By the year 2035, India is touted to be the world’s most populous nation. And that certainly does not augur well for a nation plagued by myriad health problems. While there is a double-digit annual increase in health outlays, it still remains a concern with 3.1 million people infected with HIV and roughly eight lakh contracting an infectious form of tuberculosis each year. Burgeoning issues such as lack of easy access to healthcare, low awareness about healthcare and the various treatments available is preventing people from moving up the socio-economic ladder. And the rising cost of healthcare is only adding to the already existing issues. No doubt, there are public facilities that receive a bulk of their revenues from government subsidies which provide services at a relatively lower cost to those who cannot afford expensive, private care. But is that alone sufficient to improve the healthcare system in this country? The more pressing issues need to be addressed. And in this edition of India 2.0, Vidya Amarnath of The Smart CEO spoke to Shilpa Deshpande, president of ICICI Foundation for Childcare and Nutrition, on these healthcare issues with the intent of seeking viable solutions.
ICICI Foundation is very closely involved with improving the public healthcare system, especially for children. Can you take us through what the ICICI centre for child health and nutrition does?
The ICICI Centre for Child Health and Nutrition (ICCHN) is a grant issuing research group established to address the status of early child malnutrition and development in India. Currently, ICCHN works across five states in India –Maharashtra, Bihar, Orissa, Jharkhand and Chhattisgarh. Working primarily through partnerships, ICCHN supports the development and taking mainstream, strategies designed to enable families and communities to provide women and children, optimum nutrition, care and access to health services during critical periods in their lives. ICCHN and its partners work with poor communities to improve health knowledge as well as community access to public health resources and services. Such community mobilisation is implemented and synergised with initiatives to improve public health policy and strengthen the design, resourcing and implementation of public health and nutrition programmes.
What measures do you think the government can take to improve the healthcare system in our country? Are public-private partnerships the way to go forward?
The National Rural Health Mission (NRHM) and the increased allocations for the Integrated Child Development Scheme (ICDS) in the 11th five year plan suggest that the government of India is committed to improving the poor status of child development in India. However, several targeted interventions are required to translate these provisions into health and nutrition change at the district level.
- Training public health personnel to help them understand specific health problems,
- Facilitating implementation of District Health Action Plans to support strategic alignment among different public health programmes and departments such as ICDS,
- Constructing new institutional arrangements, processes and partnerships to provide leadership, facilitation and resource support to Child Health Wellness programmes at all levels and across government, civil society and donor agencies,
- Developing an effective CHW training system and support material and decentralised training infrastructure
- Ensuring links between primary health systems and services and developing community-based accountability and feedback mechanisms
- Developing an Anganwadi Training Centre in every district to serve as a resource centre for improved training and
- Self-help groups in cooking nutritionally appropriate and hygienic food supplements for children from the ages of zero to six
According to several research reports from KPMG and McKinsey, there are four critical areas that need to improve. How can we best tackle the following issues?
Doctors and specialists are expected to staff Primary Health Centres (PHC) and Community Health Centres (CHC) along with various paramedical workers and attendants, including nurses, dressers, compounders and technicians. There are currently 1,42,655 sub centres, 23,109 PHCs and 3,222 CHCs across the country. If optimally staffed and equipped, this chain of providers and facilities should be able to meet the preventive, promotive and curative care needs of the population at the primary level. Gaps in infrastructure, skilled manpower and equipment should be addressed in parallel to quality and adequacy of utilisation of services.
Easier access to affordable health insurance, especially for the poor
ICCHN concentrates its efforts on achieving universal access to public healthcare in India. We believe that health insurance is a mechanism of choice for those who have ready access to healthcare facilities, both private and public. The communities we work with primarily seek accessibility to improved health systems in terms of services, infrastructure and personnel above all.
Educating the poor about hygiene and preventive care
A participatory approach in health education is essential to enable communities to make informed choices on healthcare. Behaviour change communication for improving child caring and feeding practices, as well as nutrition counseling is important. Community mobilisation around issues of food and nutrition and awareness generation about entitlement and food and nutrition schemes such as the ICDS, Mid Day Meal Scheme and Public Distribution System in the community and facilitating community action to increase quality of services and accountability of these systems are some strategies that can be followed to tackle hygiene issues.
Policy changes to accommodate public-private partnerships
We aim to initiate and strengthen civil society-state partnerships for improved quality and reach of health services to communities in India. We have supported the setting up of the Public Health Resource Society at the national level. It is a network of individuals and organisations that work towards building public health capacities in the respective states