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  • India: Towards Universal Health Coverage Series 1-7

    Excellent paper worth reading in full;



    Lancet 2011; 377: 252?69
    Published Online
    January 12, 2011
    DOI:10.1016/S0140-6736(10)61265-2


    India: Towards Universal Health Coverage 1
    Continuing challenge of infectious diseases in India
    T Jacob John*, Lalit Dandona, Vinod P Sharma, Manish Kakkar

    In India, the range and burden of infectious diseases are enormous. The administrative responsibilities of the health
    system are shared between the central (federal) and state governments. Control of diseases and outbreaks is the
    responsibility of the central Ministry of Health, which lacks a formal public health department for this purpose.
    Tuberculosis, malaria, fi lariasis, visceral leishmaniasis, leprosy, HIV infection, and childhood cluster of vaccinepreventable
    diseases are given priority for control through centrally managed vertical programmes. Control of HIV
    infection and leprosy, but not of tuberculosis, seems to be on track. Early success of malaria control was not sustained,
    and visceral leishmaniasis prevalence has increased. Inadequate containment of the vector has resulted in recurrent
    outbreaks of dengue fever and re-emergence of Chikungunya virus disease and typhus fever. Other infectious diseases
    caused by faecally transmitted pathogens (enteric fevers, cholera, hepatitis A and E viruses) and zoonoses (rabies,
    leptospirosis, anthrax) are not in the process of being systematically controlled. Big gaps in the surveillance and response
    system for infectious diseases need to be addressed. Replication of the model of vertical single-disease control for all
    infectious diseases will not be effi cient or viable. India needs to rethink and revise its health policy to broaden the
    agenda of disease control. A comprehensive review and redesign of the health system is needed urgently to ensure
    equity and quality in health care. We recommend the creation of a functional public health infrastructure that is shared
    between central and state governments, with professional leadership and a formally trained public health cadre of
    personnel who manage an integrated control mechanism of diseases in districts that includes infectious and noninfectious
    diseases, and injuries

    ...

    Key messages
    ? Although the burden of infectious diseases has decreased as a result of overall
    socioeconomic progress and increasing use of vaccines and antimicrobials in the past
    60 years since independence from colonial rule, they still contribute about 30% of the
    disease burden in India.
    ? Only a few infectious diseases are prioritised in the vertical control programmes
    managed by the central government, and even among these diseases only the control
    of HIV and leprosy seems to be successful but not that of diseases such as tuberculosis,
    malaria, and visceral leishmaniasis.
    ? Infectious diseases that are not in the vertical control programmes are mostly
    neglected, with no formal monitoring or control system at the population level.
    ? Functional integration of vertical programmes and their coordination with the
    health-care system, which is managed by state governments, is needed for effi cient
    and sustainable reduction of the burden of a wide range of infectious diseases.
    ? Case-based disease surveillance, generated through health-care personnel in the
    public and private sectors, and public health response at the district level, as part of a
    functional public health infrastructure, are urgently needed for eff ective control of all
    infectious diseases.
    ? The public sector health-care network is overwhelmed with preventable morbidity
    from infectious and other diseases, encouraging growth of largely unregulated private
    commercial health care that entails large out-of-pocket expenditures by families.
    ? For a formal cadre of public health personnel at district, state, and national levels,
    reorganisation of the system and adequate training programmes will be necessary to
    control infectious diseases and link this eff ort with control of the increasing burden of
    non-infectious diseases and injuries that are already major causes of death and
    economic loss.

    ...

