Role of government within the health sector with few
suggested majors:
Health forms a major
criteria in the evaluation of the developmental status of a country. The
Constitution of India envisages the establishment of a new social order based
on equality, justice and dignity of the individual. The Preamble, Directive
Principles of State Policy and Fundamental Rights in the Constitution of India
stand testimony to the commitment of the State to its people in this regard.
The commitment made by the nation has found expression in the various
developmental activities undertaken by the Government since independence.
Various government
departments are contributing to the well being and healthy development of the
people, either directly or indirectly. While the Ministry of Health &
Family Welfare is the nerve center of all health related activities, other
Ministries like Human Resource Development, Rural Development, Agriculture,
Food and Civil Supplies and Urban Affairs also contribute substantially.
Ministry of Health
& Family Welfare has the constitutional obligation to guide, regulate,
assist and finance State Governments in the area of population control, family
planning, medical education, adulteration of food, drugs and poisons, medical
profession, vital statistics and mental deficiency, leaving the other areas of
public health, sanitation and nutrition to the State Governments' exclusive
jurisdiction. The central Government evolves broad policies and plans through
Central Council of Health & Family Welfare for implementing various health
programme in the country.
At the time of
independence the health situation in the country was dismal with millions of
people succumbing to the scourge of Malaria, Plague, Influenza, Pneumonia,
Tetanus,and Tuberculosis. Added to this misery was the frequent occurrence of
droughts.
With the inception of
planning in the country, the Government took concerted measures to
control/eradicate communicable and non‐
communicable diseases through various National Health Programmes. These are
being implemented as centrally sponsored schemes aimed mainly at reduction of
mortality and morbidity caused by major diseases.
The major health
schemes include the National programmes for Eradication/Control of Malaria,
Blindness, Leprosy, Tuberculosis, AIDS including Blood safety measures and STD
control, Cancer control, Iodine Deficiency Disorders Control, Mental Health and
Guineaworm Eradication programme.
The National Rural
Health Mission (NRHM) launched by the Government of India is a leap forward in
establishing effective integration and convergence of health services and
affecting architectural correction in the health care delivery system in India.
India is a signatory to
the Alma‐Ata declaration of Health for All by 2000 A.D.
through primary health care approach. In 1983, the National health Policy was
adopted to give effect to this commitment. It laid stress on the provision of
preventive, promotive and rehabilitative health services to the people
representing a shift from medical care to health care, and from urban to rural
population.
To achieve this a huge
network of rural health infrastructure comprising of 1,36,339 sub‐ centres, 22,010 Primary health Centres and 2,622
community health centres have been set up throughout the country. The Common
Minimum Programmes of the Government also attaches importance to primary health
care and envisages to provide 100% coverage both in the rural and urban areas.
Health Care Institutions.
Over the years the
country has expanded the health care delivery system and has adequate
availability of health manpower and training institutes. At present there are
about 489189 allopathic doctors, 11,300 Dental Surgeons and 5,59,896 Nurses in
the country. Every year about 18,000 medical graduates and post graduates are
passing out of nearly 164 medical colleges and other institutions.
India has many premier
educational and research institutes like AIIMS, New Delhi; PGI, Chandigarh,
JIPMER, Pondicherry, NIMHANS, Bangalore, ICMR, New Delhi; NTI, Bangalore; NICD
New Delhi; CLTRI Changalpattu; NBE, New Delhi and All India Institute of
Hygiene and Public Health, Calcutta, attached to the Ministry of health &
Family Welfare.
India has attained self‐sufficiency in the manufacture of many drugs and
vaccines and a chain of laboratories are working in this area. Many institutes
of Department of Science & Technology like Centre for Cellular &
Molecular Biology, Hyderabad; National Institute of Immunology, New Delhi and
DRDO, Bangalore have been contributing usefully towards health sector.
To strengthen the
secondary health care development system, Government has started State Health
Systems Development projects in Andhra Pradesh, Karnataka, West Bengal, Orissa
and it is being extended to six more States with World Bank's assistance.
To strengthen disease
surveillance system in the country, especially at District and State level a
pilot project has been started. Two districts each in Madhya Pradesh, Gujarat,
Maharashtra, Bihar, Andhra Pradesh, Rajasthan, karnataka, Haryana, Uttar
Pradesh, Kerala and Delhi have been selected under this project. Pilot projects
have also been initiated on Cancer, Oral health, Diabetes and Micro‐ nutrients. Realising the importance of Information,
Education and Communication (IEC) strategy in India, Government has taken
measures to utilise all forms of media to propagate and advocate health
messages.
