means opting for the high-cost, specialist-led and hospital-based US system of care. The US is already paying a heavy price because of their model; in India, it could be catastrophic.

Health policy wants public hospitals certified for quality

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Targets safe water for all by 2020

The long awaited National Health Policy (NHP), announced a few days ago, proposes to raise public health expenditure as a percentage of the GDP from the current 1.15% to 2.5% by 2025. The resource allocation to individual States will be linked with their development indicators, absorptive capacity and financial indicators. “There will be higher weightage given to States with poor health indicators and they will receive more resources. The Policy aims to end inequity between States. But at the same time, States will be incentivised to increase public health expenditure,” says Manoj Jhalani, Joint Secretary — Policy, Ministry of Health and Family Welfare.

While public health expenditure as a percentage of GDP will reach 2.5% only by 2025, many of the goals listed in the Policy have a deadline of 2025, some of them even sooner.

Preventive healthcare

The policy stresses preventive healthcare by engaging with the private sector to offer healthcare services and drugs that are affordable to all. It wants to reduce out-of-pocket “catastrophic” health expenditure by households by 25% from current levels by 2025. It wants to increase the utilisation of public health facilities by 50% from the current levels by 2025.

The Centre is working on introducing a health card — an electronic health record of individuals. “The health card will be for retrieving and sharing health data by lower [Primary Health Centre] and higher [secondary and tertiary] healthcare facilities,” says Mr. Jhalani. “It will be launched in six months to one year’s time in those States that show interest to roll it out in certain districts or across the State.”

Like the Health Ministry’s national strategic plan for tuberculosis elimination 2017-2025 report, the Policy wants to reduce the incidence of new TB cases to reach elimination by 2025. In a similar vein, the policy has set 2017 as the deadline to eliminate kala-azar and lymphatic filariasis in endemic pockets, and 2018 in the case of leprosy. In the case of chronic diseases such as diabetes, cancer and cardiovascular diseases, it envisages a 25% reduction in premature mortality by 2025.

Challenging ambitions

The policy “aspires” to provide secondary care right at the district level and reduce the number of patients reaching tertiary hospitals. For the first time, there is a mention of public hospitals and facilities being periodically measured and certified for quality.

But the most ambitious target is providing access to safe water and sanitation by all by 2020. As per the January 2016 Ministry of Drinking Water and Sanitation’s country paper, sanitation coverage was only 48%.

Other challenging targets set by the Policy include reducing the infant mortality rate to 28 per 1,000 live births by 2019 and under five mortality to 23 per 1,000 live births by 2025. According to the National Family Health Survey 4 (NFHS-4), IMR was 41 in 2015-16; it took 10 years to reduce IMR from 57 to 41.

As against 62% children 12-23 months old, who were fully immunised in 2015-16 according to the NFHS-4 data, the Policy has set a target of 90% by 2025.