    Gaps in information gathering
    The Public Health Act of 1897 has not been amended (a
    draft of the revised act is pending in Parliament); hence
    notifi able diseases are generally not reported. A realtime,
    effi cient, and inexpensive surveillance of diseases
    in districts that are prone to outbreaks and are targeted
    for control, in both public and private-sector hospitals,
    has been successfully fi eld tested.9,10 It could not be scaled
    up because health care is the responsibility of the state,
    and outbreak control is mainly the responsibility of the
    federal government. Therefore, the Integrated Disease
    Surveillance Project, another vertical programme,
    supported by the World Bank, was established in 2004. It
    is not integrated with other vertical programmes or with
    health care, and is virtually ineff ective yet for the control
    of infectious diseases.11 Therefore, a badly designed
    solution does not achieve the desired result and also
    prevents the application of the right solution. WHO?s
    Regional Offi ce for South-East Asia reports monthly data
    for selected infectious diseases in member countries,
    but data from India are often reported as not available.
    Civil law requires death registration before cremation
    or burial. Rural communities often ignore it; about
    70% of deaths happen at home, and more than threequarters
    of these without certifi cation of the cause of
    death.13 In urban communities, local health departments
    register death, but the information is not captured in
    the health-care system.14 Autopsies are rarely done,
    except when a criminal case is registered. Invaluable
    data about frequency, age pattern, and causes of death
    are lost. To capture these data, a public health
    infrastructure must include all administrative units.
    The neglect of the relevant civil law shows the widely
    held belief that life events are externally directed and not
    changed by human endeavour.
    Another potential source of data for infectious diseases
    is the diagnostic laboratory. However, primary and
    secondary public sector health-care networks have no
    access to microbiology laboratories (except for blood and
    sputum smears to test for the presence of malarial
    parasites and acid-fast bacilli). The Medical Council of
    India does not recognise infectious diseases as a
    specialty for postgraduate medical education, resulting
    in inadequately prepared teachers who seldom use
    evidence-based diagnosis of these diseases in
    undergraduate teaching, and thereby perpetuate low
    demand and supply of laboratory services. Qualityassured
    support for microbiology laboratories is
    restricted to a few medical-care institutions.15 Antibiotics
    are sold over the counter, overused, and misused,
    leading to increasing drug resistance.
    Estimates of disease burden are thus obtained from
    fragmentary databases, mostly generated through
    primary health centres that cater to only a small
    proportion of people with illnesses. Denominator-based
    data are available only from surveillance of polio
    infection and yearly surveys of HIV infection. Within
    these limitations, the estimates by the Global Burden of
    Disease Project (table) suggest a 15-times greater burden
    of infectious diseases per person in India than in the
    UK in 2004, and that about 30% of the disease burden in
    India is attributable to infections.16 These data do not
    capture several other infectious diseases of clinical and
    public health importance.
    ...

    Creation of public health infrastructure
    India, as an emerging world economic leader, needs to
    rescue its reputation as a country that provides its people
    freedom from the many endemic and outbreak-prone
    infectious diseases that impoverish families through loss
    of income and out-of-pocket spending on health care.
    Families often have to borrow, or occasionally liquidise
    their capital assets?eg, selling cattle, land, or even their
    homes. Prevention and control of infectious diseases
    require a public health infrastructure, a cadre structure,
    professional leadership, trained human resources, and
    adequate economic investment.1,2
    Incrementally adding new programmes will not solve
    the fundamental systemic defi ciency. Even the innovative,
    highly visible, and generally successful Integrated Child
    Development Service Programme (for nutrition, missing
    in primary health care), National Rural Health Mission,
    and proposed National Urban Health Mission have
    severe limitations in terms of public health functions.
    Although all such programmes are good in themselves,
    none of them can individually or collectively fi ll the void
    of an overarching public health infrastructure.
    The health system in India has to be modifi ed with a
    major focus on public health in addition to the current
    focus predominantly on medical care. Instead of
    incremental changes, a transformation is essential. The
    current national government came to power with the
    people?s mandate for stability, continuity, and socioeconomic
    development, and promised in its election
    manifesto health security for all. Now is therefore the
    best time for an overhaul of the health system.
    The Calcutta Declaration on Public Health made a plea
    to the governments in 2000 to accept the discipline of
    public health as an essential requirement and to create
    career structures nationally, and in states and districts,3
    but this plea has not been acted on. Since the district is
    the logical unit for civil administration, so should it be
    made the unit for integration of the activities of medical
    care and public health. In 1994, in response to an
    outbreak of suspected pneumonic plague in Surat city in
    western India, the Government of India appointed the
    Technical Advisory Committee on Plague, which
    identifi ed the urgent national need for trained
    epidemiologists to respond to signals gathered through
    disease surveillance in districts and that has not
    happened.173 A Department of Public Health should be
    created that is on a par with other existing departments,
    with a government secretary selected from technically
    qualifi ed individuals, as was the case for the Department
    of Health Research, which was created in 2008.
    To cater for the expected need for trained public health
    offi cers in districts, states, and the centre, a national public
    health service could be designed that is similar to the
    Indian civil services, which include administrative, police,
    and foreign services. Side by side, the relations and
    budget-sharing between states and the centre should also
    be re-examined for adequacy and functional effi ciency.
    These prescriptions come from our own assessment, but
    we do not have the necessary skills to design a specifi c
    model, for which wider consultations are obviously
    essential. What we have provided is more of a product
    description rather than specifi cation for construction. A
    change is imperative as discussed in another report in this
    Lancet Series.174 A suitable think tank might be created by
    the Government of India, such as a National Commission
    on Healthcare and Public Health, to help make this need
    for transformation a reality.175
    There is an alarming and rapidly rising trend in the
    burden of and mortality due to lifestyle diseases (noncommunicable,
    metabolic, or related to urbanisation) in
    India as discussed by Patel and colleagues176 in this Series.
    The public health system that learns from the control of
    single-pathogen infectious diseases should be able to
    address the control of lifestyle diseases that often have
    multifactorial causes. If control of infectious diseases is
    the primary school of public health, control of lifestyle
    diseases is the high school to which we have to progress
    in the shortest possible time.
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

