INFLUCENCE OF POLITICS ON HEALTH POLICIES OF INDIA

1. TOPIC
INFLUENCE OF POLITICS ON HEALTH POLICIES
OF INDIA
Name of Scholar –SANGEETA CHATTERJEE
Enrollment Number- 200900401006

2. INFLUENCE OF POLITICS ON HEALTH POLICY
IN INDIA

3. INTRODUCTION
◦ Governments, through ministries of health and other related ministries and
agencies, play an important role in health development, through
strengthening health systems and generation of human, financial and other
resources. This allows health systems to achieve their goals of improving
health, reducing health inequalities, securing equity in health care financing
and responding to population needs.
◦ The role of governments in health development is well documented
worldwide and is illustrated by the impressive growth of health systems,
initiated and supported by governments and pursued through partnership
with the private sector, nongovernmental organizations and charitable
institutions. Governments, which levy taxes and benefit from natural
resources, have social obligations to provide security and to facilitate
socioeconomic development, including education and health development.

4. Domains of government role in health
development
Ministries of health are responsible for leading health development
through the implementation and improvement of main health system
functions including
Leadership and governance- Governments are the guardians of social
commitments and values such as solidarity, social justice and equity,
which are stated in their constitutions, signed treaties and conventions. In
many constitutions worldwide the rights to health care and education are
clearly indicated and governments are responsible for providing access to
these services without financial barriers and for ensuring that the value of
health as a basic human right of all is protected
Health service delivery - delivery of health care services is secured by
both public and private providers and nongovernmental organizations.
The role of government is often to steer the overall health development
by designing health policies and programmes, securing essential public
health functions and regulating the delivery of health services.

5. CONT’D
Health care financing Governments play a major role in health care
financing by mobilizing the necessary resources through public
budgets and other contributive mechanisms, pooling resources
allocated to health development, guiding the process of resource
allocation and purchasing health services from various providers.
Human resource development Governments are responsible for
designing appropriate policies for human resource development aimed
at meeting the real needs of populations, securing appropriate skills
mix, improving equity in distribution of human resources, managing
them properly, and monitoring and evaluation of the national health
workforce. Governments set national standards for health personnel
education and develop systems for accreditation of training
institutions.

6. Healthcare in India
positive negative
India has the largest number of
medical colleges in the world and is
among the largest producers of
doctors.
Most doctors settle in urban areas People
in rural areas must travel long distances
to reach a doctor
Healthcare facilitieshave grown
substantially over the years In 1950,
there were only 2,717 government
hospitals. In 1991, there were
11,174 hospitals. In 2017, the
number grew to 23,583
About five lakh people die from
tuberculosis every year .this number is
almost unchanged since independence
India is the 3rd largest producer of
medicines
In the world
Half of all children in India do not get
adequate food to eat and are
undernourished
India gets a large number of
medical tourists from many
countries
We are not able to produce clean
drinking water to all and 21percent of all
communicable diseases are water borne

7. Types of health
care services in
India
The health care facilities are
divided in two categories
1. Public health services- is a
chain of hospitals and health
centers run by the government
.They are linked together so
that they cover both rural and
urban areas and can also
provide treatment to all kinds
of problems – from common
illnesses to special services.

8. 2.Private health services
There is a wide range of private
health facilities that exist in our
country. A large number of
doctors run their own private
clinics. Urban areas have a
large number of doctors, many
of them providing specialized
services. There are hospitals
and nursing homes that are
privately owned. There are
many laboratories that do tests
and offer special facilities such
as x-ray, ultrasound, etc. There
are also shops from where we
buy medicines.

9. Healthcare and equality:
Is adequate healthcare available to all?
Private services are increasing but public services are not
private services Are concentrated in urban areas. The cost of these
services is rather high. Medicines are expensive. Many people cannot
afford them or have to borrow money when there is an illness in the
family.
Some private services encourage incorrect practices to earn more .For
example, some medical practitioners are found to prescribe
superfluous medicines, injections or saline when simple medication
may suffice
Poor peoples are not provided necessities like drinking water,
adequate housing, clean surroundings, etc., and therefore, are more
likely to fall ill. The expenses on illness make their situation even
worse.
Women’s health concerns are considered to be less important than
the health of men in the family

10. INDIA’S HEALTH SYSTEM
IN THE TIME OF COVID-19
• India’s health system has made significant progress in
global perspective on many indicators
• But there are large, persistent health gaps among states
and COVID-19 has exposed fault-lines
• Under-investment overall and for public health,
shortcomings in quality of care, neglect of urban health

11. COVID-19 HAS EXPOSED INDIA’S HEALTH
SYSTEM FAULT-LINES
 Insufficient focus on core public health functions: disease
surveillance, testing, contact tracing.
 Weaknesses in service delivery despite improvements in
access, including supply-side readiness challenges and high
variations in quality of care.
 Inadequate attention to urban health systems, and to
municipalities as a critical layer of government for health
 Low levels of public financing for health and high levels of
out-of-pocket (OOP) financing for health, latter is risk factor
for impoverishment.

