|Dr. K. Srinath Reddy, President, Public Health Foundation of India|
|Dr. Gangadhar B.N. , Director, NIMHANS|
|Dr. Manoj Nesari, Advisor, AYUSH|
|Dr. T.C. James, Senior Fellow, RIS|
Record of Discussion
Subject : Meeting of SRI Group on Health
Date : 20 February, 2018
Venue : Room No. G-74, Parliament Library Building, New Delhi
Experts : 1. Dr. K. Srinath Reddy, President, Public Health Foundation of India
2. Dr. Gangadhar B.N., Director, NIMHANS
3. Dr. Manoj Nesari, Advisor, AYUSH
4. Dr. T. C. James, Senior Fellow, RIS
First meeting of SRI Group on Health was held on 20 February 2018 in Room No. G-74, Parliament Library Building, New Delhi. Hon’ble Speaker, Lok Sabha chaired the meeting. In addition to Members of Parliament, four experts Dr. K. Srinath Reddy, President, Public Health Foundation of India, Dr. Gangadhar B.N., Director, NIMHANS, Dr. Manoj Nesari, Secretary, AYUSH and Shri T.C. James, Senior Fellow, RIS also participated in the meeting.
While talking about the need for forming subject specific groups, HS outlined that some members are interested in certain selected subjects only. She further said that such a mechanism provides for a platform where these MPs can discuss and deliberate on a specific subject connected to people among themselves as well as experts outside the floor of the House. Such discussion with the experts can be helpful in identifying and deliberating on subject specific focus areas such as health and related issues on which parliamentarians should focus attention.
Initiating the discussion, Honorary Advisor, SRI said that the principal objective of meetings of SRI Groups is to get ideas from the experts as well as the Members of Parliament. Parliamentarians are aware of the problems and challenges at the ground level while experts have global perspective. He added that synergy of the two perspectives will lead to better debates and better law making in Parliament. He thereafter introduced the experts and requested Dr. K. Srinath Reddy, President, Public Health Foundation of India to give his views about health issues which requires more focus.
Dr. Reddy said that health has now acquired a great deal of importance in the context of India’s development. Unfortunately, our health indicators have lagged behind our development but instead of just basically presenting a critique, its important to look at the possible solutions. He therefore, stressed upon the need to look at both system-wide strengthening efforts as well as specific health problem related issues on which requires focussed attention rapid thrust to advance health indicators. In terms of system, he presented following challenges –
In this context, he stressed on the need to create a multi-layered, multi-skilled health workforce, including nurse practitioners and so on. By strengthening the primary healthcare, a huge employment opportunity for young people and especially women can be provided. These people can be trained as allied health professionals, nurse practitioners, in multiple capacities, for strengthening primary healthcare, and they can have not only a facility-based care but also a good community outreach with health promotion and trying to build healthy habits in the community, working with other sectors like water and sanitation.
He observed that focussing on primary healthcare and health workforce development is one of the critical issues but since this requires a very strong collaboration and coordination between the Centre and the States in the true spirit of cooperative federalism, we ought to also see how the programme through the National Health Mission and other programmes can actually activate the States and energise them to act much more firmly.
Then, in terms of some specific areas of health, he urged the parliamentarians to strongly focus on the following issues:
He however added that we cannot focus only on expensive treatments but we will also have to focus on how we predict High Blood Pressure, Diabetes in primary care and how do we manage it well.
At the end of Dr. Reddy’s presentation, Hon’ble Speaker, Lok Sabha suggested that the following issues can be taken up for deliberation at length in the future group meeting or SRI workshop:
Hon’ble members of Parliament Shri Ravindra Kumar Pandey and Shri Faggan Singh Kulaste also presented their views on the subject. While Shri Ravindra Kumar Pandey bemoaned the lack of primary healthcare facilities in remote, rural and tribal areas, Shri Faggan Singh Kulaste stressed on using technology to link primary health centres with community and district health centres to improve health care facilities in rural areas.
