public-healthcare

CONTEXT

The recent Supreme Court judgement upholding the constitutionality of reservation for Other Backward Classes (OBC) in National Eligibility cum Entrance Test (NEET)‘s All-India Quota (AIQ) seats for undergraduate and postgraduate medical and dental courses is a landmark in the history of social justice in the country.

ABOUT DRAVIDIAN MODEL OF PUBLIC HEALTH

  • The introduction of the scheme reserving 50% of the postgraduate and super-specialty medical seats for government doctors in Tamil Nadu ushered in a tectonic shift in providing tertiary health care in government hospitals.
  • It resulted in the expansion of public health infrastructure in the State. This progressive reform paved the way for ensuring the availability of specialists in multiple disciplines.
    • The provision of reservation for government doctors in super-specialty courses contributed to a steady rise in the availability of multi-specialty experts not only in metropolitan cities like Chennai, Coimbatore and Madurai, but also Tier-2 cities as early as the 1990s.
  • The unique scheme had a dual effect:
    • It encouraged young MBBS graduates to serve in rural areas, as serving for three years in Primary Health Centres (PHCs) in rural areas is an eligibility criterion for graduates to avail themselves of the reservation policy.
    • As a consequence, State PHCs and government hospitals never witnessed a shortage of doctors and people got better healthcare facilities at their doorsteps.

INDIA’s HEALTHCARE SYSTEM

  • Health systems and polices have a critical role in determining the manner in which health services are delivered, utilized and affect health outcomes.
  • Essentially, a three-tier structure defined the Indian healthcare system — primary, secondary and tertiary care services.
    • The Indian Public Health Standards (IPHS) states that the delivery of primary health care is provided to the rural population through sub-centre, primary health centre (PHC), and community health centre (CHC), while secondary care is delivered through district and sub-district hospitals.
    • On the other hand, tertiary care is extended at regional/central level institutions or super specialty hospitals.

CHALLENGES OF PUBLIC HEALTH

  • Prevention of diseases:Diseases need to be prevented first,a concept that has historically been inadequately acknowledged in India.
  • Tackling Non communicable diseases (NCDs):The large burden of NCD requires lifestyle and community level interventions ensuring people eat right, sleep right, maintain good hygiene, exercise and adapt to a healthy lifestyle.
    • It necessitates concentrated interventions at various levels of the system.
  • Adequate training to health professionals: In most States population Health Management positions are staffed by Doctors, trained primarily in the provision of curated services, or by general civil servants.
    • They have limited Public Health training, which includes understanding of the causes and linkages between risk factors and diseases as well as disciplines including epidemiology, biostatistics, social and behavioral Sciences and management of Health Services.
    • Likewise, hospitals and clinics have little expertise in managing health facilities.
  • Preventable risk factors: The following preventable risk factors are causes of major proportion of diseases in the country:
    • maternal and child malnutrition
    • air pollution, healthy diets, safe water & sanitary practices 
    • high blood pressure, high blood glucose
    • tobacco consumption
      • These all factors are outside the purview of the health ministry therefore accountability for ensuring vital Public Health actions is spread thin.
  • Lack of single authority: There is no single authority responsible for public health that is legally empowered to enforce complaints from other public authorities and citizens, even though several factors may require intersectoral action to achieve a measurable impact on Population health.

WAY FORWARD

Mobilise Public Health action at multiple levels:

  • Public funding on health should be increased to at least 2.5 % of GDP as envisaged in the national health policy, 2017.
  • Create an environment through appropriate policy measures that encourages healthy choices and behaviour.
    • Make the practice of yoga a regular activity in all schools through certified instructors.
    • Increase taxes on tobacco alcohol and unhealthy food such as soda and sugar sweetened beverages.
    • Co-locate  AYUSH services in at least 50% of Primary Health Centre, 70% of Community Health centres and 100% of district hospitals by 2022 -23.
  • Strengthen the village health sanitation and nutrition the platform to cover a broader set of health issues across various population groups instead of only focusing on child health.
    • Make nutrition, water and sanitation part of the core functions of Panchayati Raj Institutions and municipalities.
  • Activate multiple channels (schools, colleges, women's groups, traditional events like fairs, social media platforms in National Cadet Corps etc.)and prepare communication materials for catalyzing behavioral change towards greater recognition of Preventive Healthcare.

Create a focal point for public health at the Central level with state counterparts:

  • Create a designated and autonomous focal agency with required capacity and linkages to perform the functions of disease surveillance, information gathering on the health impact of policies of key non health departments.
  • Create a counterpart public health agency in each state where they do not already exist.

Miscellaneous:

  • Explore the need for a public health act to legislatively empower and, if necessary, institutionalize the public health agency.
  • Redefine the role of Technical directorate (Directorate General of health services) and create a Directorate of Public Health.

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