Daily News Mail - News of 20/02/2015

Band-aid solutions for health problems

• The Ministry of Health and Family welfare has recently released the Draft National Health Policy of 2015.
• National health policies, strategies, and plans play an essential role in defining a country's vision, priorities, budgetary decisions and course of action for improving and maintaining the health of its people. 
• The latest health policy speaks about a wide variety of issues that plague our health-care system - low public health expenditure, inequity in access, and poor quality of care. It also suggests a variety of ways to address them, mainly focussed around increasing government spending on health and expanding the public delivery system.
• However, the health policy fails to tackle head-on the core problem of the Indian health system - its management, administration and overall governance structure, without which the measures it suggests are merely symptomatic(serving as a symptom or sign, especially of something undesirable) treatments, akin to putting a “Band-aid on a corpse(a dead body, especially of a human being rather than an animal).”
• Russia and South Africa both spend a significantly higher amount on public health than India. In fact their spending is even higher than the target set by the draft health policy, yet they have life expectancies that are worse, as in the case of South Africa, or only marginally better, as in the case of Russia. On the contrary, Sri Lanka and Bangladesh are both countries that actually spend less on their healthcare (as a percentage of GDP) than India, yet both have better outcomes. Within India too, the draft policy notes that States with better capacity have utilised the National Rural Health Mission (NRHM) funds more effectively, while States with poorer initial conditions have been left with worse outcomes. The fundamental difference lies in management and governance structures.
• Criticality of administration: Study find that the effectiveness of public health spending in reducing child mortality depends on the level of perceived corruption. It is found that higher integrity is associated with reduced child mortality.

Governance structures:

• If we our health outcomes to be improved then the Indian health policy needs to focus on how its health system is governed and managed. The weight of evidences clearly suggest it.
•  While our people are among the best and brightest, long years of neglect and misgovernment have vitiated(spoil or impair the quality or efficiency of) our public management systems with perverse(showing a deliberate and obstinate desire to behave in a way that is unreasonable or unacceptable; awkward; contrary) incentives. It is easier and more sensible for people within the system to subvert their jobs - through chronic absenteeism, endemic corruption and private practice - than to actually do them. The draft policy mentions band-aids for a few of these problems, but it needs to prioritise and lay far greater focus on the critical issue of governance and management of the Indian health system.
• Governance structures need to balance responsibility, flexibility and accountability in order to carry out their functions. It is clear that our systems today, at best, fix responsibility, but do not provide flexibility and accountability - managers/bureaucrats need to do their jobs. A useful, and not entirely radical, model to consider would be the one pioneered in India by the Tamil Nadu Medical Services Corporation. It is a registered corporation set up by the Tamil Nadu government to procure drugs for the public health system. It is accountable to an independent board of directors which includes the health secretary. The corporation has an IAS officer as its managing director, and professionals and academics are hired or taken on deputation as deemed necessary. The model has proved so successful in improving drug supply in Tamil Nadu that several other States, including Kerala, have adopted it as the basis of their own governance structure.
• Whether or not this specific type of model is adopted for healthcare delivery in India, the more fundamental point is that governance and management of any health system is a core determinant of its effectiveness. The National Health Policy of the Narendra Modi government should make it a prominent focus of reforms, thereby announcing a tectonic shift in India’s healthcare system.(Source - The Hindu)

Tanzania must halt violence against person with albinism : UN rights body

• The United Nations High Commissioner for Human Rights harshly condemned on 19th February the murder and mutilation(the act of inflicting damage on) of a toddler(a young child who is just beginning to walk) with albinism in Tanzania, demanding that authorities protect persons with albinism whose body parts are used for witchcraft in the country.
• Albinism : The word “albinism” refers to a group of inherited conditions. People with albinism have little or no pigment in their eyes, skin, or hair. They have inherited altered genes that do not make the usual amounts of a pigment called melanin. Albinism affects people from all races. Most children with albinism are born to parents who have normal hair and eye color for their ethnic backgrounds. Sometimes people do not recognize that they have albinism. A common myth is that people with albinism have red eyes. In fact there are different types of albinism and the amount of pigment in the eyes varies. Although some individuals with albinism have reddish or violet eyes, most have blue eyes. Some have hazel or brown eyes. However, all forms of albinism are associated with vision problems.

An albino boy

Germany rejects Greek loan extension request

• Germany rejected a request by Athens on 19th February for a six-month extension to its European Union (EU) loan programme, hitting hopes that Europe and Greece can find a solution to a bitter debt row.
• Greece said the request would satisfy the demands of its European partners, while also keeping a promise to end the hated austerity(difficult economic conditions created by government measures to reduce public expenditure) conditions in the bailout(an act of giving financial assistance to a failing business or economy to save it from collapse) which it says has destroyed the economy and punished the poor.