12. A SNAPSHOT OF INDIA’S
HEALTH SYSTEM PERFORMANCE

13. STRONG RECENT PERFORMANCE ON
MANY INDICATORS…
 Life expectancy at birth has risen to ~70 years, up from 58 years in
1990 and only 41 years in 1960. Above average for its income level.
 Under-five mortality rate is 37 per 1,000 live births; at current
trends, India is on-track for attaining the 2030 SDG target of 25.
 Infant, under-five and maternal mortality are all very close to the
global average for India’s income level.
 Total fertility rate (TFR) is 2.3, almost at replacement; several states
including AP, Kerala, Tamil Nadu have TFR rates below replacement.
 Huge gains in skilled birth attendance, institutional deliveries,
immunization.

14. …BUT UNEVEN PROGRESS IN
COMPARATIVE PERSPECTIVE
 Performance on key population health outcomes lags that of peers
in South and East Asia
 Stunting rates among children under-five are among the highest in
the world as are anemia rates among women of reproductive age
 Non-communicable diseases (NCDs) account for largest share of
disease burden, but effective coverage is poor
 Highest TB burden in the world, with large economic costs; 700,000
cases not being treated/reported annually; private sector
mismanagement leading to drug resistance and continued high
transmission rates
 High burden of road traffic injuries

15. QUALITY OF CARE AS A CROSS-
CUTTING CHALLENGE
 Quality of care has emerged as a key issue in India’s health system
 Poor quality of care
 Some progress in terms of structural quality
(e.g., input availability per NQAS certification)
 Process quality remains particularly poor
 Huge variability in quality of care
 Across states
 Across levels of care
 Across types of providers
 Even by the same doctor whether
practicing in the public or private sector
 Quality of care is a global challenge, with more deaths in LMICs
estimated to be due to poor quality rather than lack of access

16. • India’s productive potential is rising:
• Demographic transitions have led to rising worker-to-
dependent ratio which will be a favorable 2.1 by 2050.
• But investments in children and adolescents needed for
better health, nutrition, cognition and productivity
• Furthermore, India has an increasing aging population:
• This implies challenges around chronic diseases, NCD
management, elder care and social security
• In addition, growing risk factors from obesity, climate change,
urbanization, and air pollution
INDIA’S POPULATION AGE STRUCTURE OFFERS
BOTH OPPORTUNITIES AND CHALLENGES

17. GETTING BETTER: A HEALTH
SYSTEM FOR THE 21ST CENTURY

18. ◦ Total health spending is currently ~3.5% of GDP, over 60%
is financed by out-of-pocket payments (OOP).
◦ OOP financing for health is both inequitable and
inefficient. It is a major risk factor for impoverishment:
An estimated 60 million Indians pushed into poverty
annually as a result of high OOP spending.
◦ WHO recommends OOP spending should be 15-20% of
total health spending
PUBLIC FINANCING SHOULD
PREDOMINATE

19.  At ~1% of GDP (~US$20 per capita), India's government health
spending is among the lowest in the world, despite a steady
increase in real terms due to economic growth.
 National health policy 2017 target to reach 2.5% of GDP by
2025
 Low priority to health is the major constraint. Health share of
consolidated government spending <4% in india, global
average is ~11%. India ranks about 175th out of 190 countries
in budget prioritization of health, in the same range as fragile
and donor-dependent countries
Budget prioritization of health is the major
constraint to more spending

20.  Achievement of key health financing objectives – resource
mobilization, risk-pooling, efficient purchasing, and equity – should
guide the reform agenda
 Scope to spend better:
 PFM reforms to improve budget execution, enable service
delivery, and find the right balance between flexibility and
control
 Resource allocation formulas to inform allocations from states
to districts to better reflect population need
(mortality/morbidity/equity), not historical norms
 Reduce fragmentation of health protection schemes (CGHS,
ESIS, PMJAY, state schemes)
 Better service delivery and public health investments (as
described below)
SPENDING MORE IS NOT SUFFICIENT, INDIA
MUST SPEND BETTER TOO

21. ◦ Service delivery reform is happening in India, but needs to be accelerated,
broadened, and deepened ,No single model or “recipe” can be decreed; wide
variation prevails even among advanced health systems
◦ But there are key ingredients as embodied in common service delivery
transitions as systems mature. A shift from:
INGREDIENTS, NOT RECIPES, FOR SERVICE
DELIVERY REFORM

