Public health concerns and reforms: Perceptions of the civil society
01 May 2012
Health is an important indicator of a nation’s development, and nations with healthy people are more likely to be the most prosperous. The importance given to the health sector by national governments, however, varies across nations, and there are many examples where a low priority, weak governance and poor environmental conditions have led to the emergence of significant health problems. There could be several other causes for the existence of unhealthy nations. It has been generally accepted that much knowledge remains to be acquired and shared in order to recognise and address the challenges in the health sector.
Observer Research Foundation (ORF) in association with the Rosa Luxemburg Stiftung (RLS) organised a discussion on ’Public Health Concerns and Reforms: Perceptions of the Civil Society’ on 25 April 2012. The objective was to offer a platform to knowledgeable persons to present their views and opinions on the current state of the health sector, issues and challenges to progress, innovative practices in use, and policy measures and governance mechanisms needed to reduce health disparities in various parts of India. The deliberations produced worthy experiences, and the lessons learned can contribute to the policy-making process in the field of public healthcare.
The discussion was chaired and moderated by Prof. K.R. Nayar, faculty at the Centre of Social Medicine and Community Health, JNU. In his inaugural remarks, Prof. Nayar shared his views on the current state of the health sector and pointed out that we were at a crucial juncture health-wise and a lot of issues need to be addressed. He stressed on the role of the civil society in taking forward our public health agenda. Partnerships beyond profit motive, democratisation initiatives and need to focus on innovation, were some of the suggestions described for solving the problems.
A variety of issues were taken up during the discussion. Prof. Pramila Goyal, faculty at the Centre for Atmospheric Sciences, IIT Delhi, described the impact of environmental pollution on health. She explained about the use of a model to assess major sources of pollution in Delhi (such as industries, vehicles, domestic burning and power plants) and the types of pollutants released in the air including lead, methane and benzene. It was stated that the model can be used for air quality forecasting, and would help the concerned government authorities as well as the people to take necessary precautions.
Dr. Amod Kumar, senior consultant and head, Department of Community Health, St. Stephen’s Hospital, touched upon various aspects of health education and community health. He pondered over the fact that whether ’people’s health in people’s hand’ holds any substance and if it is actually possible to hand over health planning to people. He talked about the need to include health education in school curriculum and invest in young people. He stated that democracy in an unaware society may not be a good thing and hence, democratisation in the health sector might not help. In his opinion, there is a need for convergence in health and education.
The problem of female foeticide and sex selection as a big public health concern was highlighted by Dr. Sabu George, an activist working on the issue of girl child. Describing the present situation in India, he stated that the practice was expanding and we could witness elimination of 9-10% girls in the times to come. He talked about the linkages between this practice and its consequences for global security. He stated that there was an absolute failure on part of the public health institutions to deal with the problem. The need for the mainstream media to be more sensitive towards the issue, regulation of private medical education by the government, the need to take up this issue in the public health discourse, and looking into the ethics of doctors and corporates, were some of the suggestions put forth.
Dr. J. S. Raghuvanshi, founder president and chief coordinator of Centre for Research in Ayurveda and Social Medicine for International Brotherhood (CRASMIB) explained his study on integration and use of tribal system of medicine and Ayurveda in evolving effective treatment and rehabilitation strategies for AIDS, conducted in the tribal areas of Mizoram and Madhya Pradesh. He highlighted the prevalence of corrupt practices at the ground level and absence of knowledge among the local authorities about the schemes of the Ministry and the system of delivery. He also talked about the effectiveness of Ayurvedic medicines in curing incurable diseases like AIDS, cancer, arthritis, etc., and the need to harness this knowledge along with integrating it with the modern methods, so as to benefit the country and the world.
Mr. Dinesh Sharma, science editor with Mail Today, presented an overall perspective of the current health sector, which he said was most commercialised and fragmented, and pointed out that most health indicators are not faring well. He touched upon the various issues ailing the health sector today - increasing private investment coupled with declining public investment, poor regulation, pendency of bills, lack of convergence on major issues, among others. He strongly emphasised the need to address these issues in order to evolve a system of health care which is equitable, affordable, effective and accountable. It was argued that bringing back States’ involvement in health would be necessary.
Ms. Jyotsna Lall, senior programme officer with the Nizamuddin Basti Urban Renewal Initiative, Aga Khan Foundation, described health initiatives undertaken in Nizamuddin Basti in order to improve the health, as well as quality of life, of people residing there. This is being done by adopting a public-private partnership approach. She highlighted the issues pertaining to maternal and child mortality. Strengthening of the MCD Polyclinic Services, gynecology and antenatal services, community health outreach, bring together public and private service providers to provide affordable and quality health care, community mobilisation for positive health seeking behavior, mapping of vulnerable population through surveys, among others, were some of the existing health initiatives described.
The issue of health challenges and health threats was also taken up by Dr. Papiya G. Mazumdar, assistant professor at the Department of Policy Studies, TERI University. She stated that the major issue pertained to ’inequity’ in health outcomes and that there was lack of a consensus on major policy concerns. Further, she pointed out that uncertainties arising out of environmental risks and changing climate, which is an important concern, have been excluded so far in the list of challenges. She stressed on the need for managing climate threats in Public Health as well as the need for innovative health care service delivery option - integration with Primary Healthcare.
Dr. Rajmohan Panda, specialist at the Public Health Foundation of India, spoke about the public health and management reforms in health care. Taking the case of National Rural Health Mission (NRHM), he stated that while policy-wise there has been an increased emphasis on public health (reflected in increased health budget, serious focus on maternal mortality rate, openness to civil society, etc.), effectiveness and accountability still need to be fixed. He emphasised the need for synergy and convergence of efforts of both the public and private sectors to ensure provision of Universal Health Care (UHC). Establishment of National and State health regulatory authorities, health system surveillance, use of information and technology and setting up of drug supply Logistics Corporation were some of the recommendations made. Prof. K.R. Nayar agreed that regulation and monitoring are very important issues that need to be tackled.
The discussion saw questions and suggestions pertaining to community health, the aims of education, democratisation of health institutions, gaps in availability of data, ethics of medical professionals and corporates alike, right to health, big ticket reforms in health sector, regulating private medical education and the possibility of health care being hijacked by the insurance lobby.
Earlier during the inaugural session, Dr. Rumi Aijaz, Senior Fellow at ORF, welcomed the distinguished speakers and the participants representing various institutions such as Institute for Human Development, Sulabh International, National Health Systems Resource Centre, etc. A brief mention was made to the activities carried out by ORF, and nature of collaboration with RLS. The participants were informed about the main objectives of the ORF-RLS Project on Health for the year 2012, namely: to highlight policy and governance - related problems prevailing in the health sector, and to explain what should be done to address growing concerns. Before the discussion, a set of talking points / questions were shared in order to promote a focused discussion. In his closing remarks, he thanked the participants for an enriching discussion and observed the need to upgrade the existing facilities at local level and provide for mobile services to improve access especially in rural areas of India.
(This report is prepared by Ms. Ruchira Chaturvedi, Research Intern, Observer Research Foundation)