(Premium) Gist of Yojana: November 2012

Content

1. Challenges in India’s Health Scenario (Free Available)

• The Challenge of Establishing NCHRH (Free Available)
• The Challenge of Allopathy and AYUSH (Free Available)

2. Drug Pricing and Pharmaceutical Policy (Free Available)

• Everything you want to know about nutrition (Free Available)

3. Janani Surakasha Yojana (Free Available)

4. Pulse Polio Immunisation (Free Available)

5. Universal Immunisation Programme (Only For Premium Members)

Do You Know? (Only For Premium Members)

NATIONAL MISSION FOR JUSTICE DELIVERY AND LEGAL REFORMS (Only For Premium Members)

• Fast Facts of India (Only For Premium Members)
• Brief Status of JSSK Programme in the Country (Only For Premium Members)
• Occupational Lifestyle Disease in India (Only For Premium Members)

Challenges in India’s Health Scenario:

The challenges facing India’s health sector are mammoth. They will only multiply in the years ahead. Surprisingly many of the challengers are neither a result of the paucity of resources nor of technical capacity. These hurdles exist because of a perception that the possible solutions may find disfavour with voters or influential power groups.

The first malady has been the utter neglect of population stabilization in states where it matters the most.

The second is the monopoly that an elitist medical hierarchy has exercise for over 60 years on health manpower planning. The result has given a system where high-tech specialty services are valued and remunerated far higher than the delivery of public health services. The latter ironically touches the lives of millions.

Related to this is the third big challenges — how to make sure that doctors serve the growing needs of the public sector when the working conditions are rotten, plagued by overcrowding, meager infrastructure and a virtual absence of rewards and punishments.

The Challenge of Reducing Maternal and Infant Mortality

There is a clear correlation between the health of the mother and maternal and infant mortality. In the northern states more than 60 percent of the girls and boys (respectively) are married well before the legal ages of 18 and 21. The repercussions of early pregnancy and child birth have not even dawned on the pair when they wed. The first child arrives within the year when most adolescent girls are malnourished, anaemic and poorly educated. With no planned spacing between the births, another child is born before the young mother has rebuilt her strength or given sufficient nutrition and mother care to the first born. These are among the main causes of high deaths of young women and infants. The chart and tables clearly show the regional difference in maternal, infant and child mortality. Narrowing the gaps poses one of the biggest health challenges.

The regional variations in the deaths of mothers in the states of Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan and Assam show that the percentage of maternal deaths is 6 times higher than in the Southern states.

Taken together the EAG States and Assam account for 62 percent of the maternal deaths. Schemes for nutrition, supplementary feeding, literacy, the right to education and health care remain hollow expressions without any meaning as long as women (and chiefly adolescents) have no control over pregnancy. Unlike other South and South East Asian countries the uses of IUD and injectibles has not taken off in India – nor are these the thrust areas for family planning anywhere in the country. Although long term, reversible methods of preventing pregnancy are available, young mothers and children continue to suffer or die. The challenges lies in bringing the issues to centre – stage and wait for incremental improvements to take place in the fullness of time. The charts show the colossal difference that has been achieved by the southern states that invested heavily in family planning (albeit through the adoption of terminal methods like sterilization which can be avoided today.

The Challenge of Establishing NCHRH

The neglect of public health is one of the fallouts of the elitism that has pervaded medical education. Whereas cities and towns at least have alternatives available – at a price-epidemics and acute illnesses that occur in rural areas often leave people in the hands of fate. The east while elected MCI has relegated public health to the lowest rung of the health hierarchy and the doctors that once decimated dreaded diseases like malaria and smallpox are not to be found. The complement of technical staff, nurses, pharmacists, dentists, lab technicians and operation theatre staff are all in short supply outside the urban areas as the bodes that register then do not work in tandem. More importantly no Council has a stake in health care of any particular state-leave alone the country.

The proposal to set up a National Council for Human Resources in Health (NCHRH), far from being a bureaucratic response was a well thought out strategy having its roots in the recommendations of independent think tanks and expert committees. The rationale for setting up such an umbrella body was to see that the goals of health manpower planning the prescription of standards, the establishment of accreditation mechanisms and preservation of ethical standards were served in a co-ordinated way, on the lines of structures that operate successfully in other countries.

The Indian Medical Association in particular and doctors in general have been arguing against the need for such a body because they perceive it as a threat to their autonomy and a camouflage for political and bureaucratic meddling. The fact that health manpower planning was simply ignored, that there was a complete lack of coordination between the councils and most important of all the fact that public health had become a low priority have been overlooked in the fire and fury of opposing the NCHRH concept tooth and nail. The challenges today is how to ensure that the health sector produces adequate professionals as required for the primary, secondary and tertiary sectors, both for the public as well as the private sector health facilities. If the NCHRH Bill before the Standing Committee of Parliament does not see light of day, the resurrection of the superseded scam-ridden MCI is a foregone conclusion.

