Disabled Health Care

 Eighty-two per cent of the persons with disabilities in the country do not have any health care protection despite the claims of the government to the contrary.

Eighty-two per cent of the persons with disabilities in the country do not have any health care protection despite the claims of the government to the contrary. Forty-two per cent of them are not even aware of the central government’s flagship programme for people’s health, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY), according to a recent national survey by the Centre for the Promotion of Employment for Disabled People.

The number of persons with different kinds of disabilities in the country is enormous, 26.8 million or 2.21 per cent of the population as per the 2011 census. While the next census, which was due in 2021 but postponed to this year, can provide the most dependable update since it covers the entire population, other studies, which, too, cannot be ignored since they are based on scientific statistical sampling methods, have shown a marked increase in this number; the NFHS-5 (2019-21) reported it to be 63.28 million people, equivalent to 4.52 per cent of the population.

This is not to say that those already covered under some government-sponsored schemes are getting hassle-free healthcare. The overall health of the health sector is not well. The experience of the enrolled suggests that many of the hospitals empaneled refuse the treatment with great impunity; the needy have either to pay, if they can, out of pocket or go without treatment if they can’t, and live or die with the disease.

The Ayushman Bharat scheme, wherever it is accepted, covers only in-patient costs, not the out-patient services that comprise a significant 80 per cent of healthcare needs. Another issue is massive corruption at different levels in the implementation of the scheme, as observed by the CAG in one of its reports. Coming to healthcare in general, the pure commercial interest and market force philosophy takes precedence over the public health responsibility of the government. The health infrastructure is neither adequate nor suitable for the masses of people in the country. It encourages private profits and helps private insurance. It has a poor 1:1,500 doctor-to-patient ratio and 1.7 nurses to 1,000 people as per IBEF’s observation. However, other official claims dispute this; in response to a parliamentary question, the minister of state for health and family welfare said this ratio was 1:836 doctors ~ more than the WHO standard of 1:1,000.

It seems that the government calculated the ratio based on the 13,86,000 allopathic doctors registered and 5,65,000 lac Ayurveda, Unani, Homoeopathy practitioners, etc. to inflate the numbers. The dimensions of the health sector neglect are multifold. The health care public spending in India as a percentage of its GDP is set at 1.9 per cent in 2026, whereas other countries the world over are already spending between 5 to 12.5 per cent of their GDP. The US, for instance, spent 16 per cent in 2023, and the OECD countries spent 9.2 per cent in 2022.

The private sector in India dominates health care in many ways. It accounts for 58 per cent of the number of hospitals.

The sector employs 81 per cent of the medical professionals. By 2022-23, there were 43,186 private hospitals with 1.18 million beds and 29,631 ventilators. The macro data doesn’t reflect the true picture because there is a wide gap between rural and urban areas in the availability of hospitals and doctors. Also, there are regional imbalances. For instance, Maharashtra has the highest number of allopathic doctors (2.10 lac), followed by Tamil Nadu (1.49 lac) and Karnataka (1.41 lac) as per 2024 data; that means more than 38 per cent of the allopathic doctors in India are concentrated in three states.

The inefficient and inadequate health care is deepening and widening the poverty in India. Due to heavy out-of pocket spending, an estimated 7 per cent of the population ~ about 10 crore ~ falls below the poverty line every year, as a Niti Aayog report asserts. Besides high medical costs, people have to put up with unethical medical practices by unscrupulous players in the system because there is no effective mechanism to stop them. Look at some of the most disturbing practices reported on and off in media. This is only an exemplary, not an exhaustive list:

* Unscrupulous hospitals accept patients not based on their severity of disease and urgency for treatment but on their paying capacity; those with disease but no money are kicked out while those with sufficient money but no disease get unnecessary treatment.

* Doctors prescribe tests lured more by the kickbacks that diagnostic centres offer than by the need for such tests. They write a battery of tests codenamed “sink tests” with one or two ‘marked tests.’ Patients are charged for all the tests and blood samples, for instance, are collected for all of them. But the actual test is conducted only for the ‘marked test,’; fake normal results are given for the rest of the tests. The excess blood collected is thrown in the sink, so the name ‘sink’ tests.

* Patients are unnecessarily referred to other doctors just to get a cut from them; those who offer higher commissions get higher referrals.

* Prenatal sex determination tests are conducted defying the legal ban on it.

* Unnecessary surgeries are conducted on the gullible persons. The types of procedures to make money include hysterectomies, C-sections, cataracts, knee replacements, and lower back operations.

* Pharmaceutical companies supply expensive gifts and medical equipment to entice doctors to prescribe their drugs. Not only gifts, they also offer foreign trips and five-star accommodations to doctors and their families.

* Poor and illiterate people are used as guinea pigs for clinical trials. * The ambulance services are paid bribes for bringing emergency patients to private hospitals.

* Hospitals force doctors to generate monthly targeted revenue to justify their high salaries, whereby doctors play mischief by subjecting innocent people to unnecessary tests and procedures.