A good system of
regulation is fundamental to successful public health outcomes. It reduces
exposure to disease through enforcement of sanitary codes, e.g., water quality
monitoring, slaughterhouse hygiene and food safety. Wide gaps exist in the
enforcement, monitoring and evaluation, resulting in a weak public health
system. This is partly due to poor financing for public health, lack of
leadership and commitment of public health functionaries and lack of community
involvement. Revival of public health regulation through concerted efforts by
the government is possible through updation and implementation of public health
laws, consulting stakeholders and increasing public awareness of existing laws
and their enforcement procedures.
Stopping the spread of
STDs and HIV/AIDS, helping youth recognize the dangers of tobacco smoking and
promoting physical activity. These are a few examples of behavior change
communication that focus on ways that encourage people to make healthy choices.
Development of community‐wide education programs
and other health promotion activities need to be strengthened. Much can be done
to improve the effectiveness of health promotion by extending it to rural areas
as well; observing days like “Diabetes day” and “Heart day” even in villages
will help create awareness at the grass root level.
There are several
shortfalls that need to be addressed in the development of human resources for
public health services. There is a dire need to establish training facilities
for public health specialists along with identifying the scope for their
contribution in the field. The Public Health Foundation of India is a positive
step to redress the limited institutional capacity in India by strengthening
training, research and policy development in public health. Preservice training
is essential to train the medical workforce in public health leadership and to
impart skills required for the practice of public health. Changes in the
undergraduate curriculum are vital for capacity building in emerging issues
like geriatric care, adolescent health and mental health. In‐service training for medical officers is essential
for imparting management skills and leadership qualities. Equally important is
the need to increase the number of paramedical workers and training institutes
in India.
Identification of
health objectives and targets is one of the more visible strategies to direct
the activities of the health sector, e.g. in the United States, the “Healthy
People 2010” offers a simple but powerful idea by providing health objectives
in a format that enables diverse groups to combine their efforts and work as a
team. Similarly, in India, we need a road map to “better health for all” that
can be used by states, communities, professional organizations and all sectors.
It will also facilitate changes in resource allocation for public health
interventions and a platform for concerted intersectoral action, thereby
enabling policy coherence.
The Ministry of Health needs
to form stronger partnerships with other agents involved in public health,
because many factors influencing the health outcomes are outside their direct
jurisdiction. Making public health a shared value across the various sectors is
a politically challenging strategy, but such collective action is crucial.
Kerala is often quoted
as an example in international forums for achieving a good status of public
health by addressing the fundamental determinants of health: Investments in
basic education, public health and primary care.
Safe drinking water and
sanitation are critical determinants of health, which would directly contribute
to 70‐80% reduction in the burden of communicable
diseases. Full coverage of drinking water supply and sanitation through
existing programs, in both rural and urban areas, is achievable and affordable.
Provision of urban
basic services like water supply, sewerage and solid waste management needs
special attention. The Jawaharlal Nehru National Urban Renewal Mission in 35
cities works to develop financially sustainable cities in line with the
Millenium Development Goals, which needs to be expanded to cover the entire
country.Other issues to be addressed are housing and urban poverty alleviation.
Action is required in
the following areas: Promotion of agricultural mechanization, improving
efficiency of investments, rationalizing subsidies and diversifying and
providing better access to land, credit and skills.
Elementary education
has received a major push through the SarvaSikshaAbhayan. In order to
consolidate the gains achieved, a mission for secondary education is essential.
“Right of children to Free and Compulsory education Bill 2009” seeks to provide
education to children aged between 6 and 14 years, and is a right step forward
in improving the literacy of the Indian population.
Recent innovations like
universalization of Integrated Child Development Services (ICDS) and setting up
of mini‐Anganwadi centers in deprived areas are examples of
inclusive growth under the eleventh 5‐
year plan. The government needs to strengthen ICDS in poor‐performing states based on experiences from other
successful models, e.g., Tamil Nadu (upgrading kitchens with LPG connection,
stove and pressure cooker and electrification; use of iron‐fortified salt to address the burden of anemia).
Micronutrient deficiency control measures like dietary diversification,
horticultural intervention, food fortification, nutritional supplementation and
other public health measures need intersectoral coordination with various
departments, e.g., Women and Child Development, Health, Agriculture, Rural and
Urban development.
