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Draft National Health Policy: Views of Indian Medical Association

 Executive Summary

 
 Thirteen years after the last National Health Policy, the Ministry of Health has brought out a new draft National Health Policy, which is already in the public domain. Indian Medical Association place on record its appreciation for immediately bringing out a National Health Policy soon after assuming power. The National Health Policy of 1983 and that of 2002 have served us well, in guiding the approach for the health sector in the Five-Year Plans. Development of a more robust, effective and credible new National Health Policy will give direction and coherence to our efforts further to improve health of the nation.

 The importance given to urban health, addressing social determinants of health, suggestions to harness newer technologies like tele-medicine, recognizing the role of private sector through health strategic purchasing, newer strategies for resource generation like health cess etc. are appreciable.
 Indian Medical Association (IMA) feels that the policy, should give greater focus for preventive and rehabilitative care in the context of rising burden of non-communicable diseases. However the IMA is of the view that greater contribution in terms of GDP will be required to attain the set goals in the present policy. The association feels that at least around 5% of GDP needs to be earmarked for health.
 The policy recommends setting up of task forces for developing indicators and targets and mechanisms for achievement. While task force for implementation of programmed makes sense, it is mandatory that the policy clearly spells out indicators and targets. For any task force the scope and target should be predefined, if not the task force will come out with its own indicators and targets, which could be contrary to the philosophy of the policy.

 Strengthening the family planning program, improving medical education, school health education, programmes for health of the elderly, mental health, four tier system of health care, family doctor concept, health manpower assessment, improving overall efficiency of health management, addressing intra state and inter state disparities and system for monitoring and expenditure tracking, IMA feels, are all important areas where the health policy needs to focus more.

 A large part of allocation of funds are usually spent on pay and allowances, pensions, transport and establishments, hence funds for actual expenditure on health and medical care needs to be increased and specified. There should be a permanent mechanism to monitor the utilization of funds and to ensure that funds reach the targeted population for whom it is intended. There is need for inculcating better managerial skills for which an Indian Medical Service like IAS and IRS is required.

 The private health providers cannot be bracketed together the small and medium level health institutions play a distinct role in supplementing the government health sector by serving in rural and remote areas, making health care accessible and affordable to the weaker sections of the society. In fact, these small players move the national health indices. The presence of corporate sector is largely in major cities and contributes to tertiary care. The policy needs to give special importance and consideration to the small and medium level institutions for its complementary role, while giving due importance to the corporate sector with adequate scope for independent existence and growth of both the sectors.

 Health and Education are fundamental rights of the citizen. Just as the Government is promoting education through aided schools, health needs to be promoted by introducing the novel concept of aided hospitals. If not, the policy will become more beneficial to people who can afford even otherwise.

 The concept of comparative efficiency as proposed in the policy, needs to be closely examined. Value for money is a myth since even those who seek health care from public sector do spend from Out Of Pocket, the same amount as in private sector.

 The policy, which is silent on Health Human Resource Development, needs to spell out clear cut directions to curb the uncontrolled, unregulated expansion of these sectors as has happened so far; and to ensure more uniform and even distribution of institutions with emphasis on needy and backward areas. The medical council should be made more strong and autonomous by incorporating provisions for accreditation medical grants commission and mechanisms for facility augmentation and staff promotion activities. There is a need for proportionate production of all streams of health manpower personal on the basis of manpower requirement so that the pyramidal structure of health delivery is retained.

 Quality assured drugs should be made available through the public distribution system to make them affordable. The drug quality control mechanism should be strengthened. The apprehensions following the recent amendments in the drug patent laws need to be addressed and the escalation of cost of drugs consequent on these legislations need to be prevented. The government should invest more resources in research on development of new drugs and devices. Just like techno parks, common facilities for drug research and quality assurance need to be established. ‘Make In India policy’ should be extended to manufacturing of Drugs, life saving equipments and devices.