  • #2
    Re: India: Towards Universal Health Coverage 1 - Continuing challenge of infectious diseases in India

    India: Towards Universal Health Coverage 2
    Reproductive health, and child health and nutrition in India:
    meeting the challenge

    Published Online
    January 12, 2011
    DOI:10.1016/S0140-
    6736(10)61492-4

    Vinod Kumar Paul, Harshpal Singh Sachdev, Dileep Mavalankar, Prema Ramachandran, Mari Jeeva Sankar, Nita Bhandari,
    Vishnubhatla Sreenivas, Thiagarajan Sundararaman, Dipti Govil, David Osrin, Betty Kirkwood

    India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of
    its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of
    severe manifestations of nutritional defi ciencies, but the pace has been slow and falls short of national and Millennium
    Development Goal targets. The likely explanations include social inequities, disparities in health systems between
    and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the
    National Rural Health Mission, an extraordinary eff ort to strengthen the health systems. However, coverage of priority
    interventions remains insuffi cient, and the content and quality of existing interventions are suboptimum. Substantial
    unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate.
    Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of
    intrapartum and neonatal care. Infants and young children do not get the health care they need; access to eff ective
    treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition
    programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to
    planning, fi nancing, human resources, infrastructure, supply systems, governance, information, and monitoring. We
    provide a case for transformation of health systems through eff ective stewardship, decentralised planning in districts,
    a reasoned approach to fi nancing that aff ects demand for health care, a campaign to create awareness and change
    health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda
    needs political commitment of the highest order and the development of a people’s movement.

    ...

    Key messages
    • With 1&#183;8 million deaths among children (age <5 years) and 68 000 deaths among
    mothers every year, and 52 million children who are stunted, India’s burden of
    reproductive health, and child health and nutrition is greater than that in any
    other country.
    • The pace of improvement has been slow and falls short of the national and
    Millennium Development Goal targets. For instance, the national goal for 2010—ie, an
    infant mortality rate of less than 30—will not be attained in rural India as a whole, and
    all except fi ve states, even in 2015. The reason is that the coverage for priority
    interventions remains insuffi cient, and the content and quality of existing
    programmes suboptimum, further complicated by unacceptable inequities.
    • The underlying cause of insuffi cient progress is weak health systems; substantial
    inadequacies exist in planning, fi nancing, human resources, infrastructure, supply
    systems, governance, and monitoring.
    • Adequate importance has not been given to the fi rst 2 years of a child’s life that are
    critical for prevention of undernutrition and its consequences; the focus of the
    nutrition programmes has become supplementary nutrition and preschool education
    for children aged 3–6 years.
    • The only way forward is to transform health systems. Eff ective stewardship,
    decentralised planning in districts, eff ective service delivery in communities and
    health facilities, a reasoned approach to demand-side fi nancing, a sustained campaign
    to change household behaviours, and creation of centres of excellence for health and
    nutrition policy research are essential for change.
    • Child nutrition programmes need to be changed with focus on the vulnerable fi rst
    2 years of life.
    • For long-term gains, investments in sexual and reproductive health of young people
    are essential.

