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NITI Aayog meet seeks reforms in public healthcare system

India’s public health system could be in for an overhaul if the government agrees to proposals on universal healthcare discussed at a meeting of the NITI Aayog, the think tank that has replaced the Planning Commission, on Monday.

The proposals call for outsourcing primary healthcare to private doctors and promoting competition between government and private hospitals at the secondary level, which involves services of medical specialists.

Access to healthcare for all Indians is possible through this model with a nominal increase in the health sector’s share of the Union budget if the Indian economy continues to grow 7-7.5% in the next few years.

The proposals, discussed at the at the NITI Aayog by the Hyderabad-based Foundation for Democratic Reforms (FDR) and the Mumbai-based non-governmental organization Loksatta Movement, were based on the experiences of the UK’s National Health Service, the government-run health programme.

The proposal recommends that all MBBS doctors in rural India should be trained as family physicians and be paid by the government for each patient they treat.

“Every area will have a select number of family doctors. Patients will have the choice to contact any of them as they will be paid by the government. Doctors’ merit will be based on the number of patients that they attract and will be promoted within the public health system accordingly,” said Surendra Srivastava, national president of the Loksatta Movement.

The primary health centres (PHCs) will carry out government initiatives such as immunization and provide laboratory services and free medicines.

This is a radical shift from the current system where the government funds pays salaries to physicians and specialists only in the PHCs.

At the secondary level, choice and competition are seen as the most cost-effective options. Community health centres and private nursing homes will both be offered incentives by the government for efficient treatment and whoever provides better services will get a more attractive compensation.

In the current system, the government is responsible for strengthening only district hospitals. It pays private doctors only when a public-private partnership (PPP) is announced for specific services such as institutional deliveries.

“At the tertiary level, we believe a mix of AIIMS (All India Institute of Medical Sciences)-like institutions and low-cost private models such as Sankara Nethralaya, Chennai, and Narayana Hrudayalaya should be promoted. Corporate hospitals with high-cost treatment should not be promoted,” said Srivastava.

This, too, is a radical shift because the model discourages any relationship between corporate hospitals and the government, which is the norm currently.

Most joint ventures and PPPs for tertiary care exist between the government and corporate hospitals, in addition to them being on the list of empanelled hospitals for government employees.

The proposal estimates that if the said model is put in place, primary and preventive healthcare would cost Rs.80,000 crore-1.2 trillion per year by the year 2022. Secondary care will cost Rs.40,000 crore, while tertiary care will cost Rs.93,000 crore, making it a total of Rs.2.18-2.53 trillion. Assuming a cost escalation of 50%, the amount needed will be Rs.3.27 -3.80 trillion.

“If India’s real growth rate continues to be 7% and nominal growth 11%, the country’s gross domestic product (GDP) will be Rs.240 trillion. Through our model, universal health care will be achieved by spending 1.67% of GDP,” said Jayaprakash Narayan, general secretary, FDR. Currently, India spends approximately 1.3% of GDP on the health sector.

“The officials at NITI Aayog were positive about the proposal made,” said Narayan, who was present at the meeting.

Although universal health care was a promise under the 12th Five Year Plan (2012-17), it has not taken off as the Union and state governments have not reached a consensus on the model it should be based on and the services it would offer.

The meeting at NITI Aayog is seen as beginning of a process of dialogue towards consensus.

 

Courtesy: Live Mint

Tuesday, April 26, 2016 - 18:40

Surendra Srivastava - an avid cricket fan who moved IPL out of Maharashtra

The PIL said as much as 60 lakh litres of water was to be used for maintaining cricket pitches in the three venues nominated in Maharashtra for IPL 2016.

For Surendra Srivastava, national president of NGO Loksatta Movement, which filed a public interest litigation (PIL) leading to Indian Premier League (IPL) matches being shifted out of Maharashtra from April 30 onwards, the water shortage he was facing was a far greater issue than his love for the game.

The avid cricket fan who played corporate cricket himself says he and other members of the NGO, especially those living in Thane, felt the shortage first hand.

Filed by the Foundation for Democratic Reforms and Loksatta Movement, the PIL aimed to find a solution to the water woes of people, but the April 13 order asking the BCCI, state cricket associations and IPL franchises to move the matches out of Maharashtra was “unexpected”, says Srivastava. “We were only hoping to find solutions to the water scarcity problems,” he adds.

The PIL said as much as 60 lakh litres of water was to be used for maintaining cricket pitches in the three venues nominated in Maharashtra for IPL 2016.

“For the last two to three months, our society in Lalbaug has been depending on tanker water. Several other members of the NGO who live in Thane were only getting water supply twice or thrice in a week. Chief Minister Devendra Fadnavis was appealing to people to play a dry Holi and this prompted us to think of seeking restraint on playing IPL in the state so that the water thus saved could be used to meet the water needs of people,” says Srivastava.

On April 13, the HC observed that shifting matches to adjoining states would at the most lead to financial losses but “the harm caused may be greater if matches are allowed to continue”.

The BCCI and state cricket associations have also been directed to supply 64 lakh litres of water to villages nominated by the court — the same amount that would have been used for maintaining the pitches.

Loksatta Movement, which works for political and government reforms, is registered in Hyderabad and has been operational since 1996 (since 2001 in Mumbai) . “We have filed several petitions including the PIL in the Supreme Court seeking disclosure of assets and criminal records of political candidates, and were also involved in the cancellation of 2G licences,” adds Srivastava.

“When you read about people in areas like Latur having to survive without water, you tend to question priorities…I have nothing against the game. In fact, I love cricket and have played corporate cricket myself ,” he says, pointing to a photo in which he is seen receiving a certificate. “I prefer to watch matches on TV rather than going to stadiums,” he adds.

With the PIL kept for hearing on May 2, he hopes the petition leads to greater implementation of the government’s policy in water management. “People have written letters congratulating us. Even the youth who watch IPL have come out in support,” says Srivastava.

Courtesy: The Indian Express

Saturday, April 16, 2016 - 12:59

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