‘Human resources for health is urgent and ongoing challenge’

The National Health Policy should include:

Planning: It is a well-known fact that the macro indicators of health in India has not improved fast enough despite multiple well-meaning programmes. There are many districts and sub districts where indices are far below acceptable levels and these have not changed over the last few years. There is enough evidence emerging from the various data being captured, where these districts are and what are the indicators. But there has been a lack of ‘realistic listening’ from the key stakeholders on the broader factors influencing poor indicators from these districts, and challenges of programme and policy implementation. There should be a task force, which will identify these priority districts from existing data and come up with system for collecting qualitative data through a process of listening to various stakeholders. The stakeholders should include the state-run systems, the civil society, the NGOs and private healthcare providers. The information emerging out of these should be used to review the programme and policy being planned and current programmes and policies.

Policy and programme implementation: The challenge in programme or policy of India’s healthcare is that though there is flexibility for context variations of the country, this ends at the state level. The various geographical, people group, social, economic and structural in-equities contribute much to poor implementation of programmes and policies. There has to be a way to tackle these in the programme implementation plans suggested to states so that these context challenges are addressed. Both in terms of fund flow and service delivery, there will a need for flexibility and these have to be taken up at district, sub district and taluk levels.

Coordination and collaboration: Though there has been much talk on inter ministry coordination and collaboration, it is observed that, intra ministry, there is poor collaboration across various themes. In addition to developing health strategies along with other ministries, especially those linked to water and sanitation etc., there has to be systems of close coordination, planning and implementation between sub sections of MoHFW. We also have to come together and make plans to address specific diseases challenges in a coordinated way.

Public health and primary care focus: It is well known that public health and primary health contributes to the health of a community. There has to be adequate resource allocation, creation of cadres and war foot approach to address the public heath challenges which the country is facing. We have done well in polio, HIV etc. and there are lessons learnt and principles drawn to address the larger public health issues like malnutrition among children, IMR, etc. Similarly, emerging challenges of adolescent health, geriatric health, mental health etc. should be addressed in a proactive way.

Human resources: Human resources for health is an urgent and ongoing challenge. In addition to increasing medical, nursing and allied health training opportunities, there has to be a way in which various alternative healthcare cadres can contribute to service delivery. and help identify as well as build public health programmes. These cadres would include Nurse Practioners, Physician assistants, Technologists, Public Health care Managers etc.

Universal health care and right to health: The concepts which are being currently discussed by the government are good and worth revisiting, but it has to be backed by implementation to take care of the complexities in the Indian healthcare system. The three or four stakeholders of healthcare delivery should come together for creating overall healthcare delivery programmes through custom made systems and plans. There should be systems for engaging with different stakeholders like government as the primary responsible holder, corporates, small private providers and the not-for-profit voluntary groups to focus and bring out each sector’s strengths.

– Christian Coalition of Health