    ...

    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

    Comment


    • #3
      Re: India: Towards Universal Health Coverage 1 - Continuing challenge of infectious diseases in India

      India: Towards Universal Health Coverage 3
      Chronic diseases and injuries in India

      Vikram Patel, Somnath Chatterji, Dan Chisholm, Shah Ebrahim, Gururaj Gopalakrishna, Colin Mathers, Viswanathan Mohan,
      Dorairaj Prabhakaran, Ravilla D Ravindran, K Srinath Reddy

      Published Online
      January 12, 2011
      DOI:10.1016/S0140-6736(10)61188-9

      Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the
      leading causes of death and disability in India, and we project pronounced increases in their contribution to the
      burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations
      and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are
      available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic
      diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant
      immediate action to scale up interventions for chronic diseases and injuries through private and public sectors;
      improved public health and primary health-care systems are essential for the implementation of cost-effective
      interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation
      of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed
      alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one
      another and with national health agendas. India has already passed the early stages of a chronic disease and injury
      epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in
      India, the rate at which effective prevention and control is implemented should be substantially increased. The
      emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness,
      if universal health care is to be achieved.

      ...

      Key messages
      ? Chronic diseases (including cardiovascular and respiratory
      diseases, mental disorders, diabetes, and cancers) and
      injuries are the leading causes of death and disability in
      India?their burden will continue to increase during the
      next 25 years as a consequence of the rapidly ageing
      population in India.
      ? Most chronic diseases are common and often occur as
      comorbidities.
      ? Risk factors for chronic diseases are highly prevalent
      among the Indian population.
      ? Although a wide range of cost-effective prevention
      strategies are available, implementation is generally low,
      especially among people who are poor and those living in
      rural areas.
      ? Most health care is provided by the private sector, which
      often causes high out-of-pocket health expenditure that
      leads to debt and impoverishment.
      ? Immediate action to scale up cost-effective interventions
      for chronic diseases and injuries is needed; public healthcare
      systems need to be strengthened to allow these
      interventions to be effectively implemented.
      ? Strong public policy commitments to control chronic
      diseases and injuries need to be implemented more robustly.

      ...

      Twitter: @RonanKelly13
      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

      Comment


      • #4
        Re: India: Towards Universal Health Coverage 1 - Continuing challenge of infectious diseases in India

        India: Towards Universal Health Coverage 4 Health care and equity in India
        Auteur(s) / Author(s)
        BALARAJAN Y. (1) ; SELVARAJ S. (3) ; SUBRAMANIAN S. V. (2) ;
        Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
        (1) Department of Global Health and Population, Harvard School of Public Health, Boston, MA, ETATS-UNIS
        (2) Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, ETATS-UNIS
        (3) Public Health Foundation of India, New Delhi, INDE

        R?sum? / Abstract
        In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population.
        Revue / Journal Title
        Lancet ISSN 0140-6736 CODEN LANCAO
        Source / Source
        2011, vol. 377, no9764, pp. 505-515 [11 page(s) (article)] (108 ref.)

        Twitter: @RonanKelly13
        The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

        Comment


        • #5
          Re: India: Towards Universal Health Coverage 1 - Continuing challenge of infectious diseases in India

          India: Towards Universal Health Coverage 5
          Human resources for health in India
          Mohan Rao, Krishna D Rao, A K Shiva Kumar, Mirai Chatterjee, Thiagarajan Sundararaman

          Published Online
          January 12, 2011
          DOI:10.1016/S0140-6736(10)61888-0

          India has a severe shortage of human resources for health. It has a shortage of qualifi ed health workers and the
          workforce is concentrated in urban areas. Bringing qualifi ed health workers to rural, remote, and underserved areas
          is very challenging. Many Indians, especially those living in rural areas, receive care from unqualifi ed providers. The
          migration of qualifi ed allopathic doctors and nurses is substantial and further strains the system. Nurses do not have
          much authority or say within the health system, and the resources to train them are still inadequate. Little attention is
          paid during medical education to the medical and public health needs of the population, and the rapid privatisation
          of medical and nursing education has implications for its quality and governance. Such issues are a result of
          underinvestment in and poor governance of the health sector?two issues that the government urgently needs to
          address. A comprehensive national policy for human resources is needed to achieve universal health care in India.
          The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage
          qualifi ed health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and
          mainstreaming doctors and practitioners who practice traditional Indian medicine (ayurveda, yoga and naturopathy,
          unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting
          human resources for health. At the same time, additional investments will be needed to improve the relevance,
          quantity, and quality of nursing, medical, and public health education in the country.

