An Open Letter
National Health Policy 2015
Hon'ble Ministry Of Health
Govt. of India
Sub: National Health Policy Draft-2015
We, the following socially conscious people/activists/organisations, from different parts of this vast country, do appreciate your in-depth projection of the above referred draft on the national health scenario and well thought out suggested steps. Nevertheless we, along with our decades of collective social experience, would like to bring a few points as follows—with due respect and humble submission—for your perusal, consideration & inclusion in the proposed draft. Beyond inclusion our endeavour is to see the National Health Policy in totality is more oriented to the needs of the people in general and the poor and marginalised in particular in keeping with WHO guidlines to support countries to design and implement pro-poor health policies, (i.e., Health Policy) which prioritises and respond to the needs of poor people in a comprehensive way. Certainly this must be more beyond policies and commitments but in action and implementation. You rightly mentioned that "The reality is straight forward. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need in a comprehensive way, and, on an adequate scale."
The reality is India today posseses as never before, a sophisticated arsenal of interventions, technologies and knowledge required for providing health care to her people at large. Yet, the gaps in health outcomes continue to widen. On the face of it, much of the ill health, disease, premature death, and suffering we see on such a large scale is needless, given the availability of effective interventions for prevention and treatment. There's an urgent need for this NHP to address the performance of the health systems of a nation committed to universal health coverage. There's an urgent need for a two way linkage between economic growth and health status. There's also an urgent need to leverage economic growth to achieve health outcomes and an explicit acknowledgement that better health contributes immensely to improved productivity.
We are assured that the above mentioned points have been well taken in the proposed draft in more or less the same way like the previous NHPs in 1983 & 2002 despite which the overall health scenario continues to be gloomier every day. Nevertheless, We have to move on with hopes taking a note of the changing contexts of the health priorities vis-a-vis the period during earlier NHPs which are :
a) While maintaining the focus on maternal & child mortality goals adequate attention to other health needs that currently receive little public attention like many infectious diseases which the system has failed to respond to either in terms of prevention, or, access in treatment along with the growing burden of non-communicable diseases. b)The emergence of robust Health Care Industry growing at 15% compound annual growth rate which in fact, is thrice the national economic growth rate! c) Incidence of catastrophic expenditure due to ever growing health care costs which is estimated to be one of the major contributors to poverty. In fact, the gains of increased income through every Govt. schemes to reduce poverty is being neutralised by the drains of family income due to health care costs, d) The fast deterioration of whatever little health infrastructure that we had in rural sector makes the rural people more and more hapless day by day e) Another contextual change of relative importance is that economic growth has increased the fiscal capacity available. Hence it is imperative that the country needs a new health policy that is responsive to these contextual changes and will ensure the universal access to health care services in an assured mode with a political will.
This is precisely the background in which we would like to draw your kind attention to address some of the genuine health care needs as follows :
1) Health as a Fundamental Right– The first and primary demand of the current socio-economic perspective is that make Health a fundamental right in line with Brazil, Thailand and many other industrialised nations who have made a significant progress towards universal health coverage with the help of such a law. Number of international covenants to which we are joint signatories give us such a mandate which could be used as national law. Courts have also different rulings that in effect see Health Care as a fundamental right and a constitutional obligation flowing out of the right to live with dignity. This law shall must focus on the enforcement on public health standards on water, sanitation, food safety, air pollution, health rights—access to quality health care. This bill, we feel, will give a push for more public health expenditure as well as for the recognition of health as a basic human right and its realisation as the desired goal that the nation must set itself from primary to tertiary health care—at least for the poorer section of our society.
2) DRUGS—Stringent vigilance on the qualities/bio-availabilities/avilabilities of drugs, the essential drugs in particular—must be maintained with specific provisions for strict actions against offenders, if needed.
3) Free Drugs, Free Diagnostics, Free Emergency Care Services in Public Hospitals, Free Emergency response and Patient Transport systems should be the norm to provide a high degree of easy access and financial protection at secondary & Tertiary care levels as well.
4) Generic Drugs—The enormous difference in cost between Generic and Branded drugs is an obvious reason to opt for Generic medicines in all stages of health care service giving them easy access at every point of health care in the country provided every effort is made to ensure their quality and dependability. This is really important if we remember that about 80% out of pocket expenses have to be made for medicines in general leading the sufferers to poverty level. Despite India's commitment to provide universal access to free health care, the out of pocket expenses for drugs/diagnostics/technology is prohibitively high, one of the highests in the world. These are the paradoxes that the NHP must address.
The most rational way to ensure this is to revive and utilise the presently defunct renowned Public Sector Units like (IDPL) Indian Drugs & Pharmaceutical Ltd, (HAL) Hindusthan Antibiotics Ltd, Bengal Immunity Co Pvt Ltd, Smith Stanisstreet & Co Ltd, etc. These PSUs have been our national pride for ages offering remarkable services to the mankind. Let us not allow them to wrought and rust. Under Govt. supervision all out efforts should be made to manufacture & market not only the essential generic drugs of high quality but also the highly expensive patented MNC brands with the help of Compulsory License for genuine public interest fully utilising & updating the existing Infrastructure of these PSUs. This step will lead to—(a) Revitalising of our existing infrastructure with experienced human resource, (2) Thereby cutting to size the monopolistic dictates of MNCs and Big national houses. This is bound to be a boon in serving the national public interest. This deserves Top Priority.
5) Anti Microbial Resistance and the failure of the Pharma Industry to keep pace with the resistant strains by developing newer Antibiotics—is an alarming problem. It's hard to accept that a country aspiring to reach the global forefront—has not been able to restrict, if not abolish, the rampant OTC sale of antibiotics and drugs! This calls for rapid standardisation of guidelines regrding Antibiotic uses and limiting the OTC medication.
6) Irrational combinations—We have heard experts' cautions—time & again—declaring the liquid combinations like Tonics, Cough Syrups etc. as absolutely irrational. If it is so, why not ban them to alleviate mass exploitation? Whose interests are served by this marketing of irrational combinations?
7) Banned Drugs—How and why the drugs which are banned in other countries like UK, USA are being allowed to be marketed in India?
8) Referrel System—If there's a need for a referrel system at all let the decision be taken by a competent committee under C'MOH / Dy CMOH. Let not the laymen enforce the decision.
9) Water is the perennial source of diseases, at least for the majority of them. Utmost priority should be given to ensure the supply of Pure Drinking Water in all the rural health centres and rural areas.
10) Health Research—In a knowledge based sector like Health, where advances happen almost daily—it is important to invest at least 5% of all health expenditures on Health research to revitalise health research activities in research Institutes & Medical colleges -Public as well as Private.
11) Blood and Blood supply is a major area of concern in the rural areas in particular. Needless to say that the Network of approved Blood Banks is not large enough, or, dispersed enough to ensure safe Blood supply across all Districts and Sub District Hospitals. Expanding the Blood Bank Network ensuring improved access to safe Blood is a NEED of the time.
Without much ado, we would like to emphasise that Health of the People is in reality the Health of the Nation. Let there be an early comprehensive NHP without dilly dallying further. Let the matters of Public Health interests be strongly reflected and implemented through the NHP 2015. Let the good intentions be clearly pronounced without any ambiguity whatsoever. Let there be Light. Let there be Hope. Above all let there be Change. Change for a better tomorrow.
Kolkata-700048, West Bengal
1) Prime Minister of India, PMO
2) Chief Minister of West Bengal
Vol. 48, No. 12, Sep 27 - Oct 3, 2015