The entire spectrum of political leadership should take a pledge to transform the healthcare system of India in a decade
As the countdown to the next general election begins, political parties are making multiple promises to pull in votes. All the party leaders are committing to transforming the lives of people. But health, ironically, does not feature high on their priority list, even though it is the central pillar of a nation’s development and productivity and the key to happiness for individuals, families and societies. Perhaps it is time to remind all parties that are seeking to govern the country that India’s health challenges are perhaps the greatest for any single nation in the world.
We continue to face the unrelenting burden of the old and new threats of communicable diseases. The discussion on maternal and child health care, and nutrition, is far from being complete. We have also emerged as the world’s epicentre of chronic diseases such as diabetes, hypertension, heart ailments and mental disorders. Nothing short of a massive transformation of the health system can address these challenges and meet the needs of citizens. People expect much more than a handful of select services under the limited ambit of the existing national programmes.
The good and bad newsThe fundamentals have been laid down in the last few years as part of the National Rural Health Mission. More than 8,00,000 Accredited Social Health Activists workers, 33,000 nurses, 14,000 paramedics, 8,000 doctors and 3,000 specialists have been inducted; over 20,000 facilities have been constructed; and over 20,000 ambulances have been deployed. Medical graduate seats have increased by 55 per cent and postgraduate seats by 75 per cent. The Janani Suraksha Yojana has ensured that an additional 12 to 13 crore women are now delivering in government facilities and more than 6 lakh newborn babies are receiving care in neonatal care nurseries in district hospitals each year. Polio has been eliminated from the face of the country. The Infant mortality rate (IMR) too has declined from 68 to 42 per 1000 live births between 2000 and 2012. This is exciting, but not enough. In Brazil, the IMR is 13 and in China it is 12.
Each year, more than 40 million people, mostly in rural areas, are impoverished and run into massive debts to access healthcare. The devastating contribution of out-of-pocket medical expenses to poverty is often not fully appreciated by the media and policy-makers.
Long-term goals in healthcare transformation require a timeline that surely goes beyond the life of one Lok Sabha. The Centre and States also have to work in unison, regardless of which parties are in power. An all-party commitment to broad tenets is therefore absolutely essential to ensure focus, consistency, speed and accountability. We, therefore, call for a national manifesto on health affirmed by all parties.
On Universal Health CoverageThe Twelfth Plan strategy envisages Universal Health Coverage (UHC) as the long-term goal “that will unfold over two or three Plan periods.” The doctrine of UHC guarantees cashless access to a defined package of quality health services to all citizens. Such a system that has been in existence for long in developed countries such as Germany, the U.K., Canada, Japan, Australia, New Zealand and in Scandinavian countries, has now been embraced by middle-income countries such as Thailand, Mexico and Brazil.
Given that India has a mixed health system, both public and private sectors have to work in tandem to provide appropriate, equitable and affordable care at all levels. The High-Level Expert Group (HLEG) on UHC, constituted by the Planning Commission, envisioned a National Health System wherein a strong public sector leads the design and delivery of UHC, drawing on support from the private sector in a well-regulated framework. In this system, all citizens are entitled to a comprehensive package of primary, secondary and tertiary care services, and have access to government and accredited private facilities for obtaining services such as diagnostics, vaccines, drugs or surgeries as an entitlement, without having to pay at the point of care. It is estimated that UHC would require public spending on healthcare to the tune of 3.0 per cent of the GDP or more.
A debate on the details of how the Centre and the States will deliver UHC can be settled through democratic processes in due course. It is however time that the entire spectrum of political leadership expresses unequivocal allegiance to the high principles that embody commitment to health equity and pledge to transform the health system in a decade. And let these common principles be enshrined in the manifestoes of all the national parties.
The main priorityTo begin with, parties must make healthcare a core priority for the next decade, to enable transformation of the healthcare system, while promoting pro-health policies in other sectors. We believe that the following five principles form the core national agenda on health and should be embraced by all the parties.
First, we call upon all the political parties to commit to the goal of achieving UHC in the country by the year 2025, and develop a clear roadmap thereof by mid-2015.
Second, public spending on health should be raised from a meagre 1.04 per cent of the GDP in the Eleventh Plan Plan to 3 per cent by 2020, and 4 per cent by 2025.
Third, all essential drugs, including anti-cancer agents, should be made available free to all citizens in 3-4 years.
Fourth, standards of care including clinical guidelines, applicable to both the public and the private sectors, should be developed and enforced in the next five years.
Fifth, equity must be ensured in the provision of health services across districts, communities and gender.
The next government, irrespective of its party composition, should within the first 100 days of coming to power create an enabling mechanism to plan, mentor and implement the above promises. A National Health Regulatory and Development Authority would help to effectively advance this agenda.
This election should set a benchmark and transform the landscape of healthcare in India, no matter who comes to power.
(Vinod Paul is Head, Department of Pediatrics and WHO Collaborating Centre for Training and Research in Newborn Care, AIIMS, and K. Srinath Reddy is President, Public Health Foundation of India.)
The National issues that the Nation is not talking about !!
This election should set a benchmark and transform the landscape of
healthcare in India, no matter who comes to power.
1. Social Infrastructure status for Health Care.
2. Tax incentive for the Individual Medical Practitioner who practices
at Rural and semi Urban areas and special incentives for the
receivables and professional service charges of specialists and
super specialists for on-site service of health care at Rural and tier
III and II towns.
3. Tax incentives , tax incentives means either no tax in the rural
area income or increased tax slab for the amount earned for the
service rendered in the rural area and for the poor and specially
designed financial packages for Infrastructure capital expenses/
investments for Hospitals and Health Care facilities at Rural and Tier
III and II towns.