          ...

          Key messages
          ? Develop a comprehensive national human resource policy for health
          ? Strengthen the public health system, its facilities, and the working and living
          conditions of public sector health workers
          ? As a short-term measure to overcome the substantial shortages of qualifi ed health
          workers in underserved areas, employ task-shifting and mainstream doctors and
          practitioners of ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy;
          and use private sector resources by leasing-out health centres, contracting key health
          workers, and purchasing services from qualifi ed private providers
          ? Strengthen nursing and paramedical cadres
          ? Off er appropriate packages of monetary and non-monetary incentives to encourage
          qualifi ed health workers to serve in rural, remote, and underserved areas
          ? Reorient the education and training of health workers, particularly doctors and nurses,
          to meet the health and public health needs of the country
          ? Improve provider quality through systems of continuing education, accreditation,
          and regulation
          ? Build an accurate and reliable database that provides information about key aspects of
          human resources in health, such as the number of diff erent types of health workers
          and their general locations, on the number of doctors and nurses that emigrate, and
          student capacity in public and private nursing institutions

          ...

          Twitter: @RonanKelly13
          The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

          Comment


          • #6
            Re: India: Towards Universal Health Coverage 1 - Continuing challenge of infectious diseases in India

            India: Towards Universal Health Coverage 6
            Financing health care for all: challenges and opportunities
            A K Shiva Kumar, Lincoln C Chen, Mita Choudhury, Shiban Ganju, Vijay Mahajan, Amarjeet Sinha, Abhijit Sen

            Published Online
            January 12, 2011
            DOI:10.1016/S0140-6736(10)61884-3

            India?s health fi nancing system is a cause of and an exacerbating factor in the challenges of health inequity, inadequate
            availability and reach, unequal access, and poor-quality and costly health-care services. Low per person spending on
            health and insuffi cient public expenditure result in one of the highest proportions of private out-of-pocket expenses
            in the world. Citizens receive low value for money in the public and the private sectors. Financial protection against
            medical expenditures is far from universal with only 10% of the population having medical insurance. The Government
            of India has made a commitment to increase public spending on health from less than 1% to 3% of the gross domestic
            product during the next few years. Increased public funding combined with fl exibility of fi nancial transfers from
            centre to state can greatly improve the performance of state-operated public systems. Enhanced public spending can
            be used to introduce universal medical insurance that can help to substantially reduce the burden of private out-ofpocket
            expenditures on health. Increased public spending can also contribute to quality assurance in the public and
            private sectors through eff ective regulation and oversight. In addition to an increase in public expenditures on health,
            the Government of India will, however, need to introduce specifi c methods to contain costs, improve the effi ciency of
            spending, increase accountability, and monitor the eff ect of expenditures on health.

            ...

            Key messages
            Address major shortcomings
            ? Low per person spending that results in very high private
            out-of-pocket expenditures on health
            ? Large ineffi ciencies in public and private sectors that
            reduce effi ciency and eff ectiveness of health expenditures
            ? Insuffi ciency of services to address the health needs
            ? Practically no fi nancial protection for most Indian people
            against medical expenditures
            Policy responses needed
            ? Ensure achievement of government?s commitment to
            increase public spending on health from less than 1% to
            3% of gross domestic product
            ? Improve quality, performance, effi ciency, and
            accountability of public and private health systems
            ? Introduce policy and legislative changes to contain the
            rising costs of medical care and drugs
            ? Increase availability of health services through direct
            expansion of public health services and by enlisting
            private providers of allopathic and non-allopathic drugs
            ? Increase insurance and risk pooling to include fi nancial
            protection
            ? Introduce a predominantly tax-paid universal medical
            insurance plan that off ers essential coverage to all citizens

            ...

