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Towards a Comprehensive Manifesto for People's Health

         South Asian Dialogues on Ecological Democracy (SADED)-Lecture Series

Date: 16th May 2013

Time: 2.30pm

Place: Gandhi Peace Foundation (GPF), Delhi.

                                                                                                                                                                                                                                                                                                 Ritu Priya

For a comprehensive approach to people’s health we need to address the various determinants of health as well as issues arising while strengthening health-care through long term policy and action.

Health-care, with increasing national and international commercial interest, has become the second largest growing industry after IT. Universal health coverage being the current international slogan, a country is judged by its poor health indicators and coverage by health services and medical insurance. The slogan of universal health coverage, commercial sector interests, increasing middle class interest in issues of public health has resulted in greater attention by the state as well. But the escalating cost of healthcare, both financial and iatrogenic i.e. doctor granted illness, and actions of state towards it are not promising.

Over the centuries we have seen drastic changes in health problems. Communicable diseases and malnutrition persisted and health problems such as non-communicable diseases at younger ages, increase in injuries (occupational, accidental, homicide, suicide), toxicities due to environmental contamination, addictions, iatrogenic illness and old age problems, etc. increased as an externality of modernization. This health scenario and an increase in dependence on doctors has enhanced the demand for medical services.

Classically, an ideal design of Health Service Systems is expected to be effective, safe, affordable, sustainable, people empowering with the objective of prioritizing maximum good to maximum number. Historically, there has been knowledge system pluralism in India. Societal dialogue across development models has resulted in the present provisioning and financing of health services. The structure consists of public, private and civil society (charitable, NGO, cooperative) institutions with knowledge system pluralism including both AYUSH and Modern Medicine. Strengthening the public services requires addressing issues of:

·         health planning and budget provisions,

·         Investment in human resources: education and training, postings and transfers

·         A public health cadre

·         Free medicine for all patients, systems for procurement and distribution.

The system of colonial hangover with dominance of modern science and medicine as well as commercial interest in modern medicine led to undemocratic pluralism in relation to AYUSH. There are various debates running in Civil Society (Medico friend circle, Jan Swasthya Abhiyan, Kolkata Declaration), Ministry of Health and Family Welfare (NRHM), Planning Commission, Global Health Forum, etc., related to universal health care service systems and design. Following are the frameworks reflected in debates

·          Private Sector Bio-Medical Curative frameworks: This model runs on free market logic. State and private insurance is

            considered to be third party.

·         Statist Public Health Framework where state is responsible for full provisioning and financing with PPP (Public Private Partnership) as

              a concession to the  reality of their existence.

The existing framework is mixture of two above stated frameworks. The aim has to be to extract the best from both the systems and form a unique system. Both the systems have components of various knowledge systems, reliance on STGs (short term goals?), audits, monitoring to ensure rational practice and people’s movement as a possible moderating force.

Impact of people’s movements on health systems led to: Frontiers of Modern Medical Practice changing paradigm that limits Intervention, promotes self care, patient involvement in decision-making, greater role of psychosomatic etiologies finding from studies and revitalizing primary healthcare. Questions regarding choice of Stream of International Health trends, of framework conducive for people’s health have risen. The broad points of agreement emerging from the debate and dialogue are:

·         Public funding with public and private provisioning

·         Structure of services designed for cost effective and rational services, with quality and equity

·         Rational care to contain costs and iatrognesis

Another important aspect to health caresystem is closer availability to the patient, hence starting from home, each level provides as much care as it can and is supported by the next level. So, unnecessary services move to GP, GP to HWs and to self-care. It is important to design structure of services which are cost effective and rational and also serves purpose of quality and equity: Community centred public services plus civil society provisioning; monitoring is the available solution that includes knowledge system democratic and integrative pluralism. The move towards integrating institutional structures, formalizing cross referral and interaction across pathies; for instance AYUSH education generating confidence in AYUSH and LHTs, its revitalization by growing herbal gardens in the sub-centre and PHC compound, focus and promotion of National University for Pluralistic Sciences- with one college for each recognized pathy, one institution for local health traditions, one for integrated medicine, etc.

Conclusion

We live in a country where one in every four persons goes to bed hungry. Health problems in India need to be treated at very grassroot level, provision of basic minimum needs like roti, kapda and makaan to every individual though employment generation which provide them self esteem and dignity. Access to clean drinking water, better sanitation conditions, balance between physical work, food and leisure and emotional and social well-being through community structures and dignity enhancing societal conditions can take care of 50% of diseases due to unhygienic environment, hypertension, etc.

Hence there is a need for: Health Impact Assessment of all development plans. Further, social and economic development planning needs to be centred on people’s health and well-being. Only a new policy milieu of social solidarity and caring is the solution.

 


Ritu Priya  Mehrotra is currently Professor at Centre of social Medicine and community health in School of social sciences, JNU,

http://www.jnu.ac.in/FacultyStaff/ShowProfile.asp?SendUserName=rpriya