Jun 21, 2013
The people in Karnataka are expecting several promises to be fulfilled and have greater aspiration from the newly elected Government. The newly elected Chief Minister of this south Indian state, Siddaramaiah, through his committed approach to development has ushered hope and positivity in all disciplines, writes Giridhar R Babu.
First of all, there is an urgent need to implement the practice of evidence based public health policy, planning and spending. Without getting swayed by premeditated advocacy campaigns of vested interests, the state should focus on public health planning and implementation. In order to start this process, the functioning of health department needs to be autonomous without political interference. In addition, something similar to a public health task force should constantly function at the level of Principal Secretary, with several subgroups at the state level, which focus on conducting research and collecting information to provide evidence based public health priorities.
Secondly, majority of the state’s health expenditure is through private spending; primarily through out of pocket (OOP) expenditure. This is because public funding forms an insufficient chunk. A total of 28 per cent in rural areas and 20 per cent in urban areas have no funds for health care. Insufficient funds and lack of accountability in public health sector has led to the burgeoning of private sector which is triggering the catastrophic health expenditure is pushing several people in Karnataka into poverty every year. There is an opportunity for the state to implement Universal health Coverage (UHC). This would mean that there is coverage that ensures equitable access for all citizens, regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services.
Thirdly, the state needs to shift focus from vertical program management to an integrated management. Despite of ambitious intent, Integrated Disease Surveillance Project (IDSP) does not match in performance to any of the integrated surveillance programs such as those run by Centers for Disease Classification (CDC) either in China or United States. The state needs to device legislation to create a CDC like institution in Karnataka, and bestow it with statutory and economic powers to allow it to successfully plan and implement integrated surveillance for diseases. This will be a crucial step not only from the health perspective, but also to prepare the country against the threat of biological weapons. A stronger surveillance network should be linked to advanced research settings so that the country can implement evidence-based public health planning. The policy of bestowing grants upon competitive independent research organizations or public health researchers should be implemented. Barring polio’s world-class surveillance network, we have only displayed ambitious intent but futile in performance in our Integrated Disease Surveillance Project (IDSP).
The private health system in India is totally deregulated including reported dichotomy of consultation and diagnostic fees, which in turn adds on to an extra burden of expenditure on the common man. Health related services should have uniform guided prices throughout the state. Governments at central and state level can hold consultations to publish such guiding prices for health services, which need to be followed by private health industry. Also, private health systems need to be made more accountable for safety and quality parameters while providing health services, along with mandatory reporting of notified diseases to government agencies.
Finally, Public health as a preventive discipline has been ignored in recent times with several interest groups advocating for greater allocations for curative services. Hence public health training and public health research require immediate attention. The state Government has announced that there will be an institute of public health created in Bangalore. This institute should have clear and focused approach in alleviating the varied public health challenges plaguing Karnataka. The proposed institute should conduct research on important concerns of public health in a state-wise priority-setting platform and the state should commit autonomy and funding support to this institute to reap the rich benefits for the future. Unlike Indian Institute of Technology (IIT) and Indian Institute of Management (IIM), which cater mostly to private sector, the autonomous public health institute should focus on the obligations of public health system and house researchers and analysts who can help the government to make policy decisions concerning public health.
Karnataka enjoyed being one of the first states for having the best public health systems. Mysore public health act was one of such unique legislation governing public health system in the state in early part of 20th century. The current public health challenges pose an intense and complex scenario. We cannot allow children in Karnataka to suffer from measles, adults to get cardiovascular diseases or elders to succumb to cancer. All these conditions are very common in the state and there is so much work to be done; yet Karnataka claims to be one of the fastest growing and developed states. It is high time that we focus on fixing the health system.
(Dr Giridhar R Babu is Associate Professor at Indian Institute of Public Health –Hydrabad- PHFI)