            Twitter: @RonanKelly13
            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

            Comment


            • #7
              Re: India: Towards Universal Health Coverage 1 - Continuing challenge of infectious diseases in India

              India: Towards Universal Health Coverage 7
              Towards achievement of universal health care in India
              by 2020: a call to action
              K Srinath Reddy, Vikram Patel, Prabhat Jha, Vinod K Paul, A K Shiva Kumar, Lalit Dandona, for The Lancet India Group for Universal Healthcare*
              To sustain the positive economic trajectory that India has had during the past decade, and to honour the
              fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest
              priority in public policy. We propose the creation of the Integrated National Health System in India through
              provision of universal health insurance, establishment of autonomous organisations to enable accountable and
              evidence-based good-quality health-care practices and development of appropriately trained human resources, the
              restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement
              for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the
              primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the
              out-of-pocket expenditure on health care through a well regulated integration of the private sector within the
              national health-care system. Dialogue and consensus building among the stakeholders in the government, civil
              society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In
              our call to action, we propose that India must achieve health care for all by 2020.

              Key messages
              We propose the following targets to be achieved by 2020 through the creation of the
              Integrated National Health System with three overarching goals: ensure the reach and
              quality of health services to all in India; reduce the financial burden of health care on
              individuals; and empower people to take care of their health and hold the health-care
              system accountable.
              Service delivery
              ? The entire population should be covered by an entitlement package of health care with
              financing from a combination of public, employer, and private sources. Full range of
              relevant diseases need to be included in the entitlement package of health services with
              cost-effective interventions that include health promotion and disease prevention.
              ? All health practitioners and facilities in the public and private sectors have to be
              registered with the Integrated National Health System.
              Health financing
              ? Public spending on health should be increased from 1% to 6% of the gross domestic
              product, and 15% of tax revenues?including new taxes on tobacco products, alcohol,
              and food with little nutritional value?should be earmarked for this purpose.
              ? Reduce the proportion of out-of-pocket spending from 80% to 20% of the total health
              expenditure.
              ? Increase spending on health research to 8% of the health budget.
              Human resources for health
              ? Establish the Indian Health Service with guidelines developed through an autonomous
              National Council for Human Resources in Health.
              ? An updated training curriculum should be fully in place for medical and allied
              professions that is relevant to the situation in India.
              ? Establish suitable incentive structures to retain health providers in underserved areas.
              Health information system
              ? Have in place a comprehensive health information and surveillance system that covers
              all major diseases, health-system issues, and key social determinants, which also
              facilitates assessment of public health interventions.
              ? Establish adequate research capacity in India to investigate and report key issues that
              affect the health system and policy for further improvements.
              ? Have in place a fully functional autonomous council that compiles and synthesises
              relevant information to develop guidelines for evidence-based health care and its
              assessment.
              Drugs and technology
              ? Implement a national network of pharmacies for generic low-cost drugs for the entire
              population.
              ? Establish mechanisms for bulk purchase of patented drugs to make them available at
              low cost.
              ? Have in place mechanisms to check and control the use of perverse incentives by
              pharmaceutical and biotechnology companies for health-care providers.
              Governance
              ? Have in place mechanisms to make functional the components of the National Health
              Bill 2009.
              ? Have a system in place that requires all middle and senior functionaries in public
              health to have relevant training in public health.
              ? Ensure devolution of responsibility for health care to district management systems
              along with accountability mechanisms and explicit community participation.
              Consensus building
              ? To formalise the mechanisms to achieve universal health care in India and to discuss
              the implementation of the recommended actions, a national debate involving all
              stakeholders in India including government, civil society, health professions, private
              sector, academia, and the media is needed.

              ...

              Twitter: @RonanKelly13
              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

              Comment


              • #8
                Re: India: Towards Universal Health Coverage Series 1-7

                Universal health care: the barriers and the way forward
                Dileep Mavalankar
                Health targets fail as they are set without strategies. The 12th Five-Year Plan should be used to look at the changes needed in the public health system.

                Health is currently a privilege in India. Not a right. Maternal and child health remains neglected even after countless plans, programmes and political proclamations. Every year, nearly 60,000 women die in pregnancy and childbirth, while approximately 1.7 million children less than five years of age also die. In absolute numbers, India outranks all other countries in both regards. Sadly, most deaths can be prevented with available technologies. Many diseases such as tuberculosis and pneumonia kill thousands every year. While infectious diseases are very much a concern, chronic diseases are now rapidly catching up. India has become the capital of diabetes, high blood pressure and heart disease. Health targets in plan after plan have not been achieved, yet there has been no systematic analysis of why health systems fail to achieve these targets.

