Draft National Health Policy - 2015 --->>> A Critical Analysis !

Provisions of Draft National Health Policy 2015

• The draft National Health Policy, 2015 has proposed a target of raising public health expenditure to 2.5 % from the present 1.2% of GDP. It also notes that 40% of this would need to come from central expenditure.

• The draft policy suggests making health a fundamental right similar to education and denial of the same could be punishable. The Centre shall enact, after due discussion and on the request of three or more states a National Health Rights Act, which will ensure health as a fundamental right, whose denial will be justiciable.

• The draft policy has been placed in the public domain until 28 February, 2015 for public consultation. The new policy is being introduced almost 13 years after the last health policy was drafted. 

 

•  As per the draft document, government plans to rely mostly on general taxation for financing health care expenditure.With the projection of a promising economic growth, the fiscal capacity to provide this level of financing should become available. 

• The government is also keen to explore the creation of a health cess on the lines of education cess for raising money needed to fund the expenditure it would entail. Other than general taxation, this cess could mobilize contributions from specific commodity taxes such as the taxes on tobacco, and alcohol, from specific industries and innovative forms of resource mobilization.

• While there is an intent to increase spend on health care, the draft policy also stresses on the role of private sector. While the public sector is to focus on preventive and secondary care services, the document recommends contracting out services like ambulatory care, imaging and diagnostics, tertiary care down to non-medical services such as catering and laundry to the private sector.

The draft document highlights the urgent need to improve the performance of health systems, 

• with focus on improving maternal mortality rate, 
• controlling infectious diseases, 
• tackling the growing burden of non-communicable diseases,
• bringing down medical expenses among other things.

Maternal mortality currently accounts for 0.55% of all deaths and 4% of all female deaths in the 15 to 49 year age group.

• The policy statement also assures universal access to free drugs and diagnostics in government-run hospitals. However, it proposes to pose public health system as pre-paid services instead of social service. 

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 A step in the right direction

• The policy is a first step in achieving universal health coverage by advocating health as a fundamental right, whose “denial will be justiciable”. 

• The current government spending on health care is a dismal 1.04 per cent of gross domestic product (GDP), one of the lowest in the world; this translates to Rs.957 per capita in absolute terms. The draft policy has addressed this critical issue by championing an increase in government spending to 2.5 per cent of GDP (Rs.3,800 per capita) in the next five years.

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Suggestions & Concerns

• The national programmes provide universal coverage only with respect to certain interventions such as maternal ailments, that account for less than 10 per cent of all mortalities. 
• Over 75 per cent of the communicable diseases are outside their purview and only a limited number of non-communicable diseases are covered. 
• It is, therefore, crucial for the Union government to undertake proactive measures to upgrade the health-care services of poorly performing States such as Bihar and Uttar Pradesh. 
• As it stands, health will be recognised as a fundamental right through a National Health Rights Act only when three or more States “request” it. Since health is a State subject, adoption by the respective States will be voluntary. 
• Though a different approach has been taken to improve adoption and implementation by States, the very objective of universal health coverage that hinges on portability will be defeated in the absence of uniform adoption across India. 

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Why the new National Health Policy is a step in the wrong direction ? (Counterview)

• To meet the expenses, the policy draft wants to introduce a complex system that relies largely on tax collection but also proposes tapping the services of not-for-profit ventures and trusts.

• An assortment of secondary and tertiary services are proposed to be bought by the government from public and private healthcare facilities -- though it is unclear how this differs from the present system of 'empanelled' private hospitals.This system has not proved very effective for various reasons, including delayed and inadequate reimbursement of the costs.Indeed private provision and public financing is everywhere a recipe for disaster, and will serve no interests but that of private healthcare providers.

•  The new policy acknowledges that the present concept of primary healthcare covers hardly 20 per cent of the health needs and that heavy out-of-pocket health expenditure is pushing nearly 63 million people into poverty every year.It has, consequently, done well to broaden the definition of primary healthcare to include more services related to reproductive and child health as well as several infectious and non-communicable diseases.But although bringing down medical expenses has been listed among the major objectives of the new policy, it has no ideas on how to do it.

•  It is silent, for example, on regulating the private healthcare sector.
•  Though healthcare is a state subject, most states starve it of resources.

In the end, good healthcare is about effective and well-administered public provision of the basics.The Centre and states must expand public healthcare infrastructure, recruit more doctors and paramedical staff, set up new diagnostic laboratories, and revamp procurement, stocking and distribution of drugs.

Tackling Moist Challenge !

The Nature of the Moists Attack  !!

Maoist attacks on the security forces and the symbols of state power are characterised by 

• meticulous planning, 
• systematic preparation, 
• near-surgical execution and 
• a high degree of coordination. 

On several occasions, the rebels have achieved considerable success in launching synchronised attacks on multiple targets involving large numbers of cadres. For the Maoists, besides waging a protracted people’s war with the ultimate objective of capturing or seizing political power, participating in a peace process and talks is a ‘tactic’ and considered ‘war by other means’.

Response of the State !!

The response of various state governments and the Centre is invariably reactive. While the Maoists have been expanding to newer areas and have been steadily enhancing their military capabilities, counter-Naxal operations have mostly been lackadaisical. 

