Note : Please meet Member Parliament of your respective area as early as possible & give this memorandum to him. Please stress him to participate in discussion on this bill in the parliament session. Please take photo with him & send your activity report to Hony
Sec. & State President IMA Pb.
Date :
To
The Hon’ble Member Parliament
…………………………….Constituency
Punjab
Sub : Regarding Objection & Recommendation to National Health Policy by
Indian Medical Association
Sir ,
Now 13 yrs. after the last National Health Policy , Ministry of Health, Govt. of India has
drafted New National Health Policy. It is a welcome step by the New Govt . There are few
areas which need clarity & clear vision so that “ HEALTH IN ALL” is achieved. We have few
objection & recommendations . We are hopeful that you , being our Representative in
Parliament , will present our view points on the above said matter in the interest of under
Privileged citizens of India .
Thanking you in anticipations .
Yours Sincerely
Name Hony Sec.
President / IMA ………………....Branch IMA ……………………..Branch
National Health Policy 2015
After 13 years the ministry of health, Government of India has brought out drafts national health policy with the Slogan “ HEALTH IN ALL ” . It is a commendable job for a New Government IMA appreciate it. But the policy is not inclusive. Target mentioned are not achievable in reality. The process of achieving goals of MDG are not clearly defined . e.g. Policy mentions universal immunization which is centered mainly on Children. Adolesent and elderly vaccination against flu, pneumonea, Tetanus, Hepatitis is not included.
As per WHO statement . The main reason of poverty in india in the rural , sub urban and lower middle class citizen of India is lack of affordable quality health services. If some body from this class of citizens unfortunately become critically sick and for treatment he has to shell out his reserves and many a times he has to sell out his assests. This push down these people below the poverty line for a long time bases. At the same time WHO states that the Primary Health Care infrastructure in Indian is
very good but not properly managed . IMA advocates that health is a state subject and to achieve “ “Universal Health Coverage” and “ Health in All “ , health must be declared as concurrent subject by constitution like education. Primary health care and emergency health care in platinum hour & Golden hours must be ensured by the Government . Health care system should be structured as Primary , Secondary and Tertriy. Primary health care services including the consultation , diagnostic facilities and emergency life savings drugs should be available free of costs 24 hours a day to al the citizens. To achieves this target more and more paramedical staff trainings school should be made available.
2.
Relaxing the norms and modifying the syllabus in medical and health science education is the need of the hours. Medical education must be oriented to primary care and rural care by creating department of family medicine and posting for under graduates in such departments and PHC’s must be compulsory .
3.
Speciality training in Primary care , Family medicine must be strenthed through medical colleges and NEB accriedited medical institution.
4.
Facility in primary care must be created to encourage youth to choose family medicine as their carrier option.
5.
Young MBBS doctors choosing to settle in rural area must be incentivized by high salary and additional marks in their PG selection after five years of service.
6.
Rural Medical Services must be equated to military services in emolements and promotions.
7.
PHC must be attended by MBBS Primary cares doctor and not by ASHA.
8.
Internationally a claimed three tier system recommended by BHORE is to be inclumented in word and spirits with empanelment of private hospital both is urban and rural areas.
9.
National standard operator Processor ( SOP ) must be available emergency medical care infection and N city.
10.
UG :PG seats must be 1: 1 to meet the needs of specialist doctors.
11.
Fully equipped 24 hours ambulance service at 50 KM distance must be available.
12.
Good connectivity through tele medicine and proper roads is assential.
13.
Clean drinking water , proper disposal of excreta and other public health ameneties are essential.
14.
Proper attention has to be given to the nutritional status of citizens has to be given .Mid day meals program can be improved to provide balance food through centralized kitchen models of AP, Telengana .
15.
Private Practioner’s services can be availed for running the PHC & CHC’s
16.
Mushrooming of Medical Colleges in few states and in the cities only has to be stopped . Policy should be framed to give NOC to rural oriented medical colleges & in those state which have only few medical college.
