Expert views: what the next Indian government should do for health and healthcare
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2479 (Published 03 April 2014) Cite this as: BMJ 2014;348:g2479
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Active participation of accreditation agencies in health care, education and industry.
There are main concerns are having to be addressed by the government like Health Insurance, The medical tourism, The aging population in India, backed by better health care purchasing opportunity for the middle class as well as people below the poverty line. Regulation of Medical education, This can be achieved by the active participation of the governing bodies and will help to bring change in Indian health care scenario. Government should take appropriate steps to strengthen Accreditation agencies like NABH, ICMR, CCRAS, MCI, AYUSH to think over this and work on to educate its members in following matters.
1) Designing curricula like according to the health needs of the local community. By keeping in the mind National Socio demographic goal.
2) Multi- centric research under the limelight of Bioethics. And In the case of Human trials accreditation agencies strictly pass the guidelines for the ethical committees and amend the rules as per time requirement and monitor the research.
3) One more thing is, As Complementary and alternative medicine has emerged as an indispensable ingredient of Holistic Medicine with The billion to trillion dollar market. AYUSH should think to bring reforms in the area like Promotion of the active learning, And pass proper regulation in case to maintain Safety of Patients. The effective integration of CAM (Complementary and alternative system of medicine) and conventional medicine should be encouraged by the professionalism and ethics. As Andrew Vickers rightly said that “ integration means similar clinical, scientific, and regulatory standards are being applied across all forms of healthcare”. Cost effective CAM is in greater demand. The weakness of the system is confusing laws of the land and Herb –drug, neutraceutical-drug reactions etc.
4) Education to the people about prevailing health problems and methods of preventing and controlling them this can be achieved by proper implementing of programs like PURA.
5) Separate legal cell has to constitute for Proper implementation of COPRA-1986 (Consumer protection Act.). While which guides you in burning issues like Organ transplantation, Medical Termination of Pregnancy and Female foeticide etc.
6). Health care reforms that include national accreditation for hospitals, better education for health care workers.
7) Separate body to study the insurance coverage of those who are using traditional medicine. As around 80% of Indian population depend upon its traditional health care system.
8) Constitutional body should be founded for Proper implementation of the LPG Model (Liberalization, Privatization and Globalization) in the Health care sector.
Competing interests: No competing interests
1. Revise all health and allied policy documents (priority attention for health and nutrition policies).
2. Mainstream 'social determinants of health' into all health and allied policies.
3. Chalk out an ancillary policy (as part of the National Nutrition Policy) to tackle the problem of micro-nutrient deficiency.
4. Strengthen the existing feeding programmes with a focus on (i) reduction (and prevention) of stunting and wasting and (ii) ensuring early child development among children.
5. Tag institutional delivery, birth registration and immunization certificate to eligibility criteria for welfare schemes.
6. Give GPS-enabled hand-held devises to health workers and ICDS Anganwadi Workers at all levels for data collection and retrieval, and these should be linked to the central MIS server.
7. Introduce universal health insurance (cashless) to cover the entire population.
8. Promote supply of quality generic drugs in all government hospitals and primary health centres.
9. Strengthen teaching 'social determinants of health' in medical schools, and promote social science-public health interface at all levels.
10. Establish a Department of Medical Education in the Ministry of Health & Family Welfare and assign this to a Minister of State.
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Good drinking water, sanitation and shelter still hold the key in providing primary care to the needy and poor. India has excellent facilities in health care from primary to tertiary care. The corporate sectors have made hightech care reachable to all sections of the population. Certain government institutions provide the best care to patients in need. Therefore the government policy must be directed towards community health care, particularly preventive care. Still we need to concentrate on combating mosquito transmitted diseases, parasitic infections and malnutrition.
India is a huge country with a large population. The Indian government therefore must have an imaginative but practical approach in providing health care to all segments of the population.
