Thursday, 30 April 2015

Paper 6 - Indian Polity, Social Justice and International Relation

Indian Polity, Social Justice and International Relation

- Health, 
Health as a component of Human Resource Development. Health Care System in India and Uttarakhand. Health Indicators. World Health Organisation : Objectives, Structure, Functions and its Programmes. Public Private Partnership in Health Care System.
National Rural Health Mission and other related schemes. Health and Nutrition. Food Security Act etc.

India’s health sector is diverse and includes not just modern medicine but also a range of traditional systems like Homeopathy, Ayurveda, Unani. The overall government expenditure on health is rather low at around 1.2 percent of GDP. Communicable diseases continue to be a major public health problem in India. There is also a rising incidence of non communicable diseases, old age diseases and mental health. There is near consensus among experts that the health sector in India is plagued by acute inequity in the form of unequal access to basic health care across regions, inadequate availability of health services and acute shortage of skilled man power. 
Most of the issues pertaining to public health have been acknowledged by the policy makers and have influenced the formulation process of the 12th Five Year Plan. The Approach Paper recognises the need to provide comprehensive health care with greater emphasis on communicable diseases and preventive health care, need for upgradation of rural health care services with districts as units for planning, training and service provisioning and also the need for capital investment and bridging crucial and severe human resources gaps. 

 The High Level Expert Group on Universal Health Care constituted by the Planning Commission has recommended that public expenditure on health should be increased from the current level of 1.1 percent of GDP to at least 2.5 percent by the end of 12th Plan and to at least 3 percent of GDP by 2022. Other recommendations are the universal entitlement to comprehensive health security; ensuring availability of free medicines by increasing public spending on drug procurement; emphasis on public health investment and addressing the problem of human resources and establishment of more medical colleges and nursing schools. Over the years, there has been significant progress in improving life expectancy at birth, reducing mortality due to communicable diseases as well as reducing infant and maternal mortality. One of the major achievements is non-reporting of polio cases from any part of the country for more than 12 months. This is an endorsement of the effectiveness of the polio eradication strategies and their implementation in India. The NRHM launched in April 2005 was started with the stated objective to make health care universal, equitable and affordable in rural areas. The Mission was a policy response to the unequal development of health care across states and reflected the need of the centre to play a more proactive role in setting standards in public health provisioning and shaping state health systems to achieving the goals. Health care services to address the needs of the urban poor by making available essential primary health care services is also an area that requires attention. 

Social and family health issues such as malnutrition of women and children, declining child sex ratio, adolescent health, care of older persons however continue to be areas of concern requiring immediate intervention. 
Nutrition constitutes the foundation for human development and government has accorded the highest priority to combating malnutrition. The key issues are in preventing and reducing maternal and child undernutrition as early as possible. To address the multi dimensional nutritional challenges being faced in the country comprehensive multi sectoral interventions and redesigned institutional arrangements are needed. The need of the hour is to review the linkages between economic growth, poverty, dietary intake and nutritional status. This issue of Yojana deals with all these concerns and authors have outlined the challenges and the path that needs to be traversed to achieve India’s goals of health care for all. 

Health as a component of Human Resource Development

Health as a component of Human Resource Development

Good health status is an important contribution to economic development and contributes to rapid growth. Improvement in health status contributed in a great way to the economic growth rate in France and Great Britain. On the contrary diminished health status is one of the factors responsible for Africa’s low economic performance.

Health care in shambles (meaning of shambles - a state of total disorder)

In India, despite rapid strides in socioeconomic development, health and education, the widening economic, regional and gender disparities are posing challenges for the health sector. About 75 per cent of health infrastructure is concentrated in urban areas where only 37 per cent of the population lives. The health status of Indians, is still a cause of concern. This is reflected in the life expectancy, Which was used to be 62.3 years for male and 63.9 years for female in 2001-2005 is now 67.3 years for male and 69.6 years for female in 2011-2015infant mortality rate has come down to 42 in 2012 from 58 per 1000 live births in the year 2005; maternal mortality rate has declined from 301 per 100,000 live births in 2001-03 to 212 in 2007-09.
Total Fertility Rate has come down to 2.4 in 2011 from 2.9 in 2005. Adding a new feather in the cap is declaration of India as Polio Free Nation. On the 13th January, 2014, India made history by completing three years without a single case of wild polio. This feat was unimaginable till 2009, when India accounted for more than half of the global polio burden. 

Twelfth Plan outlook towards health care 
The role of health care in economic development has received increasing attention in recent years. Health care can be focused primarily on four growth channels: (a) health and labour, (b) health and education, (c) health and saving and (d) health and labour productivity. Investment in man and health care plays a significant role in fostering economic growth. It is, therefore, in the fitness of things that the Approach Paper of the Twelfth Five-Year Plan, whose central theme is “sustainable and inclusive growth”, has presented a comprehensive programme for the sector, aiming at to provide broad-based health care in rural areas. The Approach Paper’s visions of health care are: 
  • Decrease the infant mortality rate and maternal mortality rate. 
  • Provide access to public health services for every citizen. 
  • Prevent and control communicable and noncommunicable diseases. 
  • Improving child sex ratio for age group 0-6 years. 
  • Control population as well as ensure gender and demographic balance. 
  • Encourage a healthy lifestyle and alternative systems of medicine through. 
  • Clean drinking water, sanitation and better nutrition, childcare, etc. 
  • Expenditure on health by Centre and States to increase from 1.3 per cent of GDP to at least 2.0 per cent, and perhaps 2.5 per cent of GDP by end of 12th Plan. 
  • Need targeted approach to increase seats in medical colleges, nursing colleges and other licensed health professionals. 
  • Improve quality of NRHM services vs. quantity of NRHM infrastructure. 
  • Role of PPP in secondary and tertiary healthcare must be expanded. 
  • Health insurance cover should be expanded to all disadvantaged groups. 
  • Focus on women and children; ICDS needs to be revamped. 
Health economics

With 356 million 10-24 year-olds, India has the world’s largest youth population despite having a smaller population than China, a latest UN report said on Nov 18, 2014.