The Medical Council of India prohibits all these unethical practices, but they have little impact on the errant doctors and hospitals. The National Health Policy 2017, too, commits itself “to the highest professional standards, integrity and ethics”. These goals are not achievable without first halting the ongoing mindless commercialization of the health sector in India. While people are worried about grossly inadequate and inaccessible healthcare, the sector flourishes and provides the best facilities to those who can afford them in India and abroad.

The Indian Brand Equity Foundation (IBEF) says the Indian healthcare market, which was valued at $110 billion in 2016, is poised to reach $635 billion (Rs.54.87 lac crore) level by the end of this year. It adds that the premiums underwritten by health insurance in the financial year 2024 (up to February) grew to Rs.2.63 lac crore (about $ 32 billion). The health segment alone accounts for a 33.33 per cent share of the total gross written premiums earned in the country. Indian medical tourism is worth $7.69 billion in 2024 and is expected to reach $14.31 billion by 2029; about 6.34 lac foreign tourists came for medical treatment in India in 2023. With the above five lac international patients annually, India has found a place among the global leader destinations for international patients seeking advanced treatment.

All this suggests that India has a robust health sector and, given the will, it can be further strengthened and reformed to meet the comprehensive needs of every Indian. What we need is universal health care. What we need is the de-commercialization of the healthcare industry. What we need is to learn lessons from the damage market forces are causing to the health sector and public health. And what we need to do all this, at the cost of repetition, is the will. Delay will causes further damage, and that damage will be irreparable.

P S M RAO 

Source: The Statesman, 17/04/25

World Health Day 2023 | 5 Careers in Health and Wellness to Ensure ‘Health for All’

 Every year on 7 April, World Health Day is celebrated with a different theme each time. The theme for the year 2023 is “Health For All”. This year it also marks the 75th anniversary of the founding of the World Health Organisation (WHO) in 1948.

As the theme for this year highlights - the focus is greatly on public health. If it weren’t for the number of people who enter into public health professions, the world wouldn’t have witnessed the massive improvement in the quality of lifestyle we experience these days. From sanitary health to mental health, each and every area has seen major transformations in terms of quality of life.

As we celebrate World Health day, let’s take a look at some popular health and wellness careers:

1. Medical Researcher

These specialists conduct and analyse/diagnose various diseases, health issues and develop treatment and methods to cure or prevent those diseases.

How to become a Medical Researcher:

• Get a bachelor’s degree in Chemistry, Physics or Mathematics.
• Clear the relevant Entrance Examinations
• Pursue a PhD or opt for a dual-degree programme to learn the required clinical and research skills
• Apply for the role of researcher

2. Rehabilitation Counsellor

Mental Health has always been of great concern. Whether it is in the case of people requiring support to deal with mental health issues, or people requiring support when they are the victims of trauma caused by political or natural causes. Rehabilitation Counselling is one of the fast-growing Counselling Specialties in India, showing the advances that we have made in the field.

How to become a Rehabilitation Counsellor:

• Get a BA/BSc with your preferable specialisation(s) in Psychology, Counselling etc.
• Complete an MA/MSc in the relevant area
• Upskill further with a PG Diploma in various specialisations can definitely give a boost to your career
• Pursue PhD in your area of branches of rehabilitation to get into research related careers
• Apply for Rehabilitation Counsellor in Nursing homes, disability centres, residential care settings and the like

3. NGO Worker

Working for a social cause can prove to be a rewarding career for many. It allows you to make a living while improving the world around you. If you're passionate about health and wellness as a social cause, working for an NGO or other nonprofit organisation that works in the area of public health might prove to be an ideal career.

How to pursue a career in an NGO

• Complete your education in the area of public health that you are intersted in.
• Be sure to volunteer for the cause much before you have completed the course as this arms you with valuable experience.
• Working with NGOs will also open up employment opportunities over time.

4. Nutritionist

Dieticians and nutritionists are professionals who cater to their patients’ and clients’ nutritional and health needs. If this is an area that interests you, it could be a rewarding career with exceptional opportunities.

How to become a Nutritionist

• Get a bachelor’s course (BSc) in food and nutrition
• Complete an MSc in Food and Nutrition with specialisations like therapeutic nutrition, public health nutrition or food science from a recognised university.
• Get professional experience by completing internships or volunteering
• Apply for the role of Dietician and/or Nutritionist at hospitals, clinical laboratories, wellness startups, government agencies working for public health departments and the like.

5. Nurse & Nursing Assistant

A nurse plays a huge part in a patient's recovery and also assists doctors and surgeons. Nurses serve to care for people who are suffering from disabilities, accidents, or diseases etc. and are usually the primary caregivers in many circumstances.

How to become a Nurse

• Complete your 10+2 with core subjects like Physics, Chemistry and Biology with a minimum of 50% aggregate.
• Prepare for the Bachelor degree entrance examination and enrol in a BSc Nursing course.
• Complete the requisite training before you apply for a position at hospitals, nursing homes, public health centres, old age homes, etc.
• Complete a Master’s degree to grow further in your career.

