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All India Public Health Service Cadre: Special cadre for health services mooted

October 24, 2011 Leave a comment

NEW DELHI: India must put in place a new army of health workers – the Public Health Service Cadre – to fight the public health threats.

The Planning Commission’s high-level expert group (HLEG) on universal health coverage (UHC) says, a national and state-level Public Health Service Cadre and a specialized state-level Health Systems Management Cadre needs to be put in place. This will help provide greater attention to public health and also strengthen the UHC system’s management.

A new cadre, comprising public health professionals with multi-disciplinary education, would improve the functioning of the system by enhancing the efficacy, efficiency and effectiveness of healthcare delivery.

“We recommend the creation of an All India Public Health Service Cadre that should be responsible for all public health functions starting at the block level and going up to the state and national level. This cadre should be supported by a state level public health cadre. This would be akin to the civil services, which provide for both all India and state-level officers,” the HLEG’s final report, submitted to the government on Saturday, said.

The state-level cadre will provide the operational framework of public health services, the All-India cadre will not only health strengthen state services with a high level of professional expertise, but also provide strong connectivity between state and Central planning.

The HLEG has recommended the creation of a new Health Systems Management Cadre.

Quality assessment and assurance for health facilities will be a key function for the cadre. The health system managers would take over many of the administrative responsibilities in areas such as IT, finance, human resources, planning and communication that are currently performed by medical personnel.

“We further recommend the appointment of appropriately trained hospital managers at sub-district, district hospitals and medical college hospitals so as to improve the managerial efficiency and also enable medical officers to concentrate on clinical activities. Appropriate training of these new cadres is likely to significantly enhance the management capacities at all levels and end the practice of untrained personnel being assigned to manage health institutions,” the report added.

India faces an acute shortage of allopathic doctors. HLEG’s estimates say the number of allopathic doctors registered with the Medical Council of India has increased since 1974 to 6.12 lakhs in 2011 – a ratio of 1 doctor for 1,953 people or a density of 0.5 doctors per 1,000 population.

It will take India at least 17 more years before it can reach the World Health Organization’s recommended norm of one doctor per 1,000 population.

The HLEG has predicted the availability of allopathic doctors to one doctor per 1000 population by 2028, which can be achieved by setting up of 187 medical colleges in 17 high focus states during the 12th and 13th Five Year plan.

Sources:- Times Of India

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Plan to double health spend over next 5 yrs: Ahluwalia

September 10, 2011 Leave a comment

NEW DELHI (Reuters) – India plans to more than double its health budget over the next five years, a move that would expand access to much-needed health care and reach more voters ahead of 2014 national elections, but could also further stretch government finances.

The UPA government led by Manmohan Singh, under fire from the opposition and civil society groups over various corruption scams and inflation, is trying to win back voters, as it has to face elections in five states next year.

“In the 12th plan…we will be able to increase both centre and state spending (on health) as percentage of GDP somewhere upto 2.5 percent from a little over 1 percent,” said Montek Singh Ahluwalia, deputy chairman of the planning commission, on Friday.

India’s plan panel — which recommends the allocation of federal funds for key national programmes — is expected to finalise the spending plan for the next five years to March 2017 by December.

Private households contribute to about three-fourth of total healthcare spending, which is at about 4 percent of the GDP – estimated at $1.6 trillion.

The government is struggling to meet a deficit target of 4.6 percent of GDP.

The World Bank has said despite improvement in health indicators in the country, slow progress has failed to match the impressive gains in economic growth during the past decade.

Ahluwalia said the government could focus on the poor – about 50 percent of the total 1.2 billion population – who could not afford health services, while partly subsidising the middle income groups.

A committee appointed by the Prime Minister to suggest universal health insurance coverage for all Indians is expected to submit its report by month end, Ahluwalia said.

Under the proposed universal health insurance scheme, the premium may be linked to income levels of the beneficiaries, although the government may pay the entire premium for those below the poverty line, he said.

(Reporting by Manoj Kumar; Editing by Aradhana Aravindan)

Every district in India will have a medical college within next five years

August 30, 2011 Leave a comment

In order to bring down the shortage of doctors and improve healthcare services at the minutest level, the government is planning to have medical colleges in each district.

It has plans to convert district hospitals into training institute the paramedical personnel as well.

Besides, the government also plans to integrate AYUSH doctors and have capacity building programmes for other traditional healthcare providers such as Registered Medical Practitioners (RMPs) and Traditional Birth Attendants (TBA) so that traditional care practices and local remedies are encouraged.

