Premium Gist of Yojana: November 2012
1. Challenges in India’s Health Scenario ()
- The Challenge of Establishing NCHRH ()
- The Challenge of Allopathy and AYUSH ()
2. Drug Pricing and Pharmaceutical Policy ()
- Everything you want to know about nutrition ()
3. Janani Surakasha Yojana ()
4. Pulse Polio Immunisation ()
5. Universal Immunisation Programme
NATIONAL MISSION FOR JUSTICE DELIVERY AND LEGAL REFORMS
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
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
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
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
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.