India’s growing importance at global health diplomacy

Context

• SoumyaSwaminathan’s elevation to the post of Deputy Director – General for Programmes (DPP) at the World Health Organization (WHO) is a reflection of India’s growing importance in global health diplomacy.

What does this mean for the India at the WHO?

• Recognition as such underlines the fact that India plays a role in global health.
• It is both challenge and huge opportunity because the WHO has the convening power that no other body has.
• The involvement of patient voices and the community and civil society are extremely important for public health gains.

World Health Organization (WHO):

• The World Health Organization (WHO), established on 7 April 1948, is the body of the United Nations (UN) responsible for directing and coordinating health.
• Its current priorities include:

1. communicable diseases, the mitigation of the effects of non-communicable diseases,
2. sexual and reproductive health, development, and ageing,
3. nutrition, food security and healthy eating,
4. occupational health; substance abuse and
5. driving the development of reporting, publications, and networking.

What are the focus areas?

• Bringing affordable, quality healthcare and scaling up the use of innovations should be the priority.
• Introducing innovations in public sector that happen mostly in the private sector should be the area of focus. There is a huge amount of innovation in devices, diagnostics, sensors, and drug delivery systems.
• Innovations that impact public heath delivery will be of utmost importance in the coming time for India. Therefore, one needs to study it well, evaluate them as they create benchmarks and work them to develop for large production and use.
• This should go hand in hand with access to medicines and the best treatments, and prevention strategies, to all citizens of any country.

What can be challenging?

• Balancing the needs and demands of intellectual property protection vis-a-vis access and equity in that access is going to be a challenge.
• A lot more needs to be done, including drugs for non-communicable diseases, cancers, and vaccines needs to be developed for emerging infections.
• Emerging epidemics will have to be a key aspect. Vector-borne diseases are a serious concern for the entire developing world. Southeast Asia and South America have suffered from chikungunya, zika, dengue.

What are Vector – borne diseases?

• Vectors are smart, they have the capability of adapting themselves to the changing ecosystem.
• As urbanization expands, the whole thing is going to spread.
• Vector-borne diseases account for more than 17% of all infectious diseases, causing more than 700 000 deaths annually.
• More than 3.9 billion people in over 128 countries are at risk of contracting dengue, with 96 million cases estimated per year.
• Malaria causes more than 400 000 deaths every year globally, most of them children under 5 years of age.

Where does India stand in the agenda?

• WHO will be focusing on tropical diseases.
• There are several diseases now with elimination targets — for kala-azar, filariasis, and measles.
• There are also neglected diseases like snake bite causing estimated 50,000 deaths in India. Snake venom manufacturing needs to be regulated, as availability of access to the right venom at the right time needs to be looked into.
• Soil-transmitted helminths, or intestinal worms, have an impact on morbidity-causing anaemia and nutritional deficiencies. WHO is planning a study to see if deworming the entire population for a few years, instead of just children, will drive down infection with worms.
• One of the biggest areas of concern is Universal Health Coverage, a priority laid out in the National Health Policy.
• There is a need of task – shifting, proper use of available health – care providers, training community health – care providers and launch of health literacy campaigns to reach large populations of countries deprived of accessibility of doctors.

National Health Policy 2017

• The Union Cabinet has approved the National Health Policy 2017 after having deferred it twice before. The last health policy was issued 15 years ago in 2002.
• It aims to provide healthcare in an “assured manner” to all, the policy will strive to address current and emerging challenges arising from the ever-changing socio-economic, technological and epidemiological scenarios.
• The policy advocates a progressively incremental assurance-based approach.
• It envisages providing comprehensive packages for primary health care through the ‘Health and Wellness Centres’ and denotes important change from very selective to comprehensive primary health care package which includes care for major NCDs,mental health, geriatric health care, palliative care and rehabilitative care services.
• It aims to allocate major proportion of resources to primary care and intends to ensure availability of two beds per 1,000 populations.
• The policy proposes free drugs, free diagnostics and free emergency and essential health care services in all public hospitals in a bid to provide access and financial protection.
• It also envisages a three-dimensional integration of AYUSH systems encompassing cross referrals, co-location and integrative practices across systems of medicines. It also boasts of having an effective grievance redressal mechanism.
• The policy proposes raising public health expenditure to 2.5 per cent of the GDP in a time-bound manner.
• The policy intends to increase life expectancy at birth from 67.5 to 70 by 2025 and reduce infant mortality rate to 28 by 2019.
• It also aims to reduce under five mortalities to 23 by the year 2025. Besides, it intends to achieve the global 2020 HIV target.
• The policy would adopt an “assurance-based approach” thus abandoning a radical change proposed in the draft policy of 2015, that of a National Health Rights Act aimed at making health a right.
• It reiterates health spend targets set by the High Level Expert Group (HLEG) set up by the erstwhile Planning Commission for the 12th Five Year Plan (which ends on March 31, 2017).