Health ministry sources indicated that the AYUSH doctors may be trained further to handle normal chidbirth cases in remote areas.

They will also be trained to take care of serious medical cases so that the patient is stabilised before he/she is sent to bigger hospital. Ministry officials said that this help will bring down maternal and infant mortalities.

Expressing concerns over the low density of doctors and paramedical staff in India the Planning Commission’s approach paper for the 12th Five Year Plan, has prescribed drastic reforms to improve healthcare.

As of now medical colleges are concentrated in only 193 districts of the country that have 640 medical colleges among them. The rest 447 districts do not have any medical college.

Against 335 colleges, there are about 319 Auxiliary nurses and midwives (ANM) training schools, 49 health and family welfare training schools and only 34 LHV (Lady Health Visitor) schools.

The present doctor patient ratio 0.6 per 1000 while the ratio of health workers (including midwives, nurses etc) is 2.5 per 1000.

“To fill the gap in training needs of paramedical professionals, the 12th Plan proposes to develop each of the district hospitals into knowledge centres, and 4,535 CHCs into training institutions,” says the Planning Commission report.

The government has already begun work on six All India Institute of Medical Sciences (AIIMS) -like medical institutions in different states.

The government has so far released Rs847 crore for the purpose. These AIIMS like institutions are coming up in Bihar (Patna), Chhattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttarakhand (Rishikesh) under the first phase of Pradhan Mantri Swasthya Suraksha Yojana .

Over the last three years, Ministry of Health and Family Welfare had announced to increase about 5,000 post graduate seats in medical colleges across the country in order to increase in the number of specialist doctors.

Sources:- DNA

Doctors, let us care for the sick, not look at their purse

Dr. Araveeti Ramayogaiah

Dr. Subba Reddy, my classmate at the medical college, practises in a village in Kurnool District of Andhra Pradesh. A decade ago, a patient came to him for treatment of hydrocele. After examination, Dr. Reddy suggested surgery costing Rs. 500. The patient asked Dr. Reddy to refer him to a bigger hospital in a city. Dr. Reddy suggested a city hospital. After a few days, he received Rs.1,000 from the hospital!

A patient approached a doctor at Vijayawada for liver abscess. The doctor said he would treat him and the fee was Rs. 2,000. The patient left him and got treated in a corporate hospital. Our doctor received Rs. 6,000 from the hospital.

Dr. Krishna Reddy, another classmate is a whole time paediatrician at Jammalamadugu, a medium town in Andhra Pradesh. One day, to his surprise he received Rs. 2,000 from a corporate hospital. He did not refer any child there, but children are his regular patients. Two decades ago, I received a letter from a fertility centre in Hyderabad asking me to refer women with fertility problems. The letter said: you will be well taken care of!

Called cut practice/fee splitting, this is a totally unethical practice. It represents a conflict of interest which may adversely affect patient care. Whose money is this? What is the health derived by the patient by parting with this money? Nothing. Do you know, dear physicians, that in our country every year 290 million people are pushed into poverty owing to exorbitant medical expenditure? Let us stop this obnoxious trend and the Medical Council of India has a responsibility in this regard.

We, doctors, know for sure from our long years of gruelling studies that most of the symptoms are self-limiting, most others are trivial and very few are serious. In the name of evidence-based medicine and defensive medicine, we order a battery of investigations even for trivial symptoms. The cut practice and cost recovery of hospital equipment play a prime role in decision-making. Unnecessary tests are a loathsome burden on patients and, at times, result in false positive results leading to unscientific treatment.

“It is in the ordering of laboratory or radiological investigations that rational thinking is necessary. Why do I order this investigation? What do I look for in the result? If I find it, will it affect my diagnosis? How will it affect the management of the case? Will this ultimately benefit the patient?” said Richard Asher, a critical medical writer. Let this be the guiding principle for all of us.

“Bring this coupon to get 10% special discount,” read a recent advertisement of a cancer hospital. Another advertisement proclaimed: “Basic health check-up including ECG, etc. — Rs. 500 only and valid till June 30, 2011. As I pass through the streets of any city, I see large hoardings of hospitals beckoning patients and some of them even display the photos of physicians. Many vernacular newspapers/magazines publish articles with the photos of doctors, their phone numbers and addresses of the hospitals. A decade ago, a friend in the media told me that there was a culture of ‘paid articles.’ ‘Paid articles’ were born prior to ‘paid news’!

