Clinical guidelines in India: Bureaucratic implementation?
Sir,
The authors describe a pragmatic approach to clinical guideline development for use in India. (1) Their efforts are laudable, given the lack of such guidance in India. However, there are several areas of concern that would need to be addressed before a robust framework for implementation is established:
1. India has a mixed health system that includes both public sector and private sector establishments. (2,3)
2. The public health system, though one of the largest in the world, is under-financed, and low-performing.(3)
3. The private sector corners about 80% of all out-patient visits, most of which are funded by out-of-pocket expenditure.(2–4)
4. India’s health sector is largely unregulated.(2,3)
5. Several approaches to regulate India’s health market have been tried, often with limited success.(3)
6. The National Health Policy 2017 makes several commitments regarding increasing public health spending, reducing out-of-pocket expenditure, and ensuring that the quality of care is not compromised. However, specific details as to how these will be achieved are lacking.(5)
In the absence of a robust and uniform regulatory mechanism, implementation of the clinical guidelines will be difficult. Therefore, although the development of clinical guidelines is a welcome move in itself, unless the concerns raised above are addressed, Indian citizens may fail to benefit from the exercise.
Rapid Response:
Clinical guidelines in India: Bureaucratic implementation?
Sir,
The authors describe a pragmatic approach to clinical guideline development for use in India. (1) Their efforts are laudable, given the lack of such guidance in India. However, there are several areas of concern that would need to be addressed before a robust framework for implementation is established:
1. India has a mixed health system that includes both public sector and private sector establishments. (2,3)
2. The public health system, though one of the largest in the world, is under-financed, and low-performing.(3)
3. The private sector corners about 80% of all out-patient visits, most of which are funded by out-of-pocket expenditure.(2–4)
4. India’s health sector is largely unregulated.(2,3)
5. Several approaches to regulate India’s health market have been tried, often with limited success.(3)
6. The National Health Policy 2017 makes several commitments regarding increasing public health spending, reducing out-of-pocket expenditure, and ensuring that the quality of care is not compromised. However, specific details as to how these will be achieved are lacking.(5)
In the absence of a robust and uniform regulatory mechanism, implementation of the clinical guidelines will be difficult. Therefore, although the development of clinical guidelines is a welcome move in itself, unless the concerns raised above are addressed, Indian citizens may fail to benefit from the exercise.
References:
1. Mehndiratta A, Sharma S, Gupta NP, Sankar MJ, Cluzeau F. Adapting clinical guidelines in India—a pragmatic approach. BMJ [Internet]. 2017 [cited 2017 Nov 28];359. Available from: http://www.bmj.com/content/bmj/359/bmj.j5147.full.pdf
2. Sheikh K, Saligram PS, Hort K. What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states. Health Policy Plan [Internet]. 2015 [cited 2017 Nov 28];30:39–55. Available from: https://academic.oup.com/heapol/article-abstract/30/1/39/563025
3. Peters DH, Muraleedharan VR. Regulating India’s health services: To what end? What future? Soc Sci Med [Internet]. 2008 [cited 2017 Nov 28];66(10):2133–44. Available from: https://ac.els-cdn.com/S0277953608000622/1-s2.0-S0277953608000622-main.p...
4. Gupta I, Bhatia M. The Indian Health Care System [Internet]. 2016 [cited 2017 Nov 28]. Available from: http://international.commonwealthfund.org/countries/india/
5. Ministry of Health and Family Welfare, Government of India. NATIONAL HEALTH POLICY, 2017 [Internet]. New Delhi: Ministry of Health and Family Welfare, Government of India; 2017 [cited 2017 Nov 28]. Available from: http://cdsco.nic.in/writereaddata/National-Health-Policy.pdf
Competing interests: No competing interests