Will the WHO be able to regulate or influence national policies with having an impact on public health?

• WHO is looking forward towards some policy measures in the sector of Non – Communicable Diseases (NCD).
• Policies like labelling of food for high salt, sugar, and fat content; higher taxes on such products; some kind of package labelling to indicate whether it is a healthy choice or not is taken into consideration.
• Policy on micronutrient fortification is mandatory fortification of milk, oil, rice wheat and double fortification of salt will help eliminate micronutrient deficiencies.

Need for intervention

• Policy-level interventions are necessity but individuals also need to take responsibility for their actions.
• Community-level like having enough open spaces and parks where people can walk safely, and urban planning is also required.
• The WHO will now bring health into all policies and one sector is environment and health, linking climate change, air pollution, and heath.
• The government has started with a screening programme, and many of them will be identified. But this is an area where lifestyle interventions will make a bigger difference.
• On the NCD front, certain validated Indian Systems of Medicine treatments and practices have proven to be effective from a preventive aspect.
• There are other areas that WHO needs to do more validation studies in. For instance, in the anti-dengue properties of certain herbal compounds.
• The ICMR is bringing together an ayurvedic college and an allopathic department to conduct a regular clinical study with a control group, and all parameters are being measured.

Indian Council of Medical Research

• The Indian Council of Medical Research (ICMR), is an apex body in India for the formulation, coordination and promotion of biomedical research.
• It is one of the oldest medical research bodies in the world.
• The ICMR attempts to address the growing demands of scientific advances in biomedical research on the one hand, and to the need of finding practical solutions to the health problems of the country, on the other.
• The good news for ICMR is that its funding has been increasing year by year. This year, it is Rs. 1150 crore.

Problems of Indian Healthcare system

• India’s total healthcare expenditure is 1% of its GDP(1.2% public expenditure) which is one of the lowest in the world.
• Doctor patient ratio is meager.
• India’s per capita gross national income (on PPP basis) in 2012 was $3910, life expectancy 65(2011), Infant Mortality Rate (IMR) 47(2011), immunization coverage 72% (2011), whereas for Bangladesh, it is $2030, 69, 37, 96% respectively.
• Life expectancy at birth has risen to 65 years from 32 years in 1950.
• IMR has come down from 129 deaths in 1971 to 42 in 2012. Small Pox, Guinea worm and Poliohave been eradicated.
• Abysmally low spending on Public Health – meagre 1.2% against WHO recommendations of 5% public spending on Health.
• Neglect of health care institutions at lower strata i.e. PHCs.
• The focus has been on building AIIMs like institutions at all India level but PHCs and CHCsdon’t get much attention.
• Poor infrastructureand inadequate human resource at all levels in hospitals.
• That is why people often go to public hospitals only for the smaller diseases, and not for the grave ones in which they have to get admitted in hospitals.
• The focus of policymakers has been to address the demand-side issues rather than the supply-side inefficiencies.
• This is evidenced by the focus on improving hygiene and environmental concerns to prevent the spread of ailments and diseases.
• Governance deficit and regulatory capturearise due to myriad laws and regulations which impede the normal development of this sector.
• Many alternative healthcare practicesexist and have been serving people since ages but it has not got adequate attention of the government since long.
• Disparity in rural-urban areas. IMR is 46/1000 in rural areas whereas it is 28/1000 in urban India.
• The inefficiency in the sector also creeps up with the widespread corruption that ails both the public and the private sector.
• Privatesector is also not efficient enough. Many of them indulge in malpractices by selling substandard and even counterfeit medicines, prescribing unnecessary drugs and tests, receiving commissions for referrals, requiring unnecessary hospital admissions and manipulating the length of stay.