Health sector,Twelfth plan and inclusive agenda for health

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Health Sector: Current Scenario

Health system in India is a mix of government and private providers at all levels of health care. Main weaknesses of the system are:

Inadequate Manpower: Against the recommended 85 doctors and 255 nurses and ANMS per lakh population at the beginning of 11th plan, there were just 45 doctors and 75 nurses and ANMs.

Quality of Health Care Services: It varies considerably in both the public and private sector. Private sector also has the problem of unqualified doctors. Regulatory standards for public and private hospitals are neither adequately defined nor effectively enforced.

Affordability: To a vast majority of population health services are not affordable. Even in government sector people as indoor services, resulting in out of pocket expenses. Costs of indoor care in private sector in super speciality hospitals or even the people in the country.

These problems communicable diseases and increase in non-communicable diseases (NCDS) as a result of are often required to purchase medicines, both for outpatient as well general hospitals quite high and beyond means of most of are going to increase in the coming years due to dual burden of are increasing life expectancy and changing lifestyles. The treatment of NCDS is quite expensive.

Twelfth Plan Strategy

The Twelfth Plan seeks to strengthen initiatives taken in the 11th Plan to expand the reach of health care and work towards the long term objective of establishing a system of Universal Health Coverage (UHC) in the country. This means that each individual would have assured access to a defined essential range of medicines and treatment at an affordable price, which should be entirely free for a large percentage of the population. This strategy will be initiated ducing 12th Plan and completed in 2-3 Plan periods.

To reduce the dependence on out of pocket expenditure by people in case of illness and pay attention to determinants of health like water supply and sanitation, the broad health budget needs to be increased from present 1.97% of the GDP to 2.5% of the GDP by the end of 12th Plan period. Since expenditure on health by the State Governments is about twice the expenditure by the Centre, the overall increase in health budget can only be achieved if, along with the Centre,
State Governments expand their health budgets appropriately. 12th Plan suggests a mechanism to incentivise states to achieve this.

In 12th Plan financial and managerial systems will be redesigned to ensure more efficient utilisation of available resources, and to achieve better health outcomes.

Inclusive Agenda for Health

Measures to be taken to ensure all the services are provided with special attention to the marginalised:

Access to Services: Barriers to access would be recognised and overcome especially for the disadvantaged and people located far from facilities. Medical and public health facilities would be accessible to the differently abled. They would be gender sensitive and child friendly.
Special Services: Special services would be made available for the vulnerable and disadvantaged groups. For example, counselling of victims of mental trauma in areas of conflict, or the supply and fitting of aids for the differently-abled are some examples of special services for certain categories of users.
      Monitoring and Evaluation Systems: Routine monitoring and evaluations are to collect disaggregated information on disadvantaged segments of the population, so that it is possible to compare access of services to these groups and their impact vis-à-vis general population.
   Representation in Community Fora: For example mandatory inclusion of marginalised into Rogi kalyan Samitis and Village Health Sanitation and Nutrition Committees. The latter to have 50% women among its members.

Training of Health and Rehabilitation Professionals: It should incorporate knowledge of disability rights and skills to deal with differences in perspectives and expectations between members of disadvantaged segments and the general population.

All health related training instituts must have a comprehensive policy to make their educational programmes friendly for the differently abled.

Towards Universal Health Coverage (UHC): UHC has been defined as “Ensuring equitable access for all Indian citizens in any part of the country, regardless of income level, social status, gender, caste or religion, which is affordable, accountable and appropriate, with assured quality health services (promotive, preventive, curative and rehabilitative) as well as services addressing wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider of health and related services.”

This definition affirms that the system must be available for all those who want it, though some, typically the upper income groups may opt out. For operational purposes, it is necessary to define with greater precision, the coverage of assured services, especially in terms of entitlement for in-patient treatment and to define the specific mechanism through which the service will be delivered. The High Level Expert Group (HLEG) has recommended the prioritisation of primary health care, while ensuring that the Essential Health Package (EHP) includes essential services at all levels of care.

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