The Twelfth Five Year Plan process is yet another opportunity to review the health system our country, but more importantly, to redeem our commitments to health and to lives lived with dignity. The Report seeks to lay out some of these commitments and also present a systemic plan for their fulfillment.
Our foremost commitment is towards evolving Universal Access to Essential Health Care and medicines, so that the disparities in access to health care, particularly those faced by the disadvantaged and underserved segments of the population, would hopefully be corrected.
The Report is organized into Chapters, which outline the key elements of an efficient health system. It also recommends some strategic changes to the existing health programmes and schemes, such that they work in conjunction with each other and collectively contribute to building a comprehensive health system. Thus it shifts the focus to a ‘systemic’ approach to Health, while also emphasizing the importance of the individual disease control programmes. Secondly, it suggests certain changes in the way we look at ‘public health’ and, its subsequent monitoring through public health systems reforms. A dedicated Public Health Cadre is proposed as the bedrock of the system.
The Twelfth Five Year Plan adopts a broad approach to health, including as ‘key determinants of health’, a range of resources like food supply chains and nutrition, drinking water and sanitation. Indeed, it takes the view that health would entail a ‘continuum of care’ across sectors. Accordingly, the health policy might encourage a multi-sectoral approach to health, which in terms of policy would translate into a ‘stewardship’ role for the Health Ministry over other sectors, in matters that have a direct bearing on health. This report proposes a road map, which is intended to guide the health sector in this regard.
In terms of the limitations of the Report, the needs of the health sector in the context of India’s diversity are so complex that it is rather impossible to engage with all its dimensions. Thus, certain overarching principles have been prioritized for the purposes of this Report.
Additionally, corresponding key deliverables have also been identified, as means of evaluating the fulfillment of our commitments to health. In effect, the attempt is for the new Plan to be oriented both towards a ‘process-based’, and also an ‘outcome-based’, health system that performs in a cost-effective and efficient manner.
An efficient assessment of system performances requires built-in measurable indicators. To make information relating to such indicators easily available, the Plan would also prioritize the strengthening of the Health Information System.
In summary, the Twelfth Plan takes a systemic approach to health sector reforms. It seeks to provide a safe and healthy environment to communities, delivering universal access to basic health services, and to medicines, and regularly evaluating the health system. Also, by using techniques of communication, behaviour change and participatory governance to make communities generally more ‘health conscious’, which would, in turn, reduce health risks. The broader understanding of ‘health’ would include and seek to correct determinants such as inadequate nutrition and unsafe drinking water. The last two proposals underline the Plan’s commitment to preventive and promotive health care. Finally, though a new range of innovations and practices for the health sector are recommended, which have huge financial implications, it has been the effort of the Steering Committee to focus on efficient utilization of available resources.
Chapter-10: AYUSH – Integration in Research, Teaching and Health Care
10.1 AYUSH sector in the country has 7.87 lakh registered practitioners, 3277 hospitals with a bed strength of 62,649xlvi . There are 24,289 dispensaries, 489 recognized Graduate and Post Graduate colleges and 8,644 drug-manufacturing units. Achievement of national health goals requires an integrated delivery of health services utilizing the mutual strengths of bio-medical and Indian Systems of Medicine.
10.2 The National Health Policy of 2002 noted that: “Under the overarching umbrella of the national health frame work, the alternative systems of Medicine – Ayurveda, Unani, Siddha and Homoeopathy – have a substantial role. Because of inherent advantages, such as diversity, modest cost, low level of technological input and the growing popularity of natural plant-based products, these systems are attractive, particularly in the under-served, remote and tribal areas.”
10.3 Similarly, the National Policy on Indian Systems of Medicine & Homoeopathy, 2002 declares as its basic objective, inter alia, the “integration of ISM&H in healthcare delivery system and National Programmes and ensure optimal use of the vast infrastructure of hospitals, dispensaries and physicians” .
10.4 The 11 Plan document made a commitment to “mainstreaming AYUSH systems to actively supplement the efforts of the allopathic systems” and thus, included co-location of AYUSH services and posting of AYUSH doctors within the primary healthcare system. Studies have reported as unsatisfactory the quality of infrastructure, presence of human resource, supply of medicines, and records among both stand-alone and co-located AYUSH facilities .
10.5 The 12 Plan provides an opportunity for bringing together the world’s largest health and child care systems through flexible frameworks that ensure a continuum of care with normative standards, while responding to local needs at village and habitation levels. (12 Plan Approach Paper). AYUSH systems and institutions can play a significant role in realizing this goal.
10.6 Research: The National Policy of 2002 set an objective, which involved a reorientation and prioritization of certain researches, which would gradually validate AYUSH therapies and drugs that address chronic and life-style related emerging diseases. However, the progress on Pharmacopoeial work has been slow and research on preclinical and clinical studies has been negligible over the 11 Plan, especially for Unani and Siddha.
Moreover, cross-disciplinary research and practice requires standardization of terminologies and of classical therapies, and development of Standard Treatment Guidelines, which must be taken up as a priority. Also, classical drugs listed in formularies and therapies should be validated for their safety and efficacy, as recommended in the National Policy of 2002 mentioned above. To take the ambitious research agenda forward, all five Research Councils of AYUSH need to pool resources, particularly human resource, clinical facilities and information, so as to avoid duplication. For this to happen on an institutionalized basis, a common governance structure for the five Research Councils should be put in place. A joint ICMR-AYUSH decision making body with representation of all Research Councils should also be constituted for promoting interdisciplinary research in areas of national interest.
10.7 Human Resources Development: Practitioners of modern Medicine, Nursing and Pharmacy need to be exposed to the strengths of the AYUSH systems. This would require introduction of short orientation modules on AYUSH in Medical, Nursing and Pharmacy courses. Codes for cross-referral across all systems should be developed jointly by experts, after an honest appraisal of the strengths of each system.
10.7.1 Cross-disciplinary learning between modern and AYUSH systems at post-graduate levels should be encouraged. Details of modifications in syllabi that would be required at the undergraduate level, in order to make such cross-disciplinary learning possible, should be worked out by a team of experts from the different Professional Councils. AYUSH chairs should be established in medical colleges, which would provide the necessary technical expertise to jointly take up research, teaching and patient care. Once cross-disciplinary education is allowed, there would be a new class of professionals who would be able to leverage the strengths of each system to develop the most appropriate and effective treatment regimes.
10.7.2 The proposed NCHRH offers a forum for realizing the integration agenda if AYUSH professionals are also brought within its purview. The Department of AYUSH can be represented on the Governance structure of the NCHRH.
10.8 Practice and promotion of AYUSH: Department of AYUSH should develop standards for facilities at primary, secondary and tertiary levels on the lines of IPHS; Standard Treatment Guidelines and Model Drugs List for community health workers. All primary, secondary and tertiary care institutions under the MoHFW, State Health Departments and other Ministries like Railways, Labour, Home Affairs etc. should have facilities to provide AYUSH services of appropriate standards.
10.8.1 Roles and responsibilities of AYUSH colleges should be defined for contributing towards national health outcomes.
10.8.2 Joint behavioural change plans should be worked out after incorporating AYUSH based lifestyle guidelines for RCH, Adolescent Health, Geriatric Care, Mental Health, Non- Communicable Diseases, Anemia, Nutrition and health promotion.
10.8.3 To enable the prescription of essential allopathic medicines by AYUSH practitioners, their extended training through bridge courses and appropriate modifications in regulations should be jointly reviewed.
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