Public Health Policies: An Account by Medical Students. Are We Doing Enough?

By: Taj Prabhugaunkar,

2nd Year Medical Student,

Goa Medical College

Anjali Mediboina,

4th Year Medical Student,

ASRAM

‘Health is Wealth’! Or has it faded to ‘Wealth is Health’? How rich do we need to be to afford the optimum healthcare services?

Yes, to a considerable extent, income and wealth do directly influence better health; financially secure people can easily avail  medical care to safeguard their own health, 

as well as that of their loved ones, hence catalyzing the socio-economic bias. 

Having said that, the advent of Healthcare policies has paved the way for enhancing equitable distribution of healthcare resources, thereby advocating ‘Health for all, in practice. 

Indian Healthcare Policies

The Indian healthcare system offers a plethora of healthcare policies that range from local to pan India coverage.  

Some of the most prominent public health policies put forth by the government as well as private entities are: 

• National Policy for Rare Diseases, 2021.
• National Health Policy, 2017.
• National Mental Health Policy 2014.
• National Policy for Access to Plasma Derived Medicinal Products from Human Plasma for Clinical / Therapeutic Use.
• National Programme on AMR Containment 2011.
• India Newborn Action Plan 2014 (INAP)
• Dr. YSR Aarogyasri Health Care Trust, Andhra Pradesh State Government
• Mahatma Jyotiba Phule Jan Arogya Yojana
• Ayushman Bharat Yojana
• Swachh Bharat Mission
• Deen Dayal Swasthya Seva Yojana, Goa State Government 
• Rashtriya Swasthya Bima Yojana
• The New India Assurance

Public Health Policies: A Cardinal Boon

Regarded as a vital blessing, public health policies are treasured for the crucial financial assistance in times of medical issues (in both government as well as private hospitals),  providing much relief to the patients and their kin. 

Speaking from experience, the DDSSY scheme in Goa has proved to be immensely helpful, providing 30% of the total expense of an elective total hysterectomy with salpingo-oophorectomy.

Optimum health results arise not only from proper medical care but also from the efforts to design and implement public health policies and programs to protect and improve the health of all people.

The rainbow of benefits posed by the health policies in India include:

• Financial assistance in medical issues.
• Amplifying awareness regarding the availability of vaccines. 
• Providing the target population with nutritious food and supplements to prevent malnutrition and anemia.
• Treating water with fluoride for oral and dental health.
• Ensuring safe food and water in communities. 
• Preparing for emergencies. 
• Educating the public about healthier lifestyle choices. 
• Creating smoke-free environments and discouraging tobacco and alcohol use. 
• Promoting physical activity and fitness along with exercises to improve mental health.  
• Broadening the scope of personal and community hygiene. 
• Preventing disease outbreaks and the spread of infectious diseases.

The Pitfalls of Indian Public Health

On the other side of the coin, despite this variety of health programs, India’s healthcare system faces a number of challenges that prevent the fruition of these policies. 

First of all, there’s a general lack of awareness; we’ll be honest- despite being medical students, we were not aware of even half of these policies, until we had read about them in Community Medicine and while doing research for this article. 

It’s not just medicos; even the general public is not aware of most of these schemes. This can be evidenced by the fact that in 2018, 55 million Indians were pushed into poverty in a single year due to “unaffordable healthcare[3]”. A fact that is quite ironic, considering that according to the government, all Indian citizens can get free outpatient and inpatient care at government facilities.

When we asked our peers their opinions regarding India’s health policies, numerous people pointed out that the quality of public hospitals must be improved, for all these policies to be truly effective. In an analysis by Vikas Bajpai[5], an interesting point was brought up regarding the effect of these policies on tertiary care hospitals: because the government is offering free services, the hospitals are “bursting at the seams” with patients. And, due to the lack of manpower and facilities, there is an increased workload for the staff at these hospitals, which in turn leads to many households seeking care from private providers and paying out-of-pocket, instead.

To quote the same paper, 

“Likewise, in the 100-bed district women hospital at Jhansi, after four p.m. there is only one nurse (who was working on contract basis at the time of the author’s visit) to take care of the labor room, the ward, and an occasional cesarean section that may take place. 100 beds do not mean only 100 patients, because one needs to count the babies of the delivered mothers as well, who require even greater medical attention.”

Aside from the low quality of public hospitals, medical malpractice also runs rampant in India, with procedures covered under insurance schemes being regularly misused. For example, hysterectomies are one of the procedures covered by Arogyasri, an insurance scheme in Andhra Pradesh. In an article in the Times of India, Roli Srivastava[7] reported that a hysterectomy can fetch anywhere between 10,00-50,000 rupees, and thus was a regularly abused procedure. Moreover, a paper by Kameswari and Vinjamuri[8] in 2013, found that in Andhra Pradesh, during 2008–2010, 60% of hysterectomies were carried out on women aged under 30 and that 95% of the operations were done in private hospitals, hinting at the ‘malpractice-for profit hypothesis’. 

Coming to the policies itself, there are also numerous loopholes and deficits within the schemes: taking the example of Arogyasri once again, a lady came to the hospital due to a candida infection in her right forearm; the infection was so severe that she needed an amputation. However, Arogyasri only covers lower limb amputations, but not upper limb amputations. 

Another example can also be the National Rural Health Mission (NRHM), which was launched in 2005 to address the inequalities in maternal and child health care. As pointed out in a paper by Sukumar Vellakkal et al[9]., while the mission improved maternal health care among the lower SES group and increased institutional deliveries, the mission neglected ANC and child immunization. 

Politics also have a major effect on these policies- There are many cases where a policy or program was struck down, merely because a rival party had implemented it; For example, Trump trying (and failing) to strike down Obamacare, an insurance scheme, in the USA.