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It is very sad to note that many of the speakers are from private care. One of them commenting on poor farmers happens to be a pioneer of health innovation and tourism. Unfortunately today to treat a simple upper respiratory infection one needs to spend more than one thousand rupees for medicine alone. The goverment should think about bringing health along the lines of the NHS. Privatisation and competition is eating into research and leading to bad care. I hope that the government revives primary care.
Competing interests: No competing interests
The new government of India need to strengthen the public health delivery system, which includes primary health care centers, district health care centers and Govt. run medical colleges.Instead of making posting of untrained undergraduates to rural areas compulsory,it would be wiser if the Govt amends the existing laws and makes it mandatory for aspirants of a post in medical colleges to serve at least 2 years in rural areas before being considered eligible for a Govt. job.Also,those who are interested in improvement, should aid the existing system, and not indulge in creating unnecessary parallel health system in the name of reforms.Public-private partnership is an eye-wash so far; it has helped the the private partner by and large.Unless some serious thought is given to it, it shouldn't be encouraged.
The govt. of India plans to open almost 150 more medical colleges in next 2-3 years.It is expected that 99% of it will go to private players.The private medical colleges so far are for minting money and not for any service, barring a few.So, they can't be entrusted.Instead the Govt. itself can upgrade existing district hospitals into medical colleges.To attract good clinicians,a policy may be launched where the fully devoted clinicians of medical colleges or other govt run centers and dispensaries could be exempted from income-tax returns, provided they don't indulge into private practice.In India we need the improvement to be visible to naked eye, not on the paper.
Competing interests: No competing interests
The Indian health scenario is beset with multitude of problems at present. The longtime wish for increase in the fund outlay to 6% of GDP is still a dream. The Indian Government should firmly make provision for an increase in the budget. This will ensure that the out of pocket expenditure of patients, which currently stands at about 90%, come down, thereby reducing the economic burden on the common man.
Universal accessibility to health care is one of the major challenges faced by the Indian population. It may be difficult for the Government to immediately construct health facilities in remote areas. However, there are many private health facilities, non-governmental organizations working in some of the remote areas. There should be a proper mechanism to involve these facilities under the public-private partnerships.
One of the major problems faced by the rural population despite availability of a public health facility is lack of proper infrastructure including availability of drugs, basic laboratory facilities, equipment, water supply, electricity, housing facility for staff, lack of medical and paramedical manpower. These amenities need to be provided so that health functionaries (both medical and paramedical personnel) can work without any problem. Basic availability of essential drugs as per World Health Organization’s guidelines for different levels of health care system is a must and it needs to be looked at.
Lack of transportation for the people in rural, far flung hilly terrains also needs to be addressed. Provision of ambulance services is a must for prompt shifting of patients requiring emergency services and for referral to the nearest health facility with adequate infrastructure.
The secondary and tertiary level health care facilities are overcrowded. Doctors and paramedical personnels are inadequate. There should be a provision for recruitment of medical and paramedical personnel on a regular basis through properly maintained register for health manpower requirements. The current focus on increasing seats in medical colleges, setting up of new medical colleges, nursing schools or colleges should be continued. There should be provision for incentives for the medical and paramedical health personnel working in the remote, hilly areas.
Keeping in view the wider acceptability of the alternative systems of medicine, there should be a provision to provide services of ayurveda, homeopathy, unani, or siddha systems of medicine which are recognized by the Government of India in addition to or in those places where the allopathic medical facilities are lacking.
Involvement of the people in providing health care to the masses is of paramount importance. People’s representatives should be involved in making local decisions for improvement of health care facilities.
All the health programmes under the Government should be properly monitored, feedbacks should be obtained from both the service providers, and clients alike for further improvement.
One of the important aspects of providing health services is quality of services. Let us focus on providing evidence based medical services, focusing on quality care. The health care functionaries and doctors needs to be oriented towards this aspect by regular continuing medical education programmes and encouraging the doctors and paramedics to participate. There is a need to improve the doctor-patient relationship which is now on the verge of decline.