22. ◦ Strengthen core public health functions
◦ Institutional reforms and innovations in vertical disease programs (TB, HIV,
RCH)
◦ Private sector engagement at scale for TB diagnosis and treatment
◦ Performance-based incentives to states and districts through TB Performance
Index
◦ Public health cadres to execute core public health functions at national, state
and district levels
◦ Production of global public goods – new vaccines, medicines and diagnostics
◦ Multisector response to tackle social determinants of health and nutrition
outcomes
◦ Access to clean water & sanitation
◦ Prevent and mitigate the impact of air pollution on population health
◦ Other drivers: gender, education, etc.
Strengthening core public health functions

23.  Roll-out targeted investments to enhance integrated public health
laboratory infrastructure and functions in states where capacities are
weak
 Develop and deploy district surveillance teams with core
competencies in integrated disease surveillance across different states
and at the central level to enhance analytical capacity for early and
appropriate response (Epidemic Intelligence Service)
 Develop and roll-out real time surveillance & reporting system for
Human and Animal Health Surveillance as most future outbreaks will
be Zoonotic
 Strengthen national and state institutions to effectively prepare for
pandemics (NCDC) and develop ICMR as a global center for excellence
in medical research
 Strengthen inter-agency coordination for disease preparedness and
response
STRENGTHENING SURVEILLANCE AND DISTRICT
LEVEL CAPACITY TO IDENTIFY AND RESPOND TO
FUTURE EPIDEMICS

24. STRENGTHEN KEY INDIAN INSTITUTIONS FOR
DISEASE PREPAREDNESS, DIAGNOSTICS,
INVESTIGATION, RESPONSE AND POPULATION
HEALTH

25. What can be
done
◦ There is little doubt that the health
situation of most people in our
country is not good. It is the
responsibility of the government
to provide quality healthcare
services to all its citizens,
especially the poor and the
disadvantaged. However, health is
as much dependent on basic
amenities and social conditions of
the people, as it is on healthcare
services. Hence, it is important to
work on both in order to improve
the health situation of our people

26. Recommendations
 Governments should promote investment in health development as
having important economic return and should advocate the centrality of
health in all development initiatives.
Governments should continue to play their leadership role in health
development in order to protect societal values of equity, solidarity and
fairness in line with health for all policies and strategies which consider
health as a human right and not as a market commodity.
 Governments should strengthen their governance capabilities,
particularly in policy development, regulation and public/private mix
management. The role of government in service delivery should be
protected in order to secure access for the poor, vulnerable groups and
rural and remote populations.

27. The Kerala
experience
◦ In 1996, the Kerala government
made some major changes in
the state. Forty per cent of the
entire state budget was given to
panchayats. They could plan and
provide for their requirements.
This made it possible for a
village to make sure that proper
planning was done for water,
food, women’s development
and education. This meant that
water supply schemes were
checked, the working of schools
and anganwadis was ensured
and specific problems of the
village were taken up. Health
centers were also improved. All
of this helped to improve the
situation

28. The Costa Rican approach
◦ Costa Rica is considered to be one of the
healthiest countries in Central America.
The main reason for this can be found in
the Costa Rican Constitution. Several years
ago, Costa Rica took a very important
decision and decided not to have an army.
This helped the Costa Rican government to
spend the money that the army would
have used, on health, education and other
basic needs of the people. The Costa Rican
government believes that a country has to
be healthy for its development and pays a
lot of attention to the health of its people.
The Costa Rican government provides basic
services and amenities to all Costa Ricans

29. conclusion
Health is closely related to the political system of a country. Often the
main obstacles to the implementation of health policies are not
technical rather political
Decisions concerning resource allocation ,manpower policy,
choice of technology and the degree to which health service are made
available and accessible to different segment of the society are example
of the manner in which the political system can shape community health
services.

30. REFERENCES
 The World Health Report 2000. Health systems: improving
performance. Geneva, World Health Organization, 2000.
 Plan of action for implementing the Global Strategy for Health for All,
Geneva, World Health Organization, 1982 (Health for All series No. 7).
Bhore J, Amesur RA, Banerjee AC. 1946. Report of the Health Survey
and Development Committee. Vol. I. Government of India, New Delhi
Ministry of Health and Family Welfare. 1983. National Health Policy.
New Delhi: Government of India. Available at:
http://mohfw.nic.in/kk/95/ii/95ii0101.htm, accessed April 24, 2002
Ramana GNV, Sastry JG, Peters DH. 2002. Health transition in India:
issues and challenges. National Medical Journal of India 13 (Suppl. 1):
37–42.