Source: The Telegraph India, 7/04/23

Who are ASHA workers, the women healthcare volunteers honoured by WHO?

 The World Health Organisation has recognised the country’s 10.4 lakh ASHA (Accredited Social Health Activist) workers as ‘Global Health Leaders’ for their efforts in connecting the community to the government’s health programmes.

While congratulatory messages have since poured in from the Prime Minister and the Health Minister among others, the women health volunteers continue to fight for higher remuneration, regular jobs, and even health benefits.While intermittent protests have been going on in several states, thousands of ASHAs from across the country took to the streets in September last year to fight for their demands.

Who are ASHA workers?

ASHA workers are volunteers from within the community who are trained to provide information and aid people in accessing benefits of various healthcare schemes of the government.hey act as a bridge connecting marginalised communities with facilities such as primary health centres, sub-centres and district hospitals.

The role of these community health volunteers under the National Rural Health Mission (NRHM) was first established in 2005.

ASHAs are primarily married, widowed, or divorced women between the ages of 25 and 45 years from within the community. They must have good communication and leadership skills; should be literate with formal education up to Class 8, as per the programme guidelines.

How many ASHAs are there across the country?

The aim is to have one ASHA for every 1,000 persons or per habitation in hilly, tribal or other sparsely populated areas.

There are around 10.4 lakh ASHA workers across the country, with the largest workforces in states with high populations – Uttar Pradesh (1.63 lakh), Bihar (89,437), and Madhya Pradesh (77,531). Goa is the only state with no such workers, as per the latest National Health Mission data available from September 2019.

What do ASHA workers do?

They go door-to-door in their designated areas creating awareness about basic nutrition, hygiene practices, and the health services available. They focus primarily on ensuring that women undergo ante-natal check-up, maintain nutrition during pregnancy, deliver at a healthcare facility, and provide post-birth training on breast-feeding and complementary nutrition of children. They also counsel women about contraceptives and sexually transmitted infections.

ASHA workers are also tasked with ensuring and motivating children to get immunised. Other than mother and child care, ASHA workers also provide medicines daily to TB patients under directly observed treatment of the national programme. They are also tasked with screening for infections like malaria during the season. They also provide basic medicines and therapies to people under their jurisdiction such as oral rehydration solution, chloroquine for malaria, iron folic acid tablets to prevent anaemia, and contraceptive pills.

“Now, we also get people tested and get their reports for non-communicable diseases. On top of that ASHA workers were given so much work during the pandemic. We are no longer volunteers,” said Ismat Arra Khatun, an ASHA worker from West Bengal and general secretary of the Scheme Workers Federation of India that led the national protest.

The health volunteers are also tasked with informing their respective primary health centre about any births 

How did the ASHA network help in pandemic response?

ASHA workers were a key part of the government’s pandemic response, with most states using the network for screening people in containment zones, getting them tested, and taking them to quarantine centres or help with home quarantine.

“During the first year of the pandemic, when everyone was scared of the infection, we had to go door-to-door and check people for Covid-19 symptoms. Those who had fever or cough had to be tested. Then, we had to inform the authorities and help the people reach the quarantine centres. We also faced a lot of harassment because there was so much stigma about the infection that people did not want to let us in,” said Ismat Khatun.

Kavita Singh from Delhi, a former ASHA worker and a member of Scheme Workers Federation of India, added, “We had to go to households with confirmed Covid-19 cases and explain the quarantine procedure. We had to provide them with medicines and pulse-oximeters. All of this on top of our routine work.”

With the vaccination drive for Covid-19 beginning in January last year, they have also been tasked with motivating people to get their shots and collect data on how many people are yet to get vaccinated.or deaths in their designated areas. 

How much are ASHA workers paid?

Since they are considered “volunteers”, governments are not obligated to pay them a salary. And, most states don’t. Their income depends on incentives under various schemes that are provided when they, for example, ensure an institutional delivery or when they get a child immunised. All this adds up to only between Rs 6,000 to Rs 8,000 a month.

“Her work would be so tailored that it does not interfere with her normal livelihood,” the National Health Mission states. However, with outreach of most health programmes depending on them, that is not the case.

“Even if we work 24 hours, we will not be able to complete all the tasks. And, we do not get any benefits like pension or health insurance. If WHO recognises our role, if the government can call us veerangna (hero), shower us with flowers, why can’t they pay us fairly for all the work that we do,” said Ismat.

For quite some time now, ASHA workers have been demanding that they be made permanent employees of the government and provided benefits.

“If not that, they should at least fix our core incentives so that we get paid at least Rs 3,000 a month no matter what. All the work is graded 0 to 12 and if I do not get at least 6 points, I get paid only Rs 500 instead of Rs 3,000. I do not get points, even if a woman goes back to her home town to deliver the baby,” said Kavita.

She said that Covid-19 pushed them to their limits.“During Covid-19, we were only being paid Rs 1,000 for all of the additional work. Since the incentive stopped in March this year, half of the ASHA workers in Delhi decided not to participate in Covid-19 vaccination related activities,” added Kavita.