                The fundamental reason why our health targets are not achieved and will not also be achieved, unless we radically change our strategies, is that we set targets without setting strategies; without understanding what is preventing progress; and without putting adequate human and financial resources toward achieving targets.

                First, we equate the number of buildings to available health services. The Planning Commission and Central and State governments only count the number of health centres, without bothering to find out what is happening at these centres. Many are without staff, electricity, a telephone, water, medicines or an ambulance. No wonder these centres do not have patients ? mothers or children ? to take care of. Surveys have shown the inadequacy of our health infrastructure and that health workers are not staying where they are posted. There are good reasons why health staff do not stay in villages. But health departments have not bothered to study this problem or remedy it. Not only are workers not staying, studies have also shown that they are quite frequently absent without reason. Such unaccountability is treated as routine and not discussed in health policy forums.

                The second reason for a lack of services is underfunding and poor management of medicines, leading to a lack of availability. How can an army fight without ammunition? The lack of medicines forces poor patients to buy medicines from private pharmacy shops, which can be expensive. Often times, the quality of medicines available from these shops and government health centres is poor due to the government's weak oversight on pharmacies and poor procurement policies. Patients do not want to go to clinics where they do not get medicines or where they are of poor quality.

                Managers

                While planning and funding are major problems, the root of the health problem in India, I feel, is the lack of adequate numbers of well-trained managers. Many national health programmes cover millions of beneficiaries, yet they are managed by just two or three technical managers who are general or specialist doctors.

                Most of the time these individuals are without any public health or management training. They learn this on the job. This is also true for health secretaries and ministers ? they all learn on the job. We are obsessed with training an eighth standard-passed village health worker with six to seven modules ? but there is no training or even orientation for top policymakers and managers in the health department before they take up such important managerial and policymaking jobs. Why isn't health systems management made compulsory before an officer takes up the job of director or secretary in the health department?

                The way out

                Fortunately, things can rapidly change in the next few years, if government and society pay a little more attention to health. During the last five years, the government has put in significant resources into the National Rural Health Mission (NRHM). At the same time, many States are also using local solutions to various problems. Preparations are underway for the 12th Five Year Plan (FYP), and thus we should be looking at what radical changes are needed in the public health system.

                Budgets for health services will need to increase by a factor of three to five times. The national government is committed to take health funding from less than one per cent to two to three per cent of the GDP. This is critical. The government must chart out how the Centre and States will increase these budgets over the next five years. This will also require advocacy on behalf of the health community. And we must also be more smart in how to spend the money that is already available. Money remains unspent in health because the regulations around spending are so complicated and confining that doctors and health works cannot spend the money. Many times, money does not arrive in time for it to be useful.

                Health care is provided by humans. Not by buildings or physical infrastructure. We need to get doctors and nurses to go to remote and rural areas and work there. This means paying them much higher wages, providing much better housing and other amenities, and making the working environment conducive to their lives.

                Appreciation of the doctors and nurses who work in remote areas will ensure that younger doctors go to rural areas and serve the poor. Another solution could be to contract private providers, where government providers are unavailable and unwilling to provide services. Gujarat did just this through its much acclaimed ?Chiranjeevi Scheme.? Here, the government pays private doctors a fixed fee for conducting child birth services for poor women in their private hospitals. ?Rashtriya Swasthya Bima Yojana? also provides financial access to care in private and public services to the poor throughout the country. This is truly innovative and revolutionary.

                Technology and drugs

                While improving health systems is critically important, we cannot afford to wait until such changes are made before also improving the technological base for health systems. This means better machines and newer drugs and vaccines. For example, new vaccines and diagnostic techniques that can prevent or diagnose early some of the diseases among children and women are currently available in the private sector, but these technologies remain out of reach for the poor. The health department must have a division of technology assessment that is responsible for identifying and rigorously evaluating potentially useful and cost effective technologies for adoption in national health programmes in India.

                All this can happen if there is a high-level of political commitment and the Prime Minister and Chief Ministers take personal interest in health improvements.

