Constituent policy

India’s health policy needs a paradigm shift to serve commoners

India’s health policy needs a paradigm shift to serve commoners

Dr. Arun Mitra

Health care today faces several challenges ranging from medical education to primary disease prevention, health care delivery, health care financing, scientific inputs, drug pricing, etc thus developed the concept of developing resistance to diseases through a healthy diet or through specific methods such as the use of herbs or other natural products. Modern scientific medicine has advanced this knowledge through extensive research to find the normal functioning of the body, the cause of disease, and the methods of managing disease and promoting good health.

In India, health planning began with the formation of a committee popularly known as the Bhore committee under the chairmanship of Sir Joseph Bhore in 1943 to study the then existing situation regarding health conditions and health organizations in the country. The committee, in its 1946 report, recommended that “the health program should be developed on the basis of preventive health work and that ‘if the health of the nation is to be built up, these activities must go hand in hand with those which relate to the treatment of patients.

It was based on the principles that “no individual should be denied access to adequate medical care because of their inability to pay; the health program should place special emphasis on preventive action; health services should be located close to people; medical services must be free for all without any distinction and the doctor must be a social doctor”. The committee also observed that “health and development are interdependent and that improvement in other sectors such as water supply, sanitation, nutrition, employment has led to an improvement in the health “. Interestingly, this is also the period when the British government introduced the National Health Services in England. The Soviet Union had already introduced the concept of state responsibility for health care for all in 1936.

In the first decades after independence, the orientation of health care in our country was based on these principles which gave priority to public health. During this period, much of health care was developed in the public sector with particular emphasis on the need for basic health services. As a follow-up, India signed the Alma-Ata Declaration in 1978, which identified primary health care as the key to achieving the goal of health for all and conceptualized “health as an essential function of development, encompassing the security of life, means of subsistence and basic care. services such as food, health, education, housing, sanitation, drinking water, electricity and transport”.

In the 1980s, when neoliberal economic policies were adopted, there was a pro-health policy shift that treated health as “technology dependent and amenable to commodification”. Even the World Health Organization (WHO) started working under the influence of international monopolistic corporations and took a stand to increase privatization and partnership with multinational corporations. In our country, we see that the public sector is now responsible for preventive services while the private sector, on the other hand, is investing heavily in secondary and tertiary care for profit making advanced care out of reach for groups at low and even middle income. population.

There was a paradigm shift in the approach of the first National Health Policy – ​​1983 which emphasized promotion, prevention, healing and rehabilitation services. The 2017 National Health Policy (PNS), however, took a leap forward towards a business-centric, insurance-based health system. As a result, public funds are diverted to the private insurance and health care sector. It is a period following the World Trade Organization which was founded on January 1, 1995.

Currently, 75% of health expenditure comes from household pockets – 80% for OPD care and 60% for Indoor care. This catastrophic cost of health care is a major cause of impoverishment which further aggravates ill health. No wonder the government recognizes the fact that every year 6.3 million people are pushed below the poverty line due to personal health care expenses.

India has about 20 health workers per 10,000 people. The total doctor to population ratio including modern medicine and AYUSH doctors as said by Shri Mansukh Mandaviya, Union Minister of Health and Family Welfare in the Rajya Sabha on April 5, 2022 is 1:834. It should be noted that the government. the physician-to-population ratio is 1:11,926 as opposed to the desired 1:1,000. This is a major cause of inequity in healthcare for marginalized sections who rely solely on the public healthcare system. The WHO recommends a minimum of 5% of GDP as health expenditure, while on the other hand our public health expenditure fluctuates around 1.1% of GDP.

That out of a population of 100,000 in our country, 32 people die each year from tuberculosis, is a matter of grave concern and shame. The condition of other communicable and non-communicable diseases is similar. Due to poor planning, diseases like malaria, tuberculosis, heart disease, diabetes, cancers, etc. have been ignored during the COVID pandemic. Despite all the above events, the Constitution of India does not expressly guarantee a basic right to health.

It is necessary to set up a primary health center for every 30,000 inhabitants, with a 24-hour service, a sub-health center for every 5,000 inhabitants and a community health center with all the equipment for each 100,000 inhabitants. Establish a 24-hour ambulance service for 30,000 residents. Delegate female medical and paramedical staff to all health centers and hospitals in sufficient numbers. All public health facilities must adhere to the standards of the Indian Public Health Standard (IPHS).

Medical education is also on the same line. Over the past few decades, there has been a move from the opening of medical schools in the public sector to the private sector.

According to the National Medical Commission (NMC) website, India currently has 605 medical colleges with 90,825 places for the undergraduate course. Out of this 306 colleges with 45035 seats are in the public sector. The number of private sector colleges is 289 with 43965 places and another 10 colleges with 1825 places. Tuition fees in private colleges range from 60 Lakh to over a crore of rupees. This is far beyond the capacity of even the middle classes. Therefore, students look for relatively cost-effective institutions. To study in overseas colleges, the total cost including travel and living is around Rs 30 Lakh. This drives students to study abroad. We have seen how Ukrainian students had to suffer during the ongoing war with Russia.

Since nutrition is the key to good health, it is imperative to eliminate malnutrition by implementing the National Food Security Act of 2013, which aims to provide subsidized food grains to around two-thirds of the Indian population and guarantees maternity rights to all pregnant women. Set up a nutritional rehabilitation center in each block to solve the problem of children suffering from severe malnutrition.

Even though spending on drugs represents nearly 63% of personal health expenditure, we currently lack a rational pharmaceutical policy that authorizes the sale of drugs only under their generic names. The drug pricing policy is flawed, allowing pharmaceutical companies to set prices as they see fit. There is a need to improve the availability, accessibility and affordability of medicines, including vaccines and serums, in the public health system through quality-conscious pooled supply systems and the promotion of the manufacture of essential drugs. Drug prices should be calculated based on their cost of production. The recommendations of the report of the “Committee on high commercial margins in the sale of medicines” submitted on December 9, 2015 must be implemented. The National Pharmaceutical Pricing Authority should be further strengthened.

It is disgusting that unscientific and non-evidence based methods of treatment are being disseminated in health care. The promotion of cow urine, cow dung and Ramdev’s Coronil as a treatment for various diseases including COVID-19 has been made by top government officials including the Minister of Health from the union, Dr. Harshvardhan, who is an ENT surgeon himself. NMC’s latest decision to introduce Charak Shapath instead of scientific oath by modern medical doctors is totally unscientific. The Charak Samhita written 300 BC says that a doctor should live a life of celibacy and grow a beard. He must not see a patient who is disliked by the king. This means that women cannot be doctors.

Some colleges have made it mandatory for modern medicine interns to rain at AYUSH. It can be understood that there is a conceptual difference on disease causation and treatment not only between modern medicine and AYUSH, but also between the various constituents of AYUSH. The National Medical Commission (NMC) has also ruled that medical students of modern medicine should undergo yoga training under the guidance of a yoga teacher and observe June 21 as Yoga Day.

There must be a concerted effort to develop a healthy India through a scientific perspective, otherwise the health of the vast majority of our poor people will continue to be exploited by false beliefs and myths in health care and expense. exorbitant. The State must come forward to assume responsibility for health for all and for this declare health as a fundamental right. (API Service)