 Since the private sector provides care for 70 percent of the population due consideration needs to be given to it. Income tax, luxury tax and service tax in hospitals and VAT on drugs goes contrary to this. Government policy should influence and encourage private health care establishments by exempting them from the purview of income tax and providing subsidies. Government also should provide water, electricity and basic amenities at reduced rates for private hospitals. Government in turn can demand a major role for these institutions in public health and curative services. Poor needs to be provided free or subsidized health care in these institutions. This will reduce the cost of care eventually avoiding catastrophic health expenses. This model will be cost effective compared to heavy investments required in health insurance systems. Failure of American model insurance - driven health care provisioning should be a lesson while framing the policy


 Considering private hospitals as pure industry is entirely misleading and it contradicts the Government policy of making health as a fundamental right. Private health care is a service sector governed by medical ethics. When the Government demands that medical ethics need to be followed and considers it as a service sector, branding clinical establishments in private sector as an industry exposes a contradiction. The pre-conceived notion that private sector is profit-driven and ignoring it in the overall structure of health delivery, allowing it to run parallel to the Government sector rather than promoting them to compliment, goes against the spirit of this policy.


 The need for standardization and quality health care services is understandable, but the mechanism to ensure it through Clinical Establishment Act will be counter-productive. A process of voluntary and incentive driven accreditation is the best practical option where professional organizations like IMA can play a pivotal role.

 The integrated medicine concept is again a misplaced thought process, which is not based on ground reality or evidence. When different systems of medicine are available, public always would like to try a different system when one system fails. Through the integration of systems, the Government is denying the right of the public to choose a pure alternate system. It is not their desire to opt for a different system when the process of integration has already diluted it. Integrating different systems of medicine, which have diametrically opposite basic principles, will only lead to destruction of these systems. Modern medical degree should be made the basic qualification to practice medicine. All other systems of medicine should be learned only after acquiring basic modern medicine degree, that is MBBS and not in the reverse order. In all other countries including Germany where Homeopathy took origin, a modern medical degree is a prerequisite to learn any other system of medicine.

 IMA feels that the new policy document does not make a strong case for moving towards our objective of universal access to affordable health-care. There are innumerable challenges to be overcome before its stated objectives become a reality. IMA demands serious deliberations and consultations with all stakeholders including professional associations before the policy is finalized. IMA being the biggest stakeholder in health scenario in India, our views should be seriously considered before finalizing the policy.

 Dr AJAY GAMBHIR,  Dr. BD BHATIA ,  Dr. SUNIL MEHENDIRATTA,  Dr. ALOK BHANDARI

 

 

 Dr AJAY GAMBHIR

Chairman PEDICON 2015
President NNF
Executive Member Delhi Medical Council
Board Member NABQP (Quality Council India)
Finance Secretary IMA HQ
Member of NTAGI
Mobile No. +91-9811557085, 9311557085

 

Comments   

 
kalyani
0 # Regarding vaccine informationkalyani 2015-11-05 11:47
Sir,

This is kalyani,My baby is now 1 year 5 months old.we are following the government vaccines for baby (birth,45 days,3 months,11 months)now one of my friend told me that there is a vaccine in 12 to 15 months old,is this mandatory.becau se in govt hospitals people saya that after 11 months next vaccine is 18 months.Colud you please let me know the details.

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Praveen
0 # RE: vaccine and autismPraveen 2017-01-16 13:12
sir[censored]Ma dam,

Ther e are more controversy regarding vaccine and autism in developed countries. there are lots of report showing that the truth of vaccine. Mainly Mercury are cause autism which are in vaccine. Not only mercury, lots of ingredient in vaccines are harmful to child. So my question is what are the case studies were conducted by Indian government about vaccine and autism in India? and Please release information about vaccine which are used in India.
1.Ph armaceutical company name which are giving vaccine in India
2.In gredient in vaccines
3.wh at are Safety studies in vaccine
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