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What India’s Public Healthcare System Could Do To Heal Itself

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By Sanjay K Bissoyi:

Public health care in India is patchy. We have made great strides, but about 1.2 million children under the age of five died in 2015 alone. Besides, as this report reveals, 9.7 million malaria infections are reported on an average per year. 2015 also saw 2.5 million new cases of Tuberculosis cropping up nationwide. Out-of-pocket expenditure (OoP) forced 63 million people to go below the poverty line. According to the World Bank Data and Draft National Health Policy, 2015 report, 28% of deaths were due to preventable but communicable diseases such as lack of maternal and perinatal nutrition and only 65% children between one to two years age were fully immunized. With underfunded and overcrowded hospitals and clinics, and inadequate rural coverage, is it possible to provide universal healthcare to 1.25 billion Indian people?

The government has initiated some good programs to tackle the public healthcare like National Newborn Action Plan, Mission Indradhanush (new vaccines), National Health Mission (Integrating NUHM), Swachh Bharat, RSSY, National eHealth Authority, Draft National Health Policy, etc. However, such programs don’t give expected results due to improper implementation at grassroots levels and fall short mid-way.

Expenditure on health care in India was an estimated to be 5% of gross domestic product (GDP) in 2013, but in the last union budget, the NDA government allocated roughly 2% of the GDP – that is Rs. 297 billion ($4.81 billion). If we go through the heath care fund allocations of the 54 countries with GDP greater than $ 300 billion, Pakistan, South Africa and Nigeria ranked below India. However, countries like USA, Australia, and Brazil spend more than 5% of the GDP on essential facilities such as health care.

Data reveals that hospitalization facilities available in rural Indian are available for only 35 people out of 1000 while urban India manages to cater to 44 only. About 70% of the OoP expenditure on health care are met with savings money while the rest is borrowed. On an average, every Indian spends 48% of their total annual income on health care.

The government spends a mere 0.1% of the GDP on publicly funded drugs while 70% of the total OoP health expenditure was incurred for purchasing drugs and medicines.
Given that over 70% of the total health care expenditure was incurred in private sectors and that most rich and upper middle-class don’t depend on public health care facilities, India will be able to solve much of its medical problems if it primarily caters to the poor and lower middle-class population. Nevertheless, it is not wise to limit such essential services to a certain section of the population.

According to a report by KPMG, by 2030, non-communicable-diseases will cause 67% of mortality in India. The only solution for this drastic scenario is “Robust Primary Care” in the country. The existing primary care system in our nation has various weaknesses. We have a good physical infrastructure, immunization, cold chain, reproductive health care, experienced ANMs and emergencies facilities available in some places but there are also bottlenecks such as lack of public trust in public health care. Most of the beds in hospitals are unutilized, absenteeism and shortage of doctors and other medical personnel is a recurrent problem, and there are very minimal OP services, no proper drug supplies, lack of robust data collection etc. These flaws push patients towards quacks or expensive health facilities, and tertiary hospitals end up overcrowded.

The population of USA is 318.9 million, and their health workforce is 12.2 million that is 3.8% of the total population. The population of the United Kingdom is 6.4 million; health workforce is 1.6 million which is equal to 2.4% of the population. However, in Indian, health sector workforce is almost abysmal. India’s population is 1250 million; health workforce is only 3.6 million and that stands for a meager 0.28% population ratio. Thus, India can create jobs for millions of unemployed youth in public health care sector.

No country ever achieved their universal health goals overnight. There are various ways to improve such systems. The Government should use existing tax revenues to pay for health care system. When the tax base widens, the government can consider levying income tax to support the health care programs. The government should spend more on primary care so that basic and preventive health care can reach the masses.

Our county needs to develop an all-India common public health service for every state. AADHAR-based registration, electronic patient records, ongoing and onward care biometric should make such a process more transparent. Free supply of generic drugs should also increase.

We should actively ask to the state how far and in what way has politics been engaged in public health care. The record is disappointing, there are no political debates for the interest of the poor, and we seldom find healthcare policies being implemented well at ground zero. But if there is will there is a way. One hopes India achieves its health care goals and brings relief to the 1.25 billion people of this country.

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  1. Neelesh

    Full of factual errors.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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