I recently saw a chemist shop displaying the signboards of a paediatrician and an obstetrician. The MCI clearly prohibits such practices. Advertising is permitted only for notifying change of address, temporary absence of the doctor from duty, etc. A physician’s photograph should not be displayed anywhere if it is for promoting medical practice.

Giddalur in Andhra Pradesh is a town near my village where I had my school education. Pharmacies nowadays pay lakhs of rupees to clinics they are attached to. “What is the cost of the doctor this year?” is the normal jargon among the healthcare people. It may be true of other towns and cities as well. Pharma companies shower doctors with gifts, arrange their birthday parties and trips to conferences at home and abroad. This is a serious professional misconduct.

Again, whose money is this? It is the blood and sweat of millions of our sick brothers and sisters. The World Health Organisation report 2008 clearly laments the influence of the pharma industry on doctors. Dear doctors, let’s not be stooges of the industry and let us be saviours of the sick.

The child sex ratio, as per Census 2011, is 914 girls for every 1,000 boys. In 1961, it was 976 girls for 1,000 boys. An unpleasant truth, it will lead to a lot of social turmoil in future. It is all owing to the abominable practices — sex determination, female foeticide and female infanticide. We are largely responsible for this heinous situation. We have violated both the MCI act and the Pre-natal Diagnostic Techniques (PNDT) Act. What a shame!

The emblem of the International Red Cross is “The Red Cross on White Background.” This originated in the 1864 Geneva Convention. It is also known as the Geneva Cross. This is inscribed on humanitarian and medical vehicles and buildings to protect them from military attack on the battlefield.

Unfortunately, we are using the Red Cross emblem wherever we like. Our paramedical personnel and even chemists use it. It is a gross violation and punishable as per the existing laws of the nation. Most of us are not even aware of this.

The common symbol to denote medical services is the caduceus, a figure that comprises a short staff rod with two serpents curled around it, sometimes surmounted by wings. It is the staff of Aesculapius, the ancient mythological god of medicine. Let us use this symbol and stop using the Red Cross symbol.

At all times, physicians should notify the public health authorities of every case of communicable disease under their care. We hardly do that. We are not above the law. Our responsible action helps formulate national and international strategies to control communicable diseases.

The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. The people of this nation are kind and generous. They sustain us even in adverse conditions.

“Restore a man to his health, his purse lies open to thee,” said Robert Burton. Come what may, let us be ethical.

(The real names of persons and places are changed to protect privacy. The article relates to practices in allopathic medicine.)

(The writer is a former Additional Director of Health, Andhra Pradesh, and former State coordinator, Breastfeeding Promotion Network of India. His email is: araveeti.ramayogaiah@gmail.com)

Sources: The Hindu

Increase public spending on health: expert

There is an imminent need to increase public spending on health and medical care in India, K. Srinivasan, former director, International Institute for Population Sciences, said.

It was expected that India would allocate two per cent for health care, but that expectation has not yet been realised. Also, with the increasing trend of public-private partnerships entering health care, it is essential to remember that the government cannot abdicate its responsibility towards providing health services for the citizens.

Dr. Srinivasan was speaking on ‘Health Policies in India – A Review’ at a lecture organised by the Voluntary Health Services, here. While there were no health policies in pre-Independent India, subsequently, the Bhore Committee made several recommendations to prevent communicable diseases, promote health and provide basic health care. This report formed the basis of the Indian public health system that prevails till date.

He also spoke of the global movements towards ‘Right to Health,’ initiated by the Soviet Union. The French Constitution of 1946 ‘guarantees to all… protection of health.’ In 1965-66, the United States declared health a human right. The declaration by the International Conference on Primary health Care held in Alma Ata (USSR) in 1978 declared the goal of global health programs should be “Health for All” by 2000. It called for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries.

The National Health Policy (NHP), formulated in 1983, was the first attempt to synthesise recommendations of three important earlier committees, the Bhore Committee of 1946, the Mudaliar Committee of 1962, the Shrivastav Committee of 1975, and the Alma Ata declaration.

The second major policy endeavour is National Health Policy 2002, which followed on the heels of the National Population Policy 2000. Both policies grew in the context of liberalisation and globalisation, Dr. Srinivasan said.

The NRHM implemented across the country since 1995 is another key policy shift that has seen improvements in using public health facilities.