India Committed To Provide Equitable Healthcare To All

Health experts from the eleven Member States of the WHO’s South-East Asia Region met in New Delhi last week (16-17 April) to brainstorm about universal health care in the region. WHO is urging countries in the region to give priority to public health and the health needs of the poor through adoption of appropriate technology and health systems that are anchored at the community level.

“The Government of India accords great importance to ensuring equitable health care to all its citizens. The National Rural Health Mission, one of the largest public health programmes, is an ambitious multi-sectoral initiative taken by the Government of India in 2005-06 to make essential health care available, accessible and affordable to the rural citizens”, stated India's Union Health and Family Welfare Minister, Ghulam Nabi Azad, while inaugurating the two day deliberations at the WHO SEARO's meeting on Universal Health Coverage.

The Minister said “It is matter of grave concern that people in our region have the highest out-of-pocket expenditures on health, as compared to anywhere in the world. In India, out of the total out-of-pocket expenses, nearly 62% is incurred by the rural populations.”

Azad added that at this point in time there is sufficient evidence and experience from all over the globe that indicates that Universal Health Coverage is a potential tool that can reduce prevalent health inequities, contribute to human development and accelerate our quest for Health for All.

Azad hoped that the international experiences presented at the conference would help us to understand what other countries are doing to cover all segments of their populations particularly, the disadvantaged, marginalized and hard to reach sections in rural areas. He said that in the scenario of several sectors competing for scarce resources, a critical issue that needs intensive discussion is health financing.

 

The three strategic dimensions for universal health coverage are:

• Population coverage, where all citizens are covered by health services irrespective of capacity to pay;
• A service package offered universally to all citizens customized to meet ground realities and all resource needs, including financing;  and

• Ensuring utilization, affordability and sustainability.

It was noted during the deliberations that Countries have placed different emphasis on each of these three dimensions in their path to universal health coverage:

• China for example is targeting access to a limited package of services for its entire population in its first phase of universal health coverage.

• Nepal is committed to providing maternal and child health services free at primary level and prioritizing better access for the poor in secondary care.

• Sri Lanka, on the other hand, has been successfully delivering a more comprehensive package for sometime now.

“Equity remains the underpinning principle that we must not lose sight of” said Dr. Samlee Plianbangchang, WHO Regional Director for South-East Asia.

India makes progress on health front

India improves on Health Indicators

At the National Dissemination workshop held in New Delhi recently (12 January, 2012) the Union Minster of Health and Family Welfare, Ghulam Nabi Azad, released reports of 5^th Common Review Mission (CRM) and 8^th Joint Review Mission (JRM) of the National Rural Health Mission (NRHM), attended by health secretaries and mission directors (NRHM) of 20 states. The Minister of State, S. Gandhiselvan  also graced the occasion.

In his address, Azad congratulated the NRHM team of centre and the states for the hard work that has led to notable improvement in the health indicators of the country. The achievements of NRHM have been endorsed by independent surveys, he said. As per the latest SRS, country’s infant mortality rate (IMR) has reduced from 58 in 2005 to 47 in 2010 and maternal mortality ratio (MMR) declined from 254 during 2004-06 to 212 in 2007-09.

Noteworthy achievements have also been recorded in the high focus States like Orissa, Rajasthan and Bihar where the IMR has dropped by 13 or more points since 2005. Fall in rural IMR has been consistently more than urban IMR for last three years. Assam, Uttar Pradesh, Uttarakhand and Rajasthan have recorded the largest fall in maternal mortality ratio of 90, 81, 81 and 70 points respectively. Further, TFR has reduced to 2.6 in 2009 from 2.9 in 2005.

Azad noted that assured referral transport including emergency medical transport services, development in infrastructure and augmentation of human resources are other major areas in which significant achievements have been recorded. He asserted that Janani Shishu Suraksha Karyakram which was launched on 1^st June 2011 to provide free services to pregnant mothers and children will further reduce out of pocket expenditure and improve institutional delivery.

Azad mentioned that development of a comprehensive facility development plan for each district was essential to ensure that essential infrastructure is established in the 12^th Plan period. He stated that provision of essential drugs free of cost, standard treatment guidelines and basic minimum set of diagnostics at all the facilities is being planned in the 12^th Plan to reduce financial stress on the poor patients. He stressed on the importance of continuous monitoring and evaluation to continue the positive trends, and reiterated the commitment of Government of India to provide accessible, affordable and quality health services to all the people of India. 

Minister of State Gandhiselvan  expressed happiness over substantial increase in health human resources, improved fund utilization and improved programme management capabilities. He appreciated the improved community ownership of the program through Rogi Kalyan Samities, Village Health Sanitation and Nutrition Committees, and ASHAs.

