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.
Conversations on Health Policy
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….
The Ayushman-Bharat- Health and Wellness Scheme(AB-HWC), launched in 2018, is India’s big hope to deliver on the promise of universal and comprehensive primary health care- a logical extension of the efforts that the National Health Mission,2005 had begun. Its success would have paved the way for the realization of the right to healthcare. But in its rapid scaling up there has been weak conceptual clarity and many essential features of the scheme are under threat. Can the situation be retrieved? In this conversation, three public health practitioners who have been closely associated with its design and/or implementation discuss some of the urgent course corrections that the public health community could help with….
A critical reading of the Progress Update is essential for those in engaged in practice or research in health systems and health policy. This conversation addresses some of the technical challenges of measurement, and implicitly its politics. What we measure as progress is closely related to where we want to go and how we intend to get there. To the average health manager and the health activist this could be heavy reading, but we hope that this conversation helps demystify health metrics, and make for more informed participation in “evidence-based decision making”.
The chronic shortfall of specialist skills in CHCs, cripples our ability to universalize comprehensive primary health care. Such skills are essential to provide referral support and continuity of care to primary care providers and patients. The persistence of the problem and the failure of many efforts to address this shortfall should lead us to introspect on basic design flaws. Drawing on national and international experience, we discuss how this gap can and must be addressed and that too on a priority basis…
We are drawing attention to this recent publication from the regional WHO. In this introduction we highlight one context – the shift from selective to comprehensive care. We hope these case stories help the reader understand the complex nature of this shift, and provides grounds for optimism, that despite the challenges, such a change is feasible…..