EMERGENCY CARE , PLATINUM HOUR AND GOLDEN HOUR TREATMENT
A corpus fund should be created by levying cess on service tax , Vat , Property tax etc and that should be utilized for funding the emergency service especially for :-
Road Traffic Accident
Cardiac Emergencies
Stroke in golden first 6 hrs
Pregnancies relates emergencies etc.
2.
Emergency Services should be available round the clock free of cost without legal entanglement .
Strengthen the transport system & training in ALCS , initial assessment , triag & safe transport of patients should be given to ambulance drivers , health care providers , Police personals etc.
3.
Payment mechanism must be in place at par with TPAS with National Emergency numbers.
4.
All primary & secondary care private hospitals should be empanelled for primary , secondary
& emergency care for all.
PRIVATE HEALTH CARE SYSTEM
70 % of Primary , Secondary & Tertiary healthcare in india is provided by the private sector and by non-corporate sector at affordable prices & near the residences of the patients.
· Growth is seen in corporate health care & Pharmaceutical Industry.
· The Govt. Policy say making health fundamental right. Equating private hospital with industry & at the same time expecting them to follow medical ethics is contradictory. when medical ethics are to be followed, private healthcare industry fall into the service sector. The norms in registration , Taxtation applicable to service sector must be applicable to private hospital .Private hospitals & drugs should not come under the perview of service tax, Laxury tax, property tax. No Vat on drugs , to reduce the cost of treatment.
· Private Health care must be supported by reducing the cost of land , water, electricity & basic amenities. Health for all can’t be achieved through corporate sector but through OAE’s only. But today OAE’s are struggling for survival & many are closing . In one survey 800 hospital s have closed in 4 yrs in state of Kerla. It is alarming.
· Clinical Establishment bill will create License Raj. It will only promote the corporate hospitals. It will enhance the cost of treatment manifold which is beyond the reach of common man. Same standard of clinical establishment bills for primary secondary & tirtioary care hospitals . does not look rational & relevant. Rather is should be used as a tool of accredition process for registration of private hospitals in primary secondary & tertiary care categories.
· Out of pocket expenses are mainly on diagnostic & essential & life saving drugs . local industries & not multi nationals should be encouraged .
POTENTIAL OF AYUSH SERVICE
Every system of medicine must be protected & grown but they should be parallel system & not tagential. They should be complementary to each other. Crosspathy is deterimental. This will
vidate the “ Right to Health ” slogan & right to chose any system . Their skills can be useful in
Public Health, Preventive & Promotive Health scheme.
OTHER RECOMMENDATIONS
HUMAN RESOURCE DEVELOPMENT
i.) There is a dearth of medical , nursing & technical staff .There is no staff to give support to the elderly at home under the family medicine concept .
ii.) It present we have 1 doctor for 1500 population against need of 1 for 650 population.
iii.) UG : PG seats must be 1:1 for specialist doctors.
iv.) Promoting family medicine at graduation level & post graduate courses in family medicine is very essential.
v.) For growing population of elderly citizens , geriatric clinic in each city, sub urban areas & village is vision for future.
POLICY :
To ensure highest level of professionalism new level of managers like Indian Medical Services at par with IAS & IPS is need of the hour. The clinical professionals should not be unnecessary burdens.
3.3 OBJECTIVES
• The objectives taken in policy must be measurable and not mere statements.
• The Government should design and implement programmes to address at least 50% morbidity by 2020. Which is now addressing only 15% of morbidity.
• Non communicable diseases like diabetics, cancers, occupational diseases, mental health is not included in depth, but is need of our to achieve HEALTH IN ALL.
• With increasing Elderly population Elderly care centres at district level must be promoted.
• Road Traffic Accident costs many young lives every day that should be included effective control of RTA and treatment of RTA victims must be included in the objectives.