Competing interests: No competing interests
The significance of drugs to health care is unquestionable: they treat illness, avert disease progression and improve well-being. The right to health and universal health coverage cannot be achieved without access to affordable essential drugs on a viable basis and also a precondition for accomplishing 4 out of 8 Millennium Development Goals.
The availability, accessibility and affordability of good quality and safe essential medicines to the beneficiaries are imperative for an efficient health system.
Despite being the one of world’s largest producers of generic drugs, an estimated 50-65 percent of the Indian population does not have adequate access to medicines and 70-80 percent of households Out-of-Pocket (OOP) payments go into buying drugs alone, leading to widespread indebtedness. The principal reason is essential drugs are not available free of cost at public health facilities and the majority population cannot afford them. This forces many Indians, even the middle class, to forgo essential care, or make trade-offs between paying for care and paying for food, education or shelter.
The next government should provide high quality generic drugs free of the cost at the point of use. The government should constitute National Medical Service Corporation (NMSC) with mandate to procure and provide generic medicine, surgical and suture goods to all public health institutions across the country.
No matter who wins in the next election, the health of India’s people must come out on top.
Competing interests: No competing interests
Re: Expert views: what the next Indian government should do for health and healthcare
India is now at a critical point- Shri Narendra Modi really has the ability and potential to transform the country and restore its rightful place as a beacon in the world. Development, good governance and robust management, the three essential ingredients, are finally coming together under his leadership, and I welcome the dawn of this new era. A focus on economic development, rooting out corruption and accountability is a win: win formula for both: the political party and the public. Of course, it will be a while before we see the results but the next few months will tell whether we are on the right road. To me, being on the right road means addressing the root causes of a failed nation and especially the health of Indian people.
Some of the worst health indices in the world, vast inequalities, unaffordable health care, poor education and training of health care professionals and corruption at almost all levels, with a few exceptions, have become the norm and are a blot on the country. Successive governments have failed to tackle the problem, and the major reasons for this are the conceptual separation between economic development and health and reliance on ‘trickle down economics’. The belief that health is a consumptive sector (needing endless resources) is fallacious- health is a productive sector; healthier people work, pay taxes, improve economy and boost development. And the last few decades have confirmed the failure of trickle-down economics- poor have become poorer and access to healthcare is further impoverishing them with millions of Indian falling below poverty line due to illness and lack of affordable and safe care. Health truly is wealth, and it is time to start taking it seriously.
Despite massive growth of the health sector recently, largely in the for-profit private sector and in high tech, acute services although I recognise the investment in public facilities including creating the new AIIMS in various parts of the country, there has been a failure to address the four key challenges facing the Indian health system. To create healthier people and ensure safe and affordable health care requires:
- Better governance including clinical governance to root out corruption, challenge poor clinical practices and raise standards
- More and better academic capacity through using modern educational programmes and promoting research
- Investment in primary care, and out of hospital care in the community and
- Most importantly a robust public health policy and systems for delivering the public health programmes
Although there are pockets of excellence in each of these domains, there has been a serious lack of a comprehensive and joined up health policy and which is then systematically programme managed. The new Government has the unique opportunity, and indeed a responsibility, to pull all this together and create a healthier and wealthier India.
It is also not a one sided affair, there are some very committed people and organisations, who if properly mandated can be mobilised to deliver this transformation and shed the image of India as the ‘Sick Nation of Asia’. I have had the privilege of meeting and working with such individuals and organisations and am sure that they will rise to the challenges, given the chance - this is a once in a life time opportunity to make a real difference for the country.
Rajan Madhok, Chairman, British Association of Physicians of Indian Origin (BAPIO), UK
Correspondence rajan.madhok@btinternet.com
Further details of my work in India are available at www.leadershipforhealth.com
An earlier version of this letter is available on
http://asianlite.com/health/indian-health-sector-good-times-are-coming/
Competing interests: No competing interests