4. Encouraging manufacturing Medical equipment at India with possible
incentives so that Capital burden is reduced since the equipments
manufactured in India shall become less costly.
Local manufactures of high tech medical equipment such as
Ultrasound , CT&MRI scans , cardiac cathlabs, diagnostic equipment
like auto analysers to be encouraged intensively and immediately so
that the Heath Care Cost shall comedown by 40%
5. Increase in the Tax exemption limits to Rs.100,000 on the premium
paid for Health Insurance [Husband, wife, Children, Parents of Both
The Spouses]
6. And parents of both the spouses must be considered as dependents of
any one of the spouses and medical insurance premium paid by one of
the spouses must be exempted for income tax.
7. Tax deduction of Rs.20,000 per individual for annual preventive
health checks and all expenses as out patient on the cost medications
for non-communicable diseases like Diabetes, Hypertension, Heart
Ailment, and Obesity must be exempted for income tax.
8. Income Tax exemptions for the capital expenses and maintenance on
personal Gym equipment or subscription to Gyms and for the purchase of
auxiliaries for physical exercises such as sports shoe, sports
costume, subscription for swimming pools etc.
9. Traffic injury prevention and health hazards by driving regularly
and repeatedly on the not properly maintained roads resulting in
intangible injuries and economics of man power loss resulting in
expenditure on health and loss in production.
10. Creation of more specialists and super specialist, paramedical and
supportive staff by creating more seats in existing institutions.
Increase the allied health care professionals by creating more seats
in the existing institutions and newly creating more institutions.
11. Labour law, acts and rules, more specific to healthcare delivery
and General Labour Law cannot be applied to health care segment.
12. More FSI for hospitals in the Urban Areas so that cost per square
feet of building becomes less, thereby capital cost of the hospital
building is reduced.
13. Procedure to arrive at Immediate release of Financial Assistance
by the Insurance companies to the victims of accidents involving
vehicles or injuries covered by insurance.
14. Restoring that the higher exemption limit for woman, which
prevailed a few years ago should be restored.
15. Insurance including health insurance is not available for aged
except for renewal, but at a very heavy premium. There is need for
rationalizing the same.
16. Deduction for medical treatment and health insurance should not be
subjected to ceiling with reference to premium, but with reference to
benefits for which a ceiling of Rs.10 lakhs may be placed subject to
revision every year proportionate to increase in the premium and
inflation.
17. Regular audit of Mental Health of the individual and the society.
Review of social violence has to be correlated with mental health.
Community oriented lifestyle practices more pertaining to Geographical
and Ethnical Culture must be encouraged for better mental and physical
Heath.
18. Public Health Audit must be made mandatory along with financial
audit for any project in Government or Private. There must be a public
health reference in the preliminary report of any project.
19. Coordination between Human, Veterinary, Agri and Marine for better
Health Care.
20. Pharmaceuticals and drugs, medical devices, disposables are
subjected for better pricing with quality.
21. Medical Research is to be encouraged. Coordinated Data collection
and analysis must be improved and periodical review is to be done.
22. With view of the ongoing tussle by the pharmaceutical industries
in India, there must be a separate and exclusive ministry for
pharmaceuticals at the government of India level. Forming such a
separate, exclusive ministry shall facilitate lower cost of medicine
for the patients / citizens of India. As an industry it will improve
economic scenario of the country and facilitate better regulations,
increasing the export income of the country.
23. A separate tribunal for medical negligence to be established and
to be taken out of ambit of the consumer forum.
24. An initiative to be established or formalized the treatment
protocol specific to Indians on the lines of international practice as
in developed countries.
25. The concept and recognition of the healthcare delivery under the
leadership of the physician by the allied healthcare and supportive
staffs as HEALTH CARE TEAM to be promoted. ""....insight on the
seismic changes hitting the healthcare workforce in the coming years.
The discussion will focus on how organizational structures and
personal career paths will be impacted by reform laws, a focus on
team-based care, the expansion of roles for supporting practitioners
and a growing emphasis on providing care in ambulatory settings.""
26. Special focus on health care information technology.
The entire spectrum of political leadership should take a pledge to
transform the healthcare system of India
Hi
We people should make the agenda.
about Environment, Health and Public Transport.( there is many other areas as well)
Cant "the hindu" take a leadership role in the same?
This article has very rightly pointed out need of having universal and
accessible health care facilities which is in fact the fundamental
right of every citizen of country and it could be denied by anyone for
that matter.Thus providing this basic amenities should not be taken as
means of garnering votes to come in power as it happened in case of
food security bill(right to food). also this should not be made the
game of taking the credit.we expect the party in power to provide this
only because this is their duty.
Much of the 12th plan dialogue was wasted in rhetorical assertions and in arguments
to increase public spending to 3% GDP. The issues are however far more complex
than what the authors herein make us believe. Total UHC as described by the authors
will need no less than 10-15% GDP. But the problem is not money alone. There is a
need to bring in a reform process and lay the fundamentals of good health and well
being in the first place, that must interalia consist of universal access to more basic
services like safe water, sanitation, nutrition and basic primary health care services.
There can be no health with 8% population having access to toilets in Jharkhand and
2.5% in Bihar having access to piped water! 4 lakh children under 5 die every year in
India due to water borne diseases and nearly a lakh young able bodied earners form
poor families due to malaria. Can our political parties resolve to save these lives in
the next five years, in the first instance?
Health is wealth but this is NOTA for all the political parties
fraying in the elections. Time has come that DPSPs take the core
seat and bring health in perspective.
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