Written by Anonna Dutt 

Source: Indian Express, 24/05/22

ASHA: A successful public health experiment rooted in the village community

 

It is a programme that has done well across the country. As skill sets improved, recognition and respect for the ASHA went up. In a way, it became a programme that allowed a local woman to develop into a skilled health worker.

The World Health Organisation (WHO) has recognized the contribution of India’s 1 million Accredited Social Health Activists (ASHAs) during the Covid-19 pandemic. It is acknowledged that ASHAs facilitate linking households to health facilities, and play pivotal roles in house-to-house surveys, vaccination, public health and Reproductive and Child Health measures.

In many states, ASHAs are involved in national health programmes, and in the response to a range of communicable and non-communicable diseases. They get performance-based payments, not a fixed salary like government servants. There have been agitations demanding employee status for ASHA workers. The idea of performance-based payments was never to pay them a paltry sum — the compensation was expected to be substantial.

The ASHA programme was based on Chhattisgarh’s successful Mitanin programme, in which a Community Worker looks after 50 households. The ASHA was to be a local resident, looking after 200 households. The programme had a very robust thrust on the stage-wise development of capacity in selected areas of public health. Dr T Sundararaman and Dr Rajani Ved among others provided a lot of support to this process. Many states tried to incrementally develop the ASHA from a Community Worker to a Community Health Worker, and even to an Auxiliary Nurse Midwife (ANM)/ General Nurse and Midwife (GNM), or a Public Health Nurse.

Important public policy and public management lessons emerge out of the successful experiment with Community Workers who were not the last rung of the government system — rather, they were of the community, and were paid for the services they rendered. The idea was to make her a part of the village community rather than a government employee.

Over 98 per cent ASHAs belong to the village where they reside, and know every household. Their selection involved the community and key resource persons. Educational qualification was a consideration. With newly acquired skills in health care and the ability to connect households to health facilities, she was able to secure benefits for households. She was like a demand-side functionary, reaching patients to facilities, providing health services nearer home.

The Expert

Amarjeet Sinha is a retired civil servant who was associated with the design and capacity-building thrust of the ASHA programme for more than five years.

Building of a cadre

It is a programme that has done well across the country. As skill sets improved, recognition and respect for the ASHA went up. In a way, it became a programme that allowed a local woman to develop into a skilled health worker.

The ASHAs faced a range of challenges: Where to stay in a hospital? How to manage mobility? How to tackle safety issues? The solutions were found in a partnership among frontline workers, panchayat functionaries, and community workers. This process, along with the strengthening of the public infrastructure for health with flexible financing and innovations under the Health Mission and Health and Wellness Centres, led to increased footfall in government facilities. Accountability increased; there would be protests if a facility did not extend quality services.

The Community Worker added value to this process. Incentives for institutional deliveries and the setting up of emergency ambulance services like 108, 102, etc. across most states built pressure on public institutions and improved the mobility of ASHAs. Overall, it created a new cadre of incrementally skilled local workers who were paid based on performance. The ASHAs were respected as they brought basic health services to the doorstep of households.

Issue of compensation

There have been challenges with regard to the performance-based compensation. In many states, the payout is low, and often delayed. The original idea was never to deny the ASHA a compensation that could be even better than a salary — it was only to prevent “governmentalisation”, and promote “communitisation” by making her accountable to the people she served.

There were serious debates in the Mission Steering Group, and the late Raghuvansh Prasad Singh made a very passionate plea for a fixed honorarium to ASHAs. Dr Abhay Bang and others wanted the community character to remain, and made an equally strong plea for skill and capacity development of Community Workers. Some states incentivised ASHAs to move up the human resource/ skilling ladder by becoming ANMs/ GNMs and even Staff Nurses after preferential admission to such courses.

The important public policy lessons are the need to incrementally develop a local worker keeping accountability with the community, make performance-based payments, and provide a demand-side push with simultaneous augmentation of services in public systems. The system can sustain and grow only if the compensation is adequate, and the ASHA continues to enjoy the confidence of the community.

Debate over status

There is a strong argument to grant permanence to some of these positions with a reasonable compensation as sustaining motivation. The incremental development of a local resident woman is an important factor in human resource engagement in community-linked sectors. This should apply to other field functionaries such as ANMs, GNMs, Public Health Nurses as well.

It is equally important to ensure that compensation for performance is timely and adequate. Ideally, an ASHA should be able to make more than the salary of a government employee, with opportunities for moving up the skill ladder in the formal primary health care system as an ANM/ GNM or a Public Health Nurse. Upgrading skill sets and providing easy access to credit and finance will ensure a sustainable opportunity to earn a respectable living while serving the community. Strengthening access to health insurance, credit for consumption and livelihood needs at reasonable rates, and coverage under pro-poor public welfare programmes will contribute to ASHAs emerging as even stronger agents of change.

Written by Amarjeet Sinha

Source: Indian Express, 24/05/22

Can your ancestors’ smoking habits have harmful effects on your health?