The Secretary, Health and Family Welfare, P. K. Pradhan highlighted that the “High Focus District” approach, under which the Ministry had identified 264 backward districts of the country having adverse health indicators and received greater attention, has paid dividends. The Ministry has also started annual health survey in nine High Focus States to continuously monitor progress. Pradhan stressed on need for closer monitoring of health of high risk mothers and low birth babies. Facility based care for this vulnerable group has increased but there is need to monitor their health post-discharge from the health facilities, he added.

Pradhan also stressed on need to make maternal death review (MDR) more comprehensive. He asked the states to fill up vacant post and ensure rational deployment of manpower. The new schemes for promoting menstrual hygiene in adolescent girls and delivery of contraceptives at doorsteps through ASHAs have been implemented, he said. The secretary AYUSH in his address emphasized on greater need for integration of AYUSH services.

The key findings of CRM include state reports of steady increase in caseload, range and quality of services offered by the public health facilities and an increase in availability of sick newborn care units and newborn care corners. The teams have noted that Mother and Child Tracking System (MCTS) and Health Management Information System (HMIS) have been established in all the States and districts. E-transfer of funds and capacity building have also yielded positive results. 

The need to increase technical and managerial resources in high focus states, strengthening of training institutions, provision of incentives to encourage skilled service providers to work in difficult areas and high focus districts, strengthening of laboratory services and district hospitals, partnership with not for profit sector institutions for service provision in high focus districts and strengthening of horizontally integrated planning at district level are other recommendations of the report. Sustained efforts in the past seven years since NRHM has been launched, have led to development of that critical mass and momentum required to achieve the goals and targets and the next phase of the Mission is set to capitalize on the momentum and accelerate our journey towards our National Health Goals. 

The CRM and the JRM (with particular focus on RCH programmes) are annual exercises to critically review the functioning of NRHM vis-à-vis its goals and objectives and assess the healthcare delivery system in the States to explore the main reasons for successes and shortcomings. The mission teams comprise of members from civil society, public health experts, representative of international development partners and senior officers of various ministries. The 5^th CRM was held during 8^th -15^th November, 2011 and the teams went to 15 States including 10 High Focus States. The 8^th JRM teams visited 5 States from 12^th to 16^th November, 2011. 

India launches Phase-III of  ‘Red Ribbon Express’ to spread health awareness

Azad also launched the National AIDS Control Organization’s Red Ribbon Express Phase III. Speaking on the occasion, he said that it was satisfying that the innovative initiative of multi-media and multi-sectoral mass mobilization project of Red Ribbon Express has been commended globally as a unique example of its kind.

At various fora, India, China and South Africa are noted for their efforts at being able to reduce the instances of HIV/AIDS infection by 50% over the last decade, he noted. Azad elaborated that Red Ribbon Express in its Ist Phase, launched on December 01, 2007, by his government focused on information dissemination. The IInd Phase of RRE in 2009 added the element of counseling and treatment services on board and in its IIIrd Phase now, RRE is focusing on micro planning with exhibitions in IEC vans and folk troupes, particularly in the States of Rajasthan, Madhya Pradesh, Bihar, Jharkhand, Orissa and Chhattisgarh, so as to be able to reach out to public even in the periphery of the districts through which the train will pass.

The RRE launch ceremony was also graced by the Union Minister for Railways, Dinesh Trivedi, Chief Minister of Delhi, Sheila Dikshit, the state health minister, Gandhiselvan, and others. The renewed focus of the Red Ribbon Project - Ph III, is on the youth and hence the launch has been timed with the National Youth Day and the birthday of Swami Vivekanand. The specially designed RRE during its year long journey will travel through 23 States and will cover 162 halt stations. It has three exhibition coaches with exhibits on HIV and AIDS while the fourth exhibition coach on National Rural Health Mission (NRHM) has exhibits on Tuberculosis, Malaria, Reproductive and Child Health services, general health and hygiene. 

There is one coach also on counseling and another one for conducting trainings of local stakeholders such as members of Panchayati Raj Institutions, self help groups, health workers, youth organizations, teachers, police personnel etc. The RRE Phase III Project will continue to focus on rural and difficult to reach areas with an objective of disseminating the information regarding primary prevention services, developing an understanding about the infection to reduce the stigma and discrimination against people living with HIV/AIDS and strengthening people’s knowledge while focusing on youth, in particular, about the measures to be taken to prevent HIV/AIDS to adopt preventive health behavior.

The on-board planned activities include interactive exhibition carrying messages on health, HIV and AIDS; sensitization and training on Health, HIV and AIDS; counseling and testing facilities; general health check-up, STI treatment and referral service and adolescent/ youth friendly reproductive and sexual health services information. The planned outreach activities will also have Red Ribbon Buses carrying a portable version of train exhibition; Counseling and testing services; condom demonstration stalls as also interpersonal communication via local folk media. (Source: PIB.12.01.2012)