The reasons for this apathetic approach are three-fold. 

1.  Firstly, Naxal terrorism is not an emotive issue at the national level like the insurgency in Jammu and Kashmir. 

2.  Secondly, there is some confusion about whether the Naxalites are terrorists or not as they have a ‘social justice’ tag attached to them. 

3.   And, lastly, an impression has gained currency that the Naxal menace is not “as bad as the media makes it out to be.”

Coordination between the police and intelligence agencies of various affected states has been generally 

• unsatisfactory. 
• acquisition, 
• compilation, 
• collation, 
• analysis, 
• synthesis and 
• dissemination of intelligence are 
• inadequate. 

The Naxalites are continuing to spread their tentacles and it is crucial that intelligence about their activities, arms and equipment, training, sources of funding and future operations is shared on a daily basis so that it trickles down in near real-time to the functional level. A national-level data base of all terrorist groups and individuals is an inescapable operational necessity.

State police forces and the Central armed police forces (CAPFs) need to be better equipped and trained like the army to successfully combat the serious threat posed by the Naxalites. 

• At present they lack the army’s organisational structure and cohesiveness, the army’s institutionalised operational experience and ethos and its outstanding junior leadership – qualities that are mandatory for success in counter-insurgency operations. 
• A great deal more needs to be done if the states are to effectively coordinate anti-Maoist operations across their borders.

The Maoist threat presents a clear and present danger. So far the national response has been inadequate, both at the policy formulation and execution levels. To cope with this serious threat, India needs a well-deliberated and finely calibrated strategy with matching operational doctrines and the allotment of necessary resources. Only a skilfully planned and coordinated strategy, with all stakeholders pooling in their resources to achieve synergy in execution, will achieve the desired results. 

At the same time, a comprehensive socio-economic strategy must be evolved to treat the root causes of this malaise that is gnawing away at the nation’s innards, along with a carefully drawn up plan for perception management. Good governance, development, security and perception management must go hand in hand.

Do u Know ? - Water Footprint !

What is a water footprint?

• The water footprint of a product is an empirical indicator of how much water is consumed, when and where, measured over the whole supply chain of the product. 
• The water footprint is a multidimensional indicator, showing volumes but also making explicit the type of water use (evaporation of rainwater, surface water or groundwater, or pollution of water) and the location and timing of water use. 
• The water footprint of an individual, community or business, is defined as the total volume of freshwater that is used to produce the goods and services consumed by the individual or community or produced by the business. 
• The water footprint shows human appropriation of the world’s limited freshwater resources and thus provides a basis for assessing the impacts of goods and services on freshwater systems and formulating strategies to reduce those impacts.

Is the water footprint more than a nice metaphor?

• The term “footprint” is often used as a metaphor to refer to the fact that humanity appropriates a significant proportion of the available natural resources (land, energy, water). 
• However, just like the “ecological footprint” and the “carbon footprint”, the “water footprint” is more than a metaphor: there is a rigorous accounting framework with well-defined measurable variables and well-established accounting procedures to calculate the water footprints of products, individual consumers, communities, nations or businesses. 

  

How does the water footprint relate to ecological and carbon 

footprint?

• The water-footprint concept is part of a larger family of concepts that have been developed in the environmental sciences over the past decade. 
• A “footprint” in general has become known as a quantitative measure showing the appropriation of natural resources or pressure on the environment by human beings. 
• The ecological footprint is a measure of the use of bio-productive space (hectares). 
• The carbon footprint measures the amount of greenhouse gases produced, measured carbon dioxide equivalents (in tonnes). 
• The water footprint measures water use (in cubic metres per year). 
• The three indicators are complementary, since they measure completely different things. Methodologically there are many similarities between the different footprints, but each has its own peculiarities related to the uniqueness of the substance considered. Most typical for the water footprint is the importance of specifying space and time. This is necessary because the availability of water highly varies in space and time, so that water appropriation should always be considered in its local context.

Why distinguish between a green, blue and grey 

water footprint?

Freshwater availability on earth is determined by annual precipitation above land. One part of the precipitation evaporates and the other part runs off to the ocean through aquifers and rivers. Both the evaporative flow and the runoff flow can be made productive for human purposes. 

The evaporative flow can be used for crop growth or left for maintaining natural ecosystems; 

• The green water footprint measures which part of the total evaporative flow is actually appropriated for human purposes. The runoff flow – the water flowing in aquifers and rivers – can be used for all sorts of purposes, including irrigation, washing, processing and cooling. 

• The blue water footprint measures the volume of groundwater and surface water consumed, i.e. withdrawn and then evaporated. 

• The grey water footprint measures the volume of water flow in aquifers and rivers polluted by humans. 

In this way, the green, blue and grey water footprint measure different sorts of water appropriation. When necessary, one can further classify the water footprint into more specific components. In case of the blue water footprint, it can be considered relevant to distinguish between ground and surface water use. In case of the grey water footprint, it can be considered valuable to distinguish between different sorts of pollution. In fact, preferably, this more specific pieces of information are always underlying the aggregate water footprint figures.

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