 

‘Children of the 90s’, a study which was carried out at the University of Bristol, that the ill-effects of smoking are not limited to an individual’s personal health, but can show up in their offspring as well.

Over the years, countless studies have documented the harmful effects that smoking can have on one’s health. But new research suggests that the threats posed by smoking can have consequences which are more far-reaching and long-term than one could have ever imagined, with the health hazards likely to be passed on to the next few generations.

In other words, people’s smoking habits can have harmful effects not just on themselves, but also on their grandchildren and great-grandchildren.

These are the findings of a study called ‘Children of the 90s’, which was carried out at the University of Bristol in the UK. The results of the recent study were published in the journal Scientific Reports last week.

The ‘Children of the 90s’ project

As a part of the project, researchers have over a period of about 30 years collected 1.5 million samples, including participants’ blood, urine, placenta, teeth, hair and nails. The aim was to assess the environment and genetic factors that affect an individual’s health and development.

About 2,200 papers have been published using data collected due to the project. Some insights have been fascinating, such as the finding that the lines on a baby’s teeth can help determine their risk of developing depression, or how watching TV is linked to an increased risk of asthma.

Some of the findings are intriguing to say the least—for instance, the study states, what you eat as a three-year-old can affect school performance many years later, and anxious pregnant women are more likely to have asthmatic children among a variety of other linkages.

Even so, not everything is connected in a cause-and-effect manner all the time. For instance, a 2013 study of 4,000 pairs of mothers and children showed that maternal Vitamin D deficiency during pregnancy was not associated with the child’s bone health.

The crux of the recent study

The results of this recent study show that the ill-effects of smoking are not limited to an individual’s personal health, but can show up in their offspring as well. Only grandfathers and great-grandfathers were involved since very few grandmothers and great-grandmothers claimed to smoke before puberty.

A crucial finding of this study is that those women, whose paternal grandfathers and great-grandfathers began smoking before puberty, reported the presence of increased body fat.

Specifically, higher body fat was noticed in women whose grandfathers and great-grandfathers had started smoking before the age of 13 years compared to those whose ancestors started smoking later (between 13-16 years of age).

What’s baffling about these observations is that the increased body fat was found only in granddaughters and great-granddaughters. No effects were seen in the grandsons or great-grandsons.

Explaining the findings

A possible explanation is that the pre-puberty smokers had some other features, such as hereditary predisposition to obesity, that might explain why their offspring had excess amounts of body fat. But this does not offer a complete picture as the authors have themselves noted that those who smoke regularly tend to have a lower risk of obesity.

Only further research and investigation into the transgenerational effects of ancestral exposure can throw more light.

For now, there are many unanswered questions, including the linkages between effects of the habits of a person’s paternal side of the ancestors. Another question is why a similar outcome was not seen in the male offspring.

If these observations hold up in other cohorts of participants, perhaps the ubiquitous advisory “Smoking is injurious to health” will be inadequate—a possible addendum that can follow is: “Smoking is also injurious to your offspring’s health”.

Findings of other smoking-related studies under the project

A study from 2013 showed that children as young as seven years old had elevated levels of cotinine—which is a by-product of nicotine—in their blood if their mother smoked. This was seen particularly in those children whose mothers smoked 10 cigarettes a day.

One study from 2014 shows that men who started smoking before the age of 11 had sons who on an average had about 5-10 kg more body fat than their peers.

A 2017 study showed that if a woman’s maternal grandmother smoked during pregnancy, she was 67 per cent more likely to display certain traits linked to autism, such as poor social communication skills and repetitive behaviours.

A study from May 2021 had a more obvious result associating smoking during pregnancy to a child’s risk of developing congenital heart disease.

Source: Indian Express, 24/01/22

The importance of inclusive healthcare

 

Discussions about healthcare need to go beyond availability, affordability. Providing equitable, high-quality care to all requires recognising — and celebrating — differences among traditionally disenfranchised populations

Everyone deserves the right to dignified healthcare, regardless of their physical, professional, and geographical circumstances. Yet, India’s health systems too often fail vulnerable and marginalised people, who face a variety of obstacles in accessing high-quality care. Think of the stigma that prevents sex workers from full access to health resources or the discrimination that LGBT individuals face. Or the dearth of geriatric care to meet the needs of the elderly, or the lack of accessible and quality care for Dalit, Bahujan, and Adivasi (DBA) communities.

The Covid-19 pandemic exposed how pervasive these inequities are — and the extent to which healthcare cannot be separated from the economic, social, and cultural circumstances in which it is provided. These inequities have existed all along, and the crisis has only deepened them.

We believe the health system in India needs to fully include everyone. To get there, discussions about healthcare need to go beyond addressing availability and affordability. Providing equitable, high-quality care to all requires recognising—and celebrating—differences among traditionally disenfranchised populations. The specific healthcare needs of these communities must be understood and addressed.

Leaders of organisations that work closely with disenfranchised groups point to several reasons why some communities are marginalised by the health system. Most prominently, vulnerable populations usually play little or no part in developing and delivering healthcare services. As a result, services may be geographically, culturally, or in other ways inaccessible, and not meet the unique needs of the community.