One of our peers pointed out that many parties introduce schemes in order to gain the public’s support and thus, they are usually planned and executed with a short-term, 4-year time span in mind, rather than being long-term, as the policies should be.

What can be done henceforth?

In our country, it is common to hear the public condemning the government and the parent organizations for the failure of the healthcare system. Such mindless conduct of overlooking the minuscule participation and increasing resistance by the target population to enforce the policies has resulted in worsening and exploitation of human health. 

So what can WE do? What’s OUR contribution? Here’s a small checklist that would probably help:

At an individual level

•Be aware! 

Especially, as a medico, we need to stay constantly updated regarding the availability of public health policies and learn how to avail them. 

• Spread the Word! 

Expand the horizons of public health by letting your loved ones know about the same.

• Volunteer! 

Through local NGOs and governmental organizations, teach the lesser privileged communities about the detailed process to avail the various public health policies. 

• Counselling! 

As a clinician, counsel your patients regarding the various health policies they are eligible for. 

At a community level!

• Collaborate! 

Reach out to the influential professionals and communities, to help the global stakeholders to design health policies, based on the needs of the target population.

• Conduct camps and myth-buster sessions! Educate and solve doubts regarding the available health policies and schemes, with the help of a healthcare task force. 

• Voice out your opinion!

Communities hold immense power, which can be used to speak up and assist the policymakers to amend the policies as per the exigencies of the target population. 

• Encourage active participation by people!

Even most meticulously designed health policies fail to be enforced if people do not participate, and this can be evidenced by the massive success of the ‘Swaccha Bharat Abhiyan’, which is substantially dedicated to the roaring participation expressed by the population. 

• Dynamic advertising and vigorous marketing!

This is the key strategy to attract people to participate through incentives and catchy slogans. 

At the level of the government and global policymakers (WHO and allies) 

• Improving monitoring systems!  

Thereby preventing the possibilities of malicious practice of misguiding and extortion. 

• Improvement of insurance systems and schemes! 

Proper insurance policies allow maximum coverage at affordable rates with prompt and cashless settlement claims, making healthcare equitable for all.

• Stressing on more programs for primary prevention!

To uproot the diseases at the grass-root level, before they produce sequelae. 

• Enhance research practices!  

Procuring sufficient funds and capacity building to inspire more research-oriented minds to work together for the advancement of the healthcare system.

• Incentives! 

To engage the possible stakeholders involved at every stage of the policy-making process. 

• Uplifting the LGBTQ+ community

The LGBTQ+ community has been subjected to tremendous deficits and prejudice. Being the need of the hour, putting forth efficient health policies for the same, with close interaction and input from the target population, would bring about a mammoth boost to the healthcare system in India. 

Remember, every small contribution potentiates the achievement of the goal set!

The Climax

The above data and stats show us the mirror, reflecting the prodigious volume engaged by teamwork in molding the public health policies. 

“Coming together is a beginning. Keeping together is progress. Working together is a success.” ~ Henry Ford

Today, NOW! You and us!

Let’s set the goal. Writing and reading this article itself, is the first step forward. Godspeed! 

References

1. Vaccines for all? [Internet]. 2021 [cited 10 September 2021]. Available from: https://www.google.com/amp/s/qz.com/india/2001946/india-should-fix-its-vaccine-pricing-strategy-to-save-its-economy/amp/

2. Students having lunch at a Bangalore school. [Internet]. 2021 [cited 10 September 2021]. Available from: https://www.businesstoday.in/magazine/focus/story/social-entrepreneurs-mid-day-meal-scheme-implementation-131782-2013-08-01

3. Public Health Foundation of India Annual Report 2018-19 [Internet]. Phfi.org. 2018 [cited 10 September 2021]. Available from: https://phfi.org/wp-content/uploads/2019/10/Annual_Report_2018-19.pdf

4. Gupta I. International health care system profiles–India. The Commonwealth Fund. 5 June 2020. Available from: https://www.commonwealthfund.org/international-health-policy-center/countries/india

5. Bajpai V. The challenges confronting public hospitals in India, their origins, and possible solutions. Advances in Public Health. 2014 Jul 13;2014.

6. [Internet]. 2018 [cited 10 September 2021]. Available from: https://chaaipani.com/india-public-healthcare/

7. Srivastava R. The uterus snatchers of Andhra. Times of India, Jul. 2010;31:2010.

8. Kameshwari SV, Vinjamuri P. Medical Ethics: A case study of hysterectomy in Andhra Pradesh. 2007. InKics Forum. net. 

9. Acharya A, Vellakkal S, Taylor F, Masset E, Satija A, Burke M, Ebrahim S. The impact of health insurance schemes for the informal sector in low-and middle-income countries: a systematic review. The World Bank Research Observer. 2013 Aug 1;28(2):236-66.

10. Béland D, Rocco P, Waddan A. Obamacare in the Trump Era: Where are We Now, and Where are We Going?. The Political Quarterly. 2018 Oct;89(4):687-94.

11. Chowdhuri, R. Given India’s size, even tiny improvements in its healthcare system make a huge difference [Internet]. 2020 [cited 10 September 2021]. Available from: https://www.google.com/amp/s/amp.ft.com/content/db9331da-4698-11ea-aee2-9ddbdc86190d

12. PTI. The Swachh Bharat mission was launched by Prime Minister Narendra Modi in 2014 to promote cleanliness and sanitation across India [Internet]. 2020 [cited 10 September 2021]. Available from: https://www.google.com/amp/s/thefederal.com/analysis/swachh-bharat-one-sweep-for-modi-%25E2%2582%25B967000-crore-for-country/%3famp