Meeting of SRI Group on Health

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Meeting of SRI Group on Health

Date: 20 Feb 2018
Speakers
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

Report

 

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 –

  1. Comprehensive Primary Healthcare along with skilled health professionals: Dr Reddy said that unless we strengthen our primary healthcare, we will be failing at the basic. He therefore advocated for a comprehensive primary healthcare as close to home as possible. Such healthcare at primary level should include basic diagnostics and treatment, and in the non-physician-centric model with technology-enabled frontline health workers, auxiliary nurse midwives, mid-level health workers. The laboratory technicians can perform some basic tests and dispense drugs.

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.

  1. Financial protection associated with health protection: Dr. Reddy said that though the proposed National Health Protection Scheme can reduce a sizeable portion of health expenditure, it will not drastically reduce the out of pocket expenditure. So, together, through primary healthcare and the National Health Protection Scheme, healthcare related poverty inducement can be reduced. This is critical to meet the NITI Aayog’s target to bring down out of pocket expenditure on health from 64 per cent, now, to 50 per cent by the year 2020. He added, "the whole idea of how universal health coverage can begin but not end with the National Health Protection Scheme, has to be discussed very carefully but this also will require that the Central Scheme and the States’ Health Scheme also be merged, and that also requires a lot of cooperation between the Centre and the States”, he added.

Then, in terms of some specific areas of health, he urged the parliamentarians to strongly focus on the following issues:

  1. Maternal Mortality, Child Mortality and Neonatal Mortality: He stated that while India has virtually succeeded in reaching the goal in under five mortality and are doing well in infant mortality, a lot more is required to reduce neonatal mortality, in the first 28 days, in the first seven days and over a period of time, in the first day. In neonatal mortality, India is 12th from the bottom. At present, its 25 and it has to be brought down to 12 by 2030. So there is an urgent need for not only good antenatal care but also very good facilities for skilled birth attendants and good care of the baby when born.
  2. Tuberculosis:  The Sustainable Development Goals set a calendar of 2030 by which India need to be free of tuberculosis but the Prime Minister has advanced the deadline by 2025. So, he suggested that we need to get everybody together, Centre and the States, Public Sector, private sector, including the individual general practitioner, to get TB under control and eliminated, especially, with the multi-drug resistant tuberculosis.
  3. Non-Communicable Diseases: Non-Communicable Diseases are heart diseases, strokes, chronic lifestyle diseases, cancers, diabetes and, of course, mental illness is also a major issue. He pointed to the fact that these are the biggest contributors to mortality, biggest contributors to disability and biggest contributors to economic loss. As per economic modelling done between 2011 to 2030 , India will lose 4.58 trillion dollars just because of non-communicable diseases and, unfortunately, many people will die in the middle age, between 40s and 50s. So India will lose a huge amount of productive person power.  So, we have to focus on that.

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:

  1. Primary Healthcare with focus on women and children
  2. Synergy amongst Central Health Schemes and State Health Schemes
  3. Non-Communicable Diseases

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:

  1. Mental Health Policy and more importantly, the Mental Health Care Act rules which will shortly be released would empower the families to receive mental health related help.
  2. Considering shortage of human resource in the area of mental health, instead of augmenting the solution, PHC and Wellness Centres may be empowered to be able to provide mental help not so much in terms of treatment, but to empower people to guard their mental health. AYUSH methods can also be incorporated and this can be a great step in terms of getting the mental health better.
  3. A lot of mental diseases can be very efficiently treated today. Nearly, 70-80 percent of people suffering from mental illness can go back to their families without any problem. Probably, the sizes of the mental hospitals can be brought down provided the families can be supported with some treatment form.

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.

  1. Collaboration with the other Ministries:  AYUSH has taken initiatives to have collaboration with the other Ministries. An MoU has been signed with the Ministry of Railways to open an Ayush health centres in the Railway Hospitals. Under National Ayush Mission, it is  intended to develop at least one integrated Ayush hospital of 50 bed in every district in the next ten years..
  2. The ante-natal care. He regretted that in ante-natal care we have now shifted on the supplement rather than the actual food which has not yielded the desired result.  He stressed upon the need to rethink about the strategy. He said that anaemia is very strong in Himachal Pradesh and about 40 per cent of the population is having iron deficiency anaemia. But having iron supplement has not cured the anaemia or has not reduced the number of women or the adolescent girls having the anaemia. Now, instead of iron supplements, if the diets like Amla and the drum stick are given which are very rich in natural iron and which gets easily absorbed without causing any gastric irritation, anaemia can be tackled, particularly in preganancy. He stressed upon the need for preventive healthcare and inculcation of the traditional concept of Health and Wellness in the habits.

In order to integrate AYUSH system of medicines, he made following suggestions:

  1. Inclusion of AYUSH system in MBBS curriculum,
  2. Mainstreaming of AYUSH Knowledge instead of mainstreaming of AYUSH doctors to provide primary healthcare services,
  3. Common legislation/Act for allopathy and AYUSH systems of medicines
  4. Elevated funding for AYUSH,
  5. AYUSH intervention for Non-Communicable Diseases which has no side effects,
  6. Greater emphasis on food rather than supplements,

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:

  1. Decreasing number of clinical trials on India-specific diseases like TB,
  2. The high cost of medical devices and their availability
  3. Safety and quality aspects relating to generic drugs
  4. Use of India’s strength in biotechnology

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:

  1. Overdependence on imported medical devices/equipment as well as raw materials for generic drugs
  2. Connection between well being and health
  3. Research on disease pattern and
  4. Health Infrastructure

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:

  1. Strengthening Primary Healthcare and Primary healthcare centers
  1. Focus on maternal, child and neonatal mortality,
  2. Training to women and ASHA workers ,
  1. Non-Communicable Diseases
  2. Central and State Health Schemes-need for convergence

 

Thereafter, the meeting concluded with a vote of thanks to the Chair.