“Creating equitable health systems is, at its core, a design issue,” noted Dr Nirmala Nair, co-founder of the Jharkhand-based nonprofit Ekjut, which works with India’s tribal communities. “The voices of these populations are often not heard.” To combat this problem, Ekjut organises tribal community meetings at the onset of the programme to engage them from the planning stage. Ekjut also conducts outreach to ensure that the poorest among those it serves participate in these meetings.

Social stigma and discrimination also pose significant obstacles. Some patients feel judged by providers because of their socioeconomic status or profession. “This judgement deters health-seeking attitudes. There is a feeling of not being wanted,” said Priti Patkar, founder of Prerana Anti-Trafficking, which aims to end intergenerational prostitution and protect women and children from human trafficking. As a result, Patkar said, patients frequently forego care or turn to local, informal providers who lack requisite knowledge and training.

Another hurdle is that healthcare systems often take an overly narrow approach when working with marginalised communities. For example, according to Patkar, healthcare for sex workers has focused almost exclusively on the treatment and prevention of HIV and other sexually transmitted diseases, ignoring other pressing health needs.

Finally, some providers lose sight of the fact that everyone, regardless of their circumstances, has value to broader society. When they do, treatment practices suffer and patients become demoralised. “At the onset of disability, if the patient is told that there is no cure, to them, that means life is over, and it shouldn’t,” said Shanti Raghavan, founder of Enable India, an NGO that supports livelihoods for people across 14 types of disability. “Instead they need rehabilitation and solutions to regain their quality of life.”

Raghavan notes that when people with disabilities receive the timely support required to regain their functional abilities—including basic forms of assistance, such as crutches or wheelchairs—many can thrive personally and professionally, sometimes “earning four or five times the national average.”

Elevating communities’ voices can contribute to better care, and collaborative action is one way to do that. For instance, our organisations, The Bridgespan Group and Piramal Swasthya, have partnered with others like the Bill and Melinda Gates Foundation to design and implement Anamaya, a recently launched tribal health collaborative. Anamaya brings together government, philanthropy/donors, NGOs, academic research organisations, and other stakeholders to work for improved tribal health outcomes.

Investing in high-quality training and support for community healthcare is another avenue for change. “It is not difficult to map out the NGOs, the communities they are working with, and what their needs are,” said Dr Thelma Narayan, co-founder of the Society for Community Health Awareness Research. “We need to do this with a sense of urgency.”

Much is also gained by employing members of traditionally vulnerable communities within healthcare systems—and celebrating their differences. These workers draw on shared experiences to develop greater trust with patients and deliver more empathetic care. For example, the ASARA project of Piramal Swasthya in the Vishakhapatnam tribal belt has engaged auxiliary nurse midwives from tribal communities, who help transcend language and cultural barriers and incorporate their lived experiences into healthcare delivery. Where the community-led programme has been implemented, maternal deaths have fallen to zero.

Covid-19 has revealed the urgency of engaging these communities with more focus and empathy. Real action is needed to build inclusive health systems that enhance communities’ confidence to seek healthcare, and provide acceptable health services. “We don’t lack resources in India,” Narayan said. “If we don’t go ahead with this, we have only ourselves to blame.”

Pritha Venkatachalam is a partner and head of market impact, South Asia in The Bridgespan Group’s Mumbai office, and Sudeshna Mukherjee is vice president – behaviour change communication at Piramal Swasthya

Written by Pritha Venkatachalam and Sudeshna Mukherjee

Source: Indian Express, 31/10/21

Recognising the role of health in India’s social and economic growth

 Focus on a system that responds to the capacity of the State and other stakeholders in the immediate-term, while building on such capacity in the longer term. Better responsiveness to the needs of citizens can drive trust between citizens and the State.

As India begins marking its 75th year of Independence, it is an appropriate time to take stock of the priority we have accorded to our biggest resource — human capital. Today, India has the largest population of young people; an enviable resource that can move India on to a stronger economic path. Research has highlighted the links between building human capital (through nutrition, health, and education) and growth. And yet, data on nutrition, health, and education suggests that the value of this resource has not been recognised.

When we focus on health, there has been progress, but India remains well below peer countries — and where it needs to be — in terms of the well being of citizens. This stems from multiple reasons.

One, it is not clear if national and political incentives to improve health have been clear to leaders. There are two aspects to this. The first is linked to the limited attention to the links between health and human capital, and growth promotion — a case that positions health not merely as a welfare issue, but as an influencer of India’s growth.

The second is the limited attention to the impact of health care on poverty. Health-related expenditures are estimated to push 3.5% of the population below the poverty line; with those already below the poverty line pushed only deeper. Anirudh Krishna’s research across four continents found health-related expenses to be the prime reason for households descending into poverty and that millions of households live “one illness away” from poverty.

