Conversations on Health Policy

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…..

The ESI is an amazing institution covering over 10% of the population. The ESI is conceptualized within a health rights framework and offers a basket of benefits that no other insurance programme even attempts. Yet when experts talk of UHC or publicly funded health insurance, the ESI is almost never mentioned. Performance in terms of delivery of benefits is poor, but this is not due to lack of funds, as the ESI has a huge surplus. This conversation is about how ESI must be saved, re-vitalized and expanded, as part of the struggle to achieve the right to healthcare and Health for All. And given some of the directions of reform that are being pushed, it it is also about how not to lose an asset that we never knew we had.

Last year, the ICMR initiated a process re-revisit WHO’s weight and height standards for children on grounds that these are not appropriate in the Indian context. But is this valid? Are current growth standards overstating India’s malnutrition crisis? In this conversation, Dr Yogesh Jain talks to Prof. Rakesh Lodha, AIIMS and Dr Pavitra Mohan,BHS, ( all of leading pediatric practitioners and academicians with experience in public policy) to clarify the issues and concerns underlying the current controversy and the values and goals that should inform our choice of standards.

India has the necessary digitized data systems in place to provide us with the mortality data we need, but yet due to some critical disconnects, we remain reliant on external global institutions for even state and national burden of disease estimates. In this conversation Dr. Chalapathi Rao, discusses how it is possible for state governments to generate reliable annual district level mortality information- even in the short run.

“Universal Health Coverage” was once hailed as “the single most important concept that public health has to offer.” ( Margaret Chan, 2012). But , even by WHO and UN assessments, it is off track, across most low and middle income countries !! In this conversation we look beyond implementation issues and disruption due the covid pandemic, to more basic questions about UHC as a strategy and as a discourse.”

Global Health Policies in an unequal world are more the resultant of political dynamics than of the public good. Introducing the WHO Tracker, a unique and powerful tool created by PHM, which empowers public health professionals, practitioners and policy makers in developing nations to understand and intervene in global policy setting and its adaptation to local needs. Use this to follow the ongoing discussions in the 77th World Health Assembly at Geneva.

We know that markets do not work to assure quality health care!! But what does? Over the last 15 years, the NHM has developed the National Quality Assurance System (NQAS) to assure quality in public health services. What is NQAS? Is it working? Is it scaleable? Is it enough? This conversation between Yogesh Jain and Sundararaman, the 8th in our series, explores the answers!!

The challenge is to secure ASHAs own rights as a woman and a front line health worker, while continuing to strengthen her solidarity with the community as part of an alternative vision of an organization of health services.

Four years after the pandemic, we have learnt a lot about it. But there is a lot we do not know as well. This is a time for reminding ourselves of what we went through and learning from it- so that we can truly say– never again !!

Much of what is said in the Negotiating Text of Pandemic Agreement is necessary and welcome. But is it sufficient to ensure that we never again have to experience the social, economic, health and human rights catastrophe that we have just been through during the Covid 19 pandemic??”

This is a picture of a 18 month old girl with severe pain due to dactylitis. Needless suffering. !!. The current policy is aspirational but flawed and needs to get it’s priorities right …

A better understanding of these three concepts and the relationship between them is essential for progress towards realization of the right to healthcare. One cannot be achieved without the other…

Preparations are on for the High Level Meeting of the United Nations on Antimicrobial Resistance, scheduled for September 2024. The proposed strategies are welcome but incomplete. There is much more that a Call for Action should address…

There has been very limited comments on the media and even in academic journals on the major changes in the strategies of tuberculosis, globally and at the national level.

The need for a new act replacing the Medical Council Act is no doubt of utmost importance. Unfortunately, the National Medical Council Bill of 2019, now an Act.