One of the most important element of a strong healthcare system is the availability, accessibility and reliability of essential medicines and services. This panel discussion intended to bring forth an essence of these key determinants of public health. The experts in this discussion recommended fortifying public healthcare and safeguarding the human touch, which is fast diminishing in a high-tech world.
The panelists for the session were Bejon Misra, Founder, Partnership for Safe Medicines (PSM) India, Healthy You Foundation, Cell For Consumer Education and Advocacy Society; Dr M Prakasamma, Executive Director, ANSWERS (Academy for Nursing Studies and Women’s Empowerment Research Studies) and Dr R K Srivastava, Sr Advisor, Public health and innovation, WISH Foundation, Former Chairman, MCI and Former DGHS, Govt of India. The session was moderated by Lokesh Sharma, Director, QuintilesIMS and Head of Government Solutions in India for QuintilesIMS Health.
The panelists deliberated on the following aspects:
- Improving accessibility to the essential medicines, especially in rural areas
- Prioritisation of service delivery imperatives such as manpower, infrastructure, medicines etc., given limited resources
- Does the new expanded version of RSBY play a significant role in improving access and quality care?
- Pragmatic models of private sector engagement
Sharma started off the discussion and said, “India is on a critical juncture wherein on one side we have increased burden of non-communicable diseases and on the other we are still fortifying our efforts to reduce the communicable diseases and curb IMR and MMR. In keeping with this fact and as we expand our health services, we need to focus on quality and ensure specific monitoring frameworks which are deployed by various stakeholders including governments, patient communities, payers and providers.
Taking the discussion forward, Sharma asked Dr Prakasamma to share her views on the existing quality of health services in India. She said that India’s healthcare system is going through a crisis situation. “Our healthcare system is fragmented and we only focus on curing sick people. There is a need to move from a unipurpose approach to a multi-purpose approach to resolve India’s health concerns. Neither are our healthcare professionals are trained to give quality care in public health, nor our health programmes are of multi-purpose nature to provide a wide variety of health services,” she stated. Our health programmes are very uni-purpose in nature, therefore scaling up becomes an issue. She pointed out that around 1970s, the healthcare system did focus on wellness, however, over the years we have moved backwards away from the wellness model. “India needs a holistic approach to health,” she averred.
Dr Prakasamma also spoke on understanding the social determinants of public health. She cited inferences from various existing healthcare programmes and pointed out their flaws. Similarly speaking about the draft national health policy and the draft National Health Assurance scheme, she mentioned that these initiatives also do not have a comprehensive primary healthcare approach. “Despite being part of the National Health Mission, I am sorry to say that our health programmes are not moving towards the direction to provide a comprehensive healthcare platform. My request to all of you to plea for wellness model in primary healthcare delivery,” she averred.
When asked about how schemes such as Jan Aushadhi can ensure quality essential medicines to all, Misra gave the entire backdrop of how the concept of essential medicines came into being. He also raised concerns on the mechanism to which the government bodies function in terms of scaling up healthcare-related projects. He went on to say, “Government does not have the mechanism to scale and reach out to those in need of these healthcare service. Therefore there is a need for public-private-partnerships (PPP).”
Misra informed that earlier these Jan Aushadhi stores were made available at very few district hospitals and that state governments have vested interest in not allowing the scheme to expand its reach to other government hospitals, NGOs and other government healthcare centres. Nevertheless, the government has now come to the realisation that these stores need to be allowed to function at various areas.
“The solution is that there needs to be a all stakeholders partnership movement in order to break monopolies,” Misra strongly affirmed.
Dr Srivastava spoke about the policy implications on such schemes. He suggested that we must have a good model for procurement, storage and timely distribution of essential medicines. Giving the example of the Government of Tamil Nadu’s model for provision of essential medicines scheme, he said that this model is time test and has been successful as it is professionally managed. He also mentioned that technology adopting in management of this system has been a key factor for its success.
Articulating on the learnings from this model, he said that the professional management built up in this system needs to be carried forward as well as the technology utilised needs to be upgraded from time to time.
He also spoke on the need for a systematic, corruption free procurement system for medicines.
Misra chipped in and said that the industry is prone to discontent when the government brings in price control. At the same time when the government encourages an open market for generic drugs, the patients become more empowered. He also confessed that after the origin of online pharmacies in India, the pharma sector has become more competitive.
Misra put forth a contention for the need of a watchdog who is not a government agency and yet has an influential say in opinion building. He further insisted the media to take on the role of a watchdog of the healthcare system and provide an informed and un-biased opinion.
Coming strongly on the need to force on caregiving in public health, Dr Prakasamma stated that all stakeholders need to upscale their efforts in this direction.
She was also alarmed on the increasing number of C- section deliveries in the private sector, which needs to be addressed. “We need to transcend beyond technology and gauge the future. We do need technology but we also have to consider the human factor in our caregiving. We have to understand that more technology cannot ensure better quality service in public health. We need to have that discomfort within us to proactively work towards the betterment of the society.”
Moving forward, the panel also discussed on how private sector can play their part in fortifying public health. The audience also posed relevant questions engaging valuable discussion between the audiences and the panelists.