In his presentation, Dr. Gangadhar B.N. from NIMHANS, Bengaluru focused on mental health. He stressed on the following points relating to mental health:
Dr. Gangadhar emphasized on awareness in the public about mental illness. He proposed to bring a team from NIMHANS so as to facilitate information sharing with the MPs in batches of 30-50.
Dr. Gangadhar also referred to the findings of a National Mental Health Survey which say that currently about 10-11 percent of the people need mental health care in the society, which would mean a number close to a whooping 15 crore. He suggested that although there is a need to generate the human resource, it is not necessarily fully trained medical doctors for this purpose, but Counsellors who can be trained from the community who will culturally understand the background of the people and they can be highly helpful. He gave an example of the Yuva Spandana Programme for youth in Karnataka aimed at empowering to guard their mental health. All the Districts have a Yuva Spandana Unit in Karnataka. He suggested that we can evolve more schemes to be able to involve the public to have Mental Health Counsellors.
Dr. Gangadhar further advocated for the use of technology. He said that technology has developed today and mentally ill people need not necessarily reach a doctor. Instead of so many investigations like many other medical people use, technology can be used to reach every household to provide the services. This is one area called as telemedicine or on-consultation training, which needs to be extended in India.
As regards neurological disorders, Dr. Gangadhar said that bulk of them come under the non-communicable disorders like stroke, epilepsy, several of the neuro-muscular disorders, CNS tumours, trauma head injury, all of which leave people quite disabled. He stated that many conditions can be intervened very early and even prevent the whole thing. In this context, he suggested that polytrauma is equally important and Primary Care Centres should be provided with a connectivity to be able to help these people with elementary treatment, which is potentially possible definitely at the District-level and then after to the Primary Care level.
Dr. Manoj Nesari, Advisor, Ayurveda in the M/o AYUSH briefed the parliamentarians about the following AYUSH initiatives taken in the last two, three years. (i) Integration of Ayush for the prevention and control of non-communicable diseases: This initiative has been taken on pilot basis. Presently, it is being implemented in six districts, that is, one district in each State of Bihar, UP, Rajasthan, Gujarat, Andhra Pradesh and West Bengal for the last two years. He said that on the basis of these observations, it can be said that the intervention of the Ayush system is very important.
In order to integrate AYUSH system of medicines, he made following suggestions:
At the end of Dr. Nesari’s presentation, Hon’ble Speaker, Lok Sabha suggested that the need for single legislation for allopathy and AYUSH systems of medicines and the issue of integration of AYUSH with mainstream healthcare system may be taken up for deliberation at length in the future group meeting or SRI workshop.
Shri T. C. James underlined the following points:
HS expressed her agreement with the fact that we need to focus more on India specific diseases like TB and aneamia rather than those specific to other countries and imposed on us.
At the end, Prof. Sachin Chaturvedi, DG, RIS and Co-convenor, SRI flagged the following four issues on which SRI must focus on:
Dr. Manoj Nesari, in continuation to the discussion suggested that there could be a health index of every person that could be helpful for Government to decide the policies and strategies. He also pointed out the need for a Central Act for public health and to check the health seeking behavior and know what the requirement of the people is.
In continuation of the discussion, Dr. Gangadhar added that no Indian vendor/manufacturer is allowed to participate in procurement of equipment for Government hospitals unless approved by USFDA. He further added that geriatrics represents one area where more discussion is needed.
While expressing her views, Secretary General, Lok Sabha reiterated that emphasis should be on prevention rather than cure. Focus should be more on providing safe and potable water instead of treatment of water-borne diseases. The same way, a girl between the age of 12-14 should be prevented from being anaemic instead of just providing food supplements to pregnant women.
In continuation of the discussion, Dr. Reddy added that urban primary healthcare also requires a lot of attention as the role of urban local bodies is becoming more important whether it is drinking water, sanitation or food safety.
While concluding the discussion, Hon’ble Speaker, Lok Sabha directed that the following subjects may be taken up for further deliberations in the future meeting of SRI Group on health:
Thereafter, the meeting concluded with a vote of thanks to the Chair.