Political incentives could also be a factor of “credit”, and in India’s federal system, a lack of clarity in “credit” from the improved health care services may further diffuse political incentives. Reforming the health care system may also be viewed as too long-term an agenda, and, therefore, not conducive to immediate political gains. Additionally, the pathways at different governance and administrative levels are often not evident, constraining political interest from relevant leaders. Two, the absence of health as an electoral demand dilutes its political salience. Data from multiple CSDS Lokniti polls has highlighted that health figures low among voter priorities. The middle-class has exited from the use of public services, and increasingly, the poor are moving in the same direction.

It is, therefore, not surprising that the health sector has one of the lowest public investments at 1.3% of the Gross Domestic Product, with a disproportionate use of private services, and 64% of health care expenditure being out of pocket at the point of service.

However, leaders have sought political legitimacy through attention to targeted sectors and the initiation of reforms. Regime shifts in several countries such as Turkey, Indonesia, and Brazil saw leaders prioritising health to establish credibility with the voter base and reaping electoral benefits. Well implemented reforms fuelled citizen expectations, leading to demand, and creating the space for further reform. India has not witnessed too many examples of this.

State capacity is a central variable in the cycle of well-implemented reforms, tangible benefits, a social compact between the government and its citizens, and electoral gains. The absence of this confidence in capacity will likely lead to a clientelist model of delivering services, rather than a systems approach.

What is the path that India should take? One, focus on a system that responds to the capacity of the State and other stakeholders in the immediate-term, while building on such capacity in the longer-term. Better responsiveness to the needs of citizens can drive trust between citizens and the State. And do this while highlighting the role of health in a nation’s journey, and building citizens’ understanding of the primacy of health and its impact on their economic status.

A lot more needs to be done to identify paths to reform, through a combination of public and private provisions, with the State as a regulator. This can offer a coherent response to constraints and political benefits at the national, state and sub-state levels.

Sandhya Venkateswaran is member, Lancet Citizens Commission on Reimagining India’s Health System and Centre for Social and Economic Progress.

Source: Hindustan Times, 29/09/21

Research contradicts earlier findings on smoking and Covid-19. Smokers, everywhere, lose a silver lining

 

A section of scientists has questioned the earlier studies, claiming that some of the researchers had ties to the tobacco industry.

Spare a thought for the smokers. Last year, at the height of the first wave of the pandemic, researchers — first in France, later in China and India — published studies that seemed to indicate smokers were at less risk of contracting Covid, and when they did, experienced less severe symptoms. In France, there was reportedly a rush on tobacconists by non-smokers hoping to get a little extra protection. For smokers everywhere, here, at last, was a justification — as much for themselves as for those they have been shunned by for the smell and cloud of carcinogens they spread — to take another drag. Now, unfortunately, they have been robbed of the only silver lining that pierced the haze and the tar all too briefly.

A recent study in England has collated observational and genetic data on Covid-19 and tobacco use and found that compared to those who had never smoked, smokers were about 80 per cent more likely to be hospitalised after contracting the virus. A section of scientists has questioned the earlier studies, claiming that some of the researchers had ties to the tobacco industry.

Not surprisingly, the disappointment among tobacco addicts is palpable. Unlike other substances — alcohol, marijuana and more notorious narcotics — smoking doesn’t really get you high. The social cost for the addiction is hardly commensurate to the pleasure — train and plane journeys have you jonesing, you’re shunned to dark corners outside bars and sometimes, even from your own homes to service the need without bothering others. All this, while it burns a huge hole in your pocket and you slowly but surely watch your health deteriorate. From France, the birthplace of existentialism, there was hope that smoking had a purpose. From England, the birthplace of utilitarianism, that hope has been taken away.

Source:29/09/21

How Covid-19 can transform health care

 The pandemic disrupted life, livelihoods, education and health like little else in recent history.The pandemic disrupted life, livelihoods, education and health like little else in recent history. The world found innovations and adaptations to minimise some of the disruptions for some people, but not all. Health care disruptions, less amenable to home-based solutions, ranged across a very broad continuum — a shift in health-seeking behaviour, limitations in health infrastructure, difficulties in outreach to community members, lack of availability of human resources and interruptions in supply chains. Not all of these were limited to the context of the pandemic — some have pre-existed but got magnified in the context of the pandemic.

Covid-19 saw health care workers diverted to the much-needed task of preventing and dealing with infections, taking them away from their regular tasks, and thus, further reducing the availability of health care workers. Health care facilities were deployed for testing and treating patients, but this made them unavailable for regular services. Supply chains were disrupted due to lockdowns. When health facilities were functioning, citizens were either fearful or unable to travel to them or were unaware that facilities were functioning. All this led to significant disruption in the provision of essential health services such as routine immunisation, testing and treating tuberculosis (TB) patients, maternal and child health care and nutrition-related interventions.

But India is no stranger to innovation. A few months into the pandemic, there were a variety of interventions, which sought to address some of these barriers related to health human resources, demand for and access to services, and provision to the last mile. Innovations were found in at least four categories — leveraging technology, leveraging community platforms, strengthening frontline workers and augmenting supply chains.