The Challenge of Allopathy and AYUSH

Public health cannot be run on contract basis and much less be farmed out to private insurance companies and HMOS (Health Management Organizations) as a recent report on Universal Health Coverage seems to suggest. Public health is squarely a state responsibility and particularly so in a developing country. It has to go hand-in-hand with sanitation, drinking water, health education and disease preventation. The National Rural Health Mission (NRHM) which is a public-sector programme has registered an encouraging impact in even the most intractable regions of the country. A UNFPA study has shown that nearly three quarters of all births in Madhya Pradesh and Odisha had been conducted in a regular health facility. The percentage of institutional deliveries in Rajasthan, Bihar in Uttar Pradesh was lower but even so, accounted for almost half the delivers conducted in those states. Indeed these achievements are immense.

Having said this, institutional deliveries alone cannot be the answer to all the problems that beset the rural health sector. A visit to any interior block or taluka in the Hindi belt states shows that most primary health centres beyond urban limits are bereft of doctors, except sporadically. Some state governments have taken to positing contractual AYUSH doctors engaged under NRHM to man the primary health centres. These doctors dispense allopathic drugs, prescribe and administer IV fluids, injections and life-saving drugs, assisted by AYUSH pharmacists and nursing orderlies.

This reality must be confronted. If an AYUSH doctor has been entrusted with the responsibility of running a primary health centre, and found in shape to handle the national programmes, the controversy over what AYUSH doctors working in as registrars and second level physicians in private sector hospitals, clinics, and nursing home is wide-spread in states like Uttar Pradesh, Maharashtra and Punjab; so also in Delhi and Mumbai. The challenge lies in understanding what can be changed and what cannot be changed, without getting intimidated by protests from Medical Associations that will always protect their turf to retain primacy.

Drug Pricing and Pharmaceutical Policy

The Department of Pharmaceuticals was established on 1st July 2008 as the nodal Department for ensuring the availability of medicines at reasonable prices in the country. Availability of good quality drugs at affordable prices with a specific focus on the poor has been the constant Endeavour of the Government. The Government is administering Drug Price Control through the Drug Price Control Orders issued from time to time.

The National Pharmaceutical Pricing Authority (NPPA), an independent body of experts in the Ministry of Chemicals & Fertilizers was formed by the Government of India. The functions of NPPA, inter-alia, relates of fixation/revision of prices of scheduled bulk drugs/formulations under DPCO’s 1995 monitoring and enforcement of the prices.

Everything you want to know about nutrition

The Union Ministry of Women & Child Development’s recently launched a website on Nutrition. This interactive website will offer a knowledge bank, library and e-forum to those in the business of nutrition and the ones interested in eating right to stay healthy.

Currently there is just much information about food, nutrition and various types of diets. There are various experts in the field of food and nutrition who give out information which at times can be contradictory and even confusing for the public.

Besides working at bridging the gap of clarity on nutrition and its co-relation with health, the website will also give bird’s-eye view of what the national and international community has to say on a particular diet or issue. The site is also meant for policy-makers. The website will help the policy-makers to connect with and understand the public’s nutrition concerns.” Besides being of public use, the website is also expected to help the Government with real-time monitoring of the Integrated Child Development Services.

Janani Surakasha Yojana

A new initiative namely Janani Shishu Surakasha Karyakaram (JSSK), launched in June 2011 which guarantees free entitlements to pregnant women and sick new born till 30 days after birth, including C-Section, drug and consumables, diagnostics, diet during stay in the health institutions, provision of blood, exemption from user charges, transport from home to health institutions, including transport between facilities in case of referral and free drop back home after 48 hrs stay, has failed to show tangible results because of lack of awareness. The benefits of the scheme are not known even at the hospitals. Expecting people to benefit from it would be rather far-fetched.

Similarly, the result of adolescent sexual reproductive health (ARSH) strategy for the promotion of menstrual hygiene among adolescent girls in the age group of 10-19 years in rural areas, is far from satisfactory. This programme is aimed at ensuring that adolescent girls (10-19 years) in rural areas have adequate knowledge and information about menstrual hygiene and the use of sanitary napkins. Under this scheme, 1.5 crore girls across these districts will be reached with the behaviour change communication campaign and provided access to an NHRM brand of sanitary napkins that will be sold to the girls by the ASHA at subsidized costs. This is expected to prevent reproductive tract infection (RTI) and sexually transmitted infections (STIs).

Pulse Polio Immunisation

Seven million children die globally before they reach their fifth birthday. Of these, 1.7 million are in India—highest anywhere in the world. Half of these deaths occur within a month of the child being born. While India has made some progress with the under-five mortality falling from 116 per 1000 live births in 1990 to 59 per 1000 live births in 2010, this is still inadequate. These figures also mask the gross inequalities between the States and between different social, cultural, gender and economic groups within them.

India’s major achievement of the recent past has been the eradication of polio. With only 42 polio cases detected in 2010 compared to 741 cases detected during 2009, the most significant progress was seen in the endemic States with no type 1 case detected in 2010 in Bihar with onset of July 2010. During 2011, only a single case of wild polio virus was detected in Howrah district in West Bengal.
Earlier this year, the World Health Organisation officially removed India from the list of polio-endemic countries, as India has not had a case of polio since January 13, 2011.

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