Saturday, May 23, 2015

Health of India, Universal Health Coverage, a big Challenge

Health of India, Universal Health Coverage, a big Challenge

"Universal Health Coverage is when ALL people receive the quality health services they need without suffering financial hardship". - WHO

"Think Big, Think Different".

"The Nation loss 2-3% of GDP if carry undernutrition". Now health in the world is metered by IQ points!

'Stunting' (low height for age) and 'Wasting' (low weight for height) are matters of serious concern. 20% Stunting and 30% Wasting is contributed to by small size at birth. The slow in beginning remains slow for whole of life.

Human brain weight 350 gms at birth grow to 1 kg in 1st year and 200-400 gms for the rest of the life. No significant raise in number of neurons after birth. If proper care taken for first 1000 days from the conceiving stage, better human resource can be build up for growth and general happiness of people.

India has performed well in 6 decades gained 30 years life expectancy since independence and run Polio eradication and other diseases control programme successfully. But under performed in reduction of IMR and MMR compare to Bangladesh, Nepal, Vietnam, Cambodia and other BRIC countries. It is still poor in IMR (42), under 5 mortality (55), immunization (66%) and birth attendance (47%). 3rd world TB cases are in India. Malaria risks here 70%. Large population of Indian girls, mothers and children are malnourished. And 50% problem of malnourishment is not food but other issues of indigestion, ambitious and deficiency of micro nutrients. Diarrhea alone contributes to 25% of undernutrition. "2 packets of ORS generate 2% GDP"

It has spend on building of infrastructure of sub centres, Dispensaries, PHCs, CHCs, referral hospitals but still it is very high in OOP (Out of pocket expenditure). People spend more from pocket (76%), ranked 172 out of 190.

Are our policies on right track?

What are the stake holders doing?

Are all ministers are "Health Minister" taking all decisions keeping human health in the centre?

We always compare ourselves with % of budget or % of GDP spending on "Health" but never estimate the basic minimum requirements to meet with MDGs (on health), and search resources (health tax) and implement it in time bound manner. Our centres made of bricks and cements are dying without medical and health personnel. And those working are bureaucrats (inefficient)!

Government with scarce resources opt for "Health Insurance but the Health Insurance Companies are more interested in giving cover to the healthier people, to earn more premium and spend less on cure. For them "Profit" is the centre.

"Patient is dependent on Provider". Private service providers are inefficient earn more through unnecessary tests, prescriptions and hospitalisation even for small diseases. Sun and open air give more immunity than air conditioned rooms of private hospitals but many die due to incurable hospital infections. And hospital bills, money making machine for the owners of the hospitals.

The most expensive medical equipment, "Doctor's Pen", why not been regulated? Second generation antibiotics are not ready and their overdoses have pushed many to a wall, from where only the graveyards are nearby. Many deaths occur due to "medical error".

Have we prioritised our expenditure on health? Prevention, Primary Care and Hospitalisation may be the order of priority but in practice we eye on insurance programme mainly addressing indoor care.

It is argued that those afford pay themselves, employers pay for employees and government pay for poors but OOP in India is one of the highest in the world. 50% of poor man income goes in health care. Nutritional food and quality of life are foreigners for them.

Due to epidemic deaths and high IMR, MMR our life expectancy was poor before independence. But those survived were healthier than present generation whose pockets are full with medicines.

Indian kitchens were 'preventive health care centres', cooking food as per the need of the season.  The old lady (doshi maa) was a "vaidhya", learned through mother-in-law, carrying knowledge of generations to perform as "gate keeper" and protecting the DNA chain of the family. But modern generation made after junk food, not know even how to feed the babies. They care more for their shape than the babies. And poor people, busy in meeting two ends of survival, can't remember "world parametres and health directions". And O vegetarians, feed more in the belly of your children, they need more energy.

Is 'Health Care' a State responsibility only? Why the couples are not tuned with "health knowledge" of 21st century? "Fittest survive", why more attention is not paid on quality of egg and sperms at the fertilisation stage.

On one side there is shortage of 4 lakh Doctors, 16 lakh nurses and 64 lakh allied staff and other side MCI and NCI made the entire country a slave of their regulations preventing growth of the sector? Short supply but highest norms!. Let people die for want of basic minimum health care need but long live regulations! Liberate medical education and bring children of poors to become doctors and para medics as their fire in belly will deliver more that those who study through public investments and do private practice or flew away abroad. Train girls to use health care equipments by making norms simpler. Give priority to "Health Care, not "Education Degrees".

When whole world is in need of "health and medical manpower" and India has greater potential to supply them to all, why the subject "medical and nursing education", not transferred to the States if failing in regulating MCI and NCI. The countries smaller than many States of India have freedom to decide, but "State Governments" in India are unable to generate medical and health personnel under stiff regulations of MCI and NCI.

Drinking water, a reason for thousands of diseases, left under the corrupt practices of local bodies. Implement regulations strictly.

And Air pollution, cities are rushing to get title of "the most polluted"! Build "Smart Cities with Smart Health".

It is "technology driven world". 850M mobiles in the country.  Can't we think giving primary health care through mobiles? Can't we provide consultancy through mobile for primary health care issues and generic medicines from the nearby medical store from auto generated SMS send to the store?

The experiment of providing "Swasthya Slate", to front line health workers for doing 33 tests in State of Jammu & Kashmir has increase the quality and speed of delivery of medical services. It can be implemented in all States under CSS and CSR.

Control non communicable diseases through taxing to reduce consumption of food and other related items. Take policy decisions of promoting or prohibiting items beneficial/hazardous to human health.

"Narayan Hrudyalaya" experiment of covering 17 lakh farmers with a premium of Rs.5/month, giving a cover of free of cost operation is remarkable. Every mobile linked with a premium of Rs.20/month can take care of operations of whole country if Dr. Devi Shetty's idea implemented. The mobile companies are charging otherwise, let they charge Rs.20/month more. And O Hospitals, buy disposable gowns and drapes in place of linen to control infection during and after surgery. It's cheaper and entrepreneurs promotional.

"Knowing is not enough, we must apply; Willing is not enough, we must do" -Goetha

"Think Big, Think Different". But Think of the small (<2s) to make India Healthy.

"If we don't create the future, the present extends Itself".

ॐ सर्वे भवन्तु सुखिनः
सर्वे सन्तु निरामयाः ।
सर्वे भद्राणि पश्यन्तु
मा कश्चिद्दुःखभाग्भवेत् ।
ॐ शान्तिः शान्तिः शान्तिः ॥

1: Om, May All become Happy,
2: May All be Free from Illness.
3: May All See what is Auspicious,
4: May no one Suffer.
5: Om Peace, Peace, Peace.

15/11/14, Mussoorie


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