Extensive interventions leveraged the digital platform such as remote counselling and consultation in several states; a child growth-monitoring app for remote monitoring of severely acute malnourished children in Rajasthan, Maharashtra and Madhya Pradesh; an Interactive Voice Response System-based solution in Uttar Pradesh for reminder calls to the community about immunisation sessions; digital surveillance applications for front-line workers for TB and Covid-vulnerability assessment in states such as Gujarat, Kerala and Punjab for simultaneous TB and Covid assessment; an artificial intelligence-based diagnostics solution to scan chest X-rays and detect abnormalities.

Various organisations leveraged digital platforms to conduct training and information sessions for frontline workers. The range of such services and their providers is vast including e-Sanjeevani, Swasth, Practo, Portea, TeCHO, Anmol, to name just a few.

The involvement of community-based organisations in the form of self-help groups (SHGs) and village organisations reinforced their potential for last-mile services. Active TB case finding by community health volunteers through outreach and awareness; demand generation for services and provision of timely information to pregnant women by volunteer groups through helpline numbers; support for essential health service delivery through panchayati raj institutions contributed to strengthening health services.

The Indian postal department was leveraged for its extensive postal network as an alternative logistics chain for delivery of family planning commodities. Social franchising model for TB diagnosis and drug dispensation via e-pharmacies to the doorsteps of patients was also utilised.

India saw many innovations rolled out, although not necessarily at scale and most not evaluated for impact. Based on rigorous impact evaluations, there is potential for scale and convergence. It is not that this potential is not recognised by the government. The introduction of telemedicine guidelines and the launch of the National Digital Health Mission provide a foundation for greater leverage of the digital platform. Admittedly, limited internet penetration in rural India, gender disparity in internet usage, data privacy and data-sharing ethics concerns limit the impact of digital platforms, but an increasing focus on health technology platforms can address, to some extent, the needs of information, triaging, counselling, consultation, scheduling visits, home delivery of drugs, and remote follow-up reducing some of the demand- and supply-side challenges.

Similarly, a stronger policy environment can enable the 70 million SHG women members to play an institutionalised role in health service functions, such as behaviour change interventions, demand for essential services, community-led accountability of health systems and services.

The pandemic saw multiple innovations surface, some deployed in small geographies, some by private organisations and others by the government, most not evaluated for impact. These innovations merit policy attention — in assessing their impact, in their geographic scale, in convergence of currently fragmented services, and in developing meaningful partnerships with private innovators for public adoption.

Scaling innovations requires attention to at least three aspects. One, assessment of innovation impact and certification, which, in turn, will require institutional mechanisms that can enable this. Second, a policy environment that encourages and facilitates public contracting of innovations, in a context where the benefits of purchasing existing, tried-and-tested products/services in the public system are large. Third, grant-and-loan mechanisms that enable innovators to address the needs of the health care system. The platforms on which these innovations are deployed are under-leveraged, with the pandemic demonstrating the opportunity to build on these innovations, leading to a stronger health systems response.

Sandhya Venkateswaran is fellow, Lancet Citizen’s Commission on Reimagining India’s Health System

Source: Hindustan Times, 10/03/21

Coronavirus: This is how a filmmaker in Wuhan documented his wife’s Covid-19 journey

The filmmaker's video series titled "Our Coronavirus Diary" recorded their experience of fighting the virus.

An emergency room nurse in Wuhan tested positive for coronavirus after handling several patients at a hospital. Her filmmaker husband documented the entire journey of the lockdown in China in January and also shot their life in quarantine. This man’s journey after he realised his wife has symptoms of the disease is heartbreaking.

“By mid-December, my wife started getting worried. She said there were more and more patients with similar symptoms. She was worried and didn’t want to go to work. But she would still put her uniform on. So I knew she wasn’t going to just abandon her patients. But one day she called me around 8.50 am and said ‘I got it’. I knew immediately what she meant,” he shared in a BBC video.

On January 26, they were informed that she had been infected. The filmmaker was actually documenting the lockdown that started in China since January but when he received news of his wife, he continued to film their daily chores. “My mind went blank. I wasn’t sure what to do next. Initially, her symptoms were mild and the medical resources were already overstretched. So the doctors prescribed some medicines and told us to self-quarantine at home,” he said in the video.

The visuals also show his wife crying in a locked room and scolding him if he came in for cleaning or disinfecting the area. He also recorded how he used to leave a bowl full of soup and move away so that she could open the door and take the bowl in. “I decided to keep filming because I was scared she would get worse. Her fever was going high but none of the hospitals had any beds available. Only after 13 days of being tested positive, she was taken to a hospital; that’s when they knew that it has gone worse. My heart sank. I kicked myself for not taking her to the hospital sooner,” he recalled.

The filmmaker’s video series titled “Our Coronavirus Diary” documented the couple’s experiences of fighting the virus. According to China.org.cn, her condition has been stable for several days now, and the most recent nucleic acid test results came back negative, according to her Weibo post on March 5. She will finally be discharged from the hospital after conducting antibody tests.

Source: Indian Express, 18/03/2020