China is second with 269 million young people, followed by Indonesia (67 million), the U.S. (65 million) and Pakistan (59 million), Nigeria with 57 million, Brazil with 51 million, and Bangladesh with 48 million, the United Nations Population Fund’s (UNFPA) State of the World’s Population report said.

It said that developing countries with large youth populations could see their economies soar, provided they invest heavily in young people’s education and health and protect their rights. 
India as a country that depends more on its human resources to excel in many streams can make it possible only if the resources are kept healthy. To be precise, economics has taken the centre stage and there is a need for integrating more of economics with health sector by increasing the focus on economics and behavioural economics, etc. 

Healthy labour force increases the participation ratio as well as hours worked. To reap the benefit of education, children must have a sound health. On the other hand medical expenses deplete savings and investment in the education of children. The reduced earning potential of individuals ultimately affects national income. According to Adam Smith, “productivity of labour can only enhance nation’s wealth” and health is the most prominent factor in determining labour productivity. Individual in good health may be able to produce more per hour worked with an efficient use of machinery and technology. They are also flexible and adoptable to change. On the other hand, health condition can set off a downward spiral, causing poverty further ill health and an inability to afford treatment. 

If every human being is treated as a stock in the human capital, than even a day’s loss of productivity will certainly impact the value of the stock and hence the human capital and productivity. Health pushes many a families in the unorganiged sector to below the poverty line status. Over 25 percent of hospitalized Indians fall below poverty line because of hospital expenses and hence health is a major cause of indebtedness, particularly in rural areas. While many of the people in the organized sector have some form of backing in the form of paid leaves, group coverage, etc., the people in the informal sector do not enjoy such privileges. The delay in treatment impacts these people in two ways: (a) capital erosion as their work is mostly semi-skilled or unskilled and depends on their physical health, (b) business continuity, the ability to continue in the business.

Some observations

The Indian economy will continue to be one of the fastest growing economies in the world. However, growth is not enough. What India is needs is growth with equity, especially growth with sustainable livelihood opportunities. In view of the obvious deficiencies in India’s overall rural infrastructure, it is unlikely that the rural areas will have a sufficient number of doctors over the next several decades. Thus, the solution to India’s doctor shortages does not lie in building more medical colleges. A better alternative would be that India must upgrade the skills of existing unlicensed rural practitioners and empower government nurses and pharmacists to take additional tasks. An alternative to the Indian Medical Council Act is the Drugs and Cosmetics Act that empowers States to recognize practitioners other than MBBS-holders to provide a limited range of medical care services. 

Health Care System in India and Uttarakhand

Public Health is a state subject. However, Central Government launched NRHM in 2005 to provide financial support to the States/UTs to strengthen their health systems particularly to cater to the healthcare needs of rural areas. Key steps taken to improve health care in rural areas include the following:
  • Support is provided to States/UTs under NRHM, to strengthen the health system including establishment/up-gradation/renovation of health infrastructure, engagement of Nurses, doctors and specialist on contractual basis based on the appraisal of requirements proposed by the States in their Programme Implementation Plans (PIP).
  • Support under NRHM is also provided by way of additional incentives to serve in remote underserved areas, so that health professionals find it attractive to join public health facilities in such areas. In order to encourage the States to fill up existing vacancies in remote rural areas, the states are being incentivized to ensure rational deployment of health human resource. Manpower deployment is also to be put on the web in public domain,
  • To increase the availability of doctors, several initiatives have been taken to rationalize the norms in medical education, such as, relaxation in land requirements, bed strength, increase in ceiling for maximum intake for undergraduates, enhancement of teacher-student ratio in Post Graduate Courses, etc., which has resulted in substantial increase in number of undergraduate and post graduate seats. Government has also approved setting up of ANM/GNM Schools in different States besides setting up of Institutes of Paramedical Sciences at National and regional levels, 
  • States/UTs are being impressed upon from time to time to make available improved health facilities including free essential medicines in all public health facilities. Accordingly, financial support is being provided for ensuring uninterrupted supply of free essential medicines in public health facilities based on the requirement proposed by the States in their PIPs.
  • An incentive of upto 5% of the NRHM outlay has also been introduced in 2012-13 for states for establishing policy framework and systems for providing free generic medicines to those who access public health facilities.
  • States/UTs are being provided support for focused attention and greater resources per capita to high priority districts with relatively poor composite health index.
  • Financial assistance is provided to the States/UTs for selection and training of Accredited Social Health Activists (ASHA), who act as a link between community and healthcare facilities.
  • States/UTs are assisted to constitute Village Health, Sanitation and Nutrition Committees so as to ensure community participation and village level planning and monitoring of health activities. 
  • New initiatives such as JananiShishuSurakshaKaryakram (JSSK), RashtriyaBalSwashthyaKaryrakram (RBSK), Rashtriya Kishore SwashthyaKaryakram (RKSK), ‘National Health Mission Free Drugs Service Initiative’ etc., have also been introduced to inter-alia make health care affordable by reducing out of pocket expenditure. 

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