3.3.2 OOP EXPENSES ARE HIGH IS AN AGREED FACT:
Ratio of public versus OPP expenses is reversed to 70:30. To achieve this public spending on health should be atleast 2.5% GDP by 2019 and atleast 4 to 5% by 2025. “ Health chess” should be created by contribution from VAT and additional tax on alcohol, tobacco, luxury vehicles and
packaged food. Further reduction OOP can be achieved by ---
1.Quality drugs distributions to public and private Institutions; free of cost/subsidized cost
2.Quality assured diagnostic facilities free
3.Tertiary care by empanelling private sector.
4.1 ENSURING ADEQUATE INVESTMENT:
International agencies have provision for financing well prepared target oriented programmes. They should be tapped for national health programmes like Global Fund Project .
4.1.4 CSR FUNDS SHOULD BE PULLED TO A CENTRAL CORPUS FUND:
A portion of CSR funds should be made to pulled to central corpus fund to be utilised for National Health Programmes leaving the balance at Corporate disposal .
4.2 PREVENTIVE AND PROMOTIVE HEALTH:
4.2.6.2 BALANCED AND HEALTHY DIETS:
Mid day meal programme can be improved to provide nutritious food through centralised kitchen model of AP / Telangana should be extended to other state.
4.2.6.3 ADDRESSING TOBACCO AND ALCOHOLS SUBSTANCE :
Health based Alcohol Control Policy must be in place in concordance with WHO approved mandate.
4.2.6.4 YATRI SURAKSHA:
All national highways must be equipped with state of art ALS ambulance with Emergency Accident Relief Centre (EARC) at every 50 kms with trauma care centres and advance trauma care centre at every 100kms. In a country where 70% population access health from private sector emergency care must have good mix of public and private healthcare.
4.2.6.5 NIRBHAYA NARI:
Adolescent Health Education should be part of School Health Programme and gender sensitisation start from school level.
4.3 ORGANISATION OF PUBLIC HEALTH CARE DELIVERY:
Social Determinants of Health (SDH) must be Strengthened at Rural &Urban level.
Sanitation ,Water, Food ,Electricity& connectivity must be well established and maintained in Rural &Urban situations.
7.3 REGULATORY FRAME WORK FOR PROFESSIONAL EDUCATION:
7.5 DRUG MANUFACTURING:
1Strict quality control of drug manufacturing essential .
2Essential drugs must be available freely for public and private sector
3Domestic pharmaceutical manufacturing must encouraged than Multinational
4Research must be actively promoted
5 over the counter sale of drug must be banned strictly
9 ICT FOR HEALTH & HEALTH INFORMATION NEEDS:
ICT is invaluable in 1.Reaching the unreached in remote areas
2.Connecting care giver and care utilizer
3.Reducing the cost of treatment, very much
1. Already working models are there existing in many state of India which should be made pan Indian.
2. Village health nurse (VHN) and other health worker cadre staff must be sensitised. ICT has great potential in making UHC a reality
In the proclaimed “Digital India” by our Honorable Prime Minister , “Digital Health” the future.
Must be strengthened and adapted
Digital Health Care:
• Create Electronic health record
• Offer SOP to Health care personal
• Primary care and Emergency care can reach to rural Areas.
• Health care expenses on Training and Inpatients adverse can be reduced.
• Medical emergencies and National Disasters can be well tackled by health work force.
• Continuum of care and solo healthcare are possible only through digital health.
• Preventive and promotive health care will be a reality
• Health education to public and HWF is possible
• Will be a boon to manage chronic diseases including Non Communicable Diseases.
11.GOVERNANCE :
Summary of Recommendations:
- Every citizen will have Health as a Constitutional right – Welcome turn.
- Health must be a Concurrent Subject Constitutionally like Education.
- UHC must Support People BPL.
- Primary care must be available at all the hours to every citizen free of cost.
- Emergency care system in place to reach to the victim with in 30mts – platinum Hour- free of cost/subsidized.
- Objectives – To reduce ,mortality 50% by 2020
-NCD care
-Elderly Care
- RTA Victims Care will reduce Mortality & Morbidity
7. Health system must be structured as Primary, Secondary & Tertiary