The social and economic
spinoff of the Mahatma Gandhi Rural Employment Guarantee Scheme (MREGS) has the
potential to change the complexion of rural India. It differs from other
poverty‐ alleviation projects in the concept of citizenship
and entitlement.[9] However, employment opportunities and wages have
taken the center stage, while development of infrastructure and community
assets is neglected. This scheme has the necessary manpower to implement
intersectoral projects, e.g., laying roads, water pipelines, social forestry,
horticulture, anti‐erosion projects and rain water harvesting. The
unlimited potential of social capital has to be effectively tapped by the
government.
Innovations are
required to strengthen the public distribution system to curb the inclusion and
exclusion errors and increase the range of commodities for people living in
very poor conditions. It is essential that the government puts forth action
plans to increase domestic food grain production, raise consumer incomes to buy
food and make agriculture remunerative.
The
RashtriyaSwasthiyaBimaYojana and AamAdmiBhimaYojana are social security
measures for the unorganized sector (91% of India's workforce). The National
Old Age Pension scheme has provided social and income security to the growing
elderly population in India.
There is all round realization
that population stabilization is a must for ensuring quality of life for all
citizens. Formulation of a National Policy and setting up of a National
Commission on Population and JanasankhyaSthirathaKosh reflect the deep
commitment of the government. However, parallel developments in women
empowerment, increasing institutional deliveries and strengthening health
services and infrastructure hold the key to population control in the future.
Women‐specific interventions in all policies, programs and
systems need to be launched. The government should take steps to sensitize
service providers in various departments to issues of women. The Department of
Women and Child Development must take necessary steps to implement the
provisions of “Protection of Women from Domestic Violence Act, 2005.” Training
for protection officers, establishment of counseling centers for women affected
by violence and creating awareness in the community are vital steps. Poverty
eradication programs and microcredit schemes need to be strengthened for
economic and social empowerment of women.
Thermal extremes and
weather disasters, spread of vector‐borne,
food‐borne and water‐borne
infections, food security and malnutrition and air quality with associated
human health risks are the public health risks associated with climate change.
Depletion of non‐renewable sources of energy and water, deterioration
of soil and water quality and the potential extinction of innumerable habitats
and species are other effects. India's “National Action Plan on Climate Change”
identifies eight core “national missions” through various ministries, focused
on understanding climate change, energy efficiency, renewable energy and
natural resource conservation. Although there are several issues concerning
India's position under UNFCCC, it has agreed not to allow its per capita
Greenhouse gas emissions to exceed the average per capita emissions of the
developed countries, even as it pursues its social and economic development
objectives.
The Ministry of Health,
in coordination with other ministries, provides technical assistance in
implementing disaster management and emergency preparedness measures. Deficient
areas include carrying out rapid needs assessment, disseminating health
information, food safety and environmental health after disasters and ensuring
transparency and efficiency in the administration of aid after disasters.
Implementation of Disaster Management Act, 2005 is essential for establishing
institutional mechanisms for disaster management, ensuring an intersectoral
approach to mitigation and undertaking holistic, coordinated and prompt
response to disaster situations.
Community participation
builds public support for policies and programs, generates compliance with
regulations and helps alter personal health behaviors. One of the major
strategic interventions under NRHM is the system of ensuring accountability and
transparency through people's participation – the RogiKalyanSamitis. The
Ministry of Health needs to define a clear policy on social participation and
operational methods in facilitating community health projects. Potential areas
of community participation could be in lifestyle modification in chronic
diseases through physical activity and diet modification, and primary
prevention of alcohol dependence through active community‐based methods like awareness creation and behavioral
interventions.
Effective addressing of
public health challenges necessitates new forms of cooperation with private
sectors (public‐private partnership), civil societies, national
health leaders, health workers, communities, other relevant sectors and
international health agencies (WHO, UNICEF, Bill and Melinda Gates foundation,
World Bank).
In order to ensure that
the benefits of social security measures reach the intended sections of
society, enumeration of Below Poverty Line families and other eligible sections
is vital. Check mechanisms to stop pilferage of government funds and vigilance
measures to stop corruption are governance issues that need to be attended. The
government should take strict action in cases of diversion of funds and goods
from social security schemes through law enforcement, community awareness and
speedy redressal mechanisms. Social audits in MREGS through the Directorate of
Social Audit in Andhra Pradesh and Rajasthan are early steps in bringing
governance issues to the fore. This process needs strengthening through
separate budgets, provisions for hosting audit results and powers for taking
corrective action. Similar social auditing schemes can be emulated in other
states and government programs like ICDS, which will improve accountability and
community participation, leading to effective service delivery.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.