Conversations on Health Policy

Despite the many declarations of elimination, leprosy persists as a significant public health problem whose contribution to suffering and disability is seriously underestimated . In this conversation, three public health practitioners with decades of engagement with leprosy control at both field and policy levels and who are still engaged with its management on a day to day basis, reflect on why active transmission of the disease persists; why disabilities continue to emerge even after cure and on the options for the way forward —beyond the rhetoric of elimination.

India’s incidence of breast cancer may be less than in developed countries, but its mortality is much more. In adult women of the 30 to 69 age group, this is now one of the top two or three causes of mortality. The introduction in 2017, of universal screening for breast cancer as part of public provision of comprehensive primary health care was a huge and highly welcome step forward. Eight years later, we take stock of where we have reached in implementing this policy and the challenges being faced, and why our understanding of primary health care needs to go far beyond what we offer as primary level health services.

After arduous and prolonged negotiations, a global Pandemic Agreement has finally been adopted at the 78th World Health Assembly. But is this Agreement good enough to avert another pandemic catastrophe? In this conversation we invite Prof. Biswajit Dhar, to help us understand the public health implications of the Agreement in the context of the non-participation of the USA, the weaponisation of tariffs and a changing global economic order. And on what developing countries need to do further…

Despite several recent policy initiatives, access to essential diagnostics remains inadequate across many facilities. As a result, patients continue to face out-of-pocket expenses : time delays and inappropriate care due to limited diagnostic availability in public facilities. In this conversation, we examine the barriers and the lessons learnt from existing models including the PPPs and explore strategies for improvement.

Increasing reports of poor quality of medicines manufactured in India, whether as exports or for domestic consumption, are a matter of great concern. But this crisis should not become an excuse for strengthening corporate monopoly and excessive centralization. In this conversation, we discuss the why and how of designing a regulatory regime in India, that can guarantee quality medicines without any compromise to affordability or public health, not only for India, but for the entire third world.

Private practice by government doctors is wide-spread, but far from universal. Further, even in places where it is allowed, the consequences due to the inevitable conflict of interests varies widely. Ongoing efforts towards mitigation also create differential impact. In this conversation we examine the justifications advanced and the principles that could guide public policy in this regard. We further discuss the various scenarios, and what we can learn from these different scenarios to chart our way forward.

As 2024 draws to a close, we take the opportunity to re-share the full series of nineteen “Conversations on Health Policy” published online by the RTH Collective over the course of the year. We also take a moment to reflect on the series as a whole and on the intent and directions with which we undertook the building of this web resource and our hopes for its evolution. Wishing you a happy new year…

Digitization of public health information systems has greatly increased the burden of data-work of frontline health care providers, reducing the time available for healthcare. But though huge volumes of data are generated, data-reliability remains low and its use in improving health outcomes uncertain. Ironically, HMIS, once the subject of health sector reforms, has now become one of its main objects. In this conversation, learning from the past, we propose some principles of design that would help develop HMISs that are more fit for purpose.

The ABDM is India’s ambitious push for digitization in the health sector. In this conversation, four researchers who have been associated with the design and implementation of healthcare IT systems, take a closer look at the ABDM and strive to understand what the program set out to do, what it has done and where it is headed. They explore what ABDM offers for the problems of access, equity and quality of care and the information needs of public health managers. Or has digitization become an end in itself? There are challenges but there are opportunities too….