                Of course, more resources need much better management in order to deliver results. Health departments must have an adequate number of qualified programme managers and health planners to ensure better programme design and effective implementation. I strongly believe that we can do this in 12th FYP, and it will be a big step towards universal access to health.

                (Prof. Dileep Mavalankar is Dean, Academics, Indian Institute of Public Health, Gandhinagar.)

                Twitter: @RonanKelly13
                The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                Comment


                • #9
                  Re: India: Towards Universal Health Coverage Series 1-7

                  Ministry of Health and Family Welfare04-October, 2012 14:57 IST
                  India Embarks on Universal Health Coverage during 12th Plan
                  India is embarking on an ambitious target of achieving Universal Health Coverage for all during 12th Plan period. Everybody will be entitled for comprehensive health security in the country. It will be obligatory on the part of the State to provide adequate food, appropriate medical care, safe drinking water, proper sanitation, education and health-related information for good health. The State will be responsible for ensuring and guaranteeing UHC for its citizens.

                  Addressing the afternoon session of the Conference on ?Responsible Use of Medicine? at Amsterdam, Netherlands yesterday, Union Minister of Health & Family Welfare, Shri Ghulam Nabi Azad said as per WHO`s World Health Statistics 2012, almost 60% of total health expenditure in India was paid by the common man from his own pocket in 2009. The Report states that 39 million Indians are pushed to poverty because of ill health every year. Around 30% in rural India did not go for any treatment for financial constraints. About 47% and 31% of hospital admissions in rural and urban India were financed by loans and sale of assets.

                  He said India has already enacted the Clinical Establishment Act. The Standard Treatment Guideline is part of the Clinical Establishment Act. The Act will ensure that unnecessary drugs are not prescribed. During nationwide polio vaccination campaign, India vaccinated 172 million children through 2.3 million vaccinators in 202 million households in each campaign. The polio vaccination campaigns had a strategy of booth vaccination in earlier years but later the programme added the component of house to house search and vaccination to reduce missed children. Transit teams were deployed at all railway stations, bus stands, markets and highways to vaccinate populations in movement. Special teams were set up to administer OPV drops to the most vulnerable mobile and migrant populations. The introduction of bivalent oral polio vaccine (BOPV) in January 2010 was India?s innovation based on research conducted in the country. The bivalent polio vaccine helped India to achieve its goal of polio eradication.

                  Shri Azad said the recommendations of the Consultative Expert Working Group set up by the WHO on research and coordination highlights the fact that very little research is happening in neglected diseases. Intellectual Property Rights have become a barrier to access to medicines. We need to consider the recommendations of the CEWG and ensure that adequate financing is made available to these diseases so that the poor and the vulnerable do not suffer from lack of proper medicines.

                  The goal of the afternoon session was to identify potential directions for the future.

                  BN/AS/HK
                  (Release ID :88129)
                  Twitter: @RonanKelly13
                  The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                  Comment


                  • #10
                    Re: India: Towards Universal Health Coverage Series 1-7

                    Government-Sponsored Health Insurance in India
                    Authors: La Forgia, Gerard; Nagpal, Somil


                    This book presents research findings on India?s major central and state government-sponsored health insurance schemes (GSHISs). The analysis centers on the GSHISs launched since 2007. These schemes targeted poor populations, aiming to provide financial protection against catastrophic health shocks, defined in terms of inpatient care. Focus is on two lines of inquiry. The first involves institutional and ?operational? opportunities and challenges regarding schemes? design features, governance arrangements, financial flows, cost-containment mechanisms, underlying stakeholder incentives, information asymmetries, and potential for impact on financial protection and on access to care and use by targeted beneficiaries. The second entails ?big picture? questions on the future configuration of India?s health financing and delivery systems that have surfaced, due in part to the appearance of a new wave of GSHISs. In addition to gains in population coverage, reaching about 185 million low-income beneficiaries by 2010, the new crop of schemes introduced a demand-side approach to public financing while embracing several innovation features, at least for the Indian context. These include: defined entitlements, separation of purchasing from financing, patient choice of providers, impressive use of information and communication technology and engagement with the private sector in the areas of insurance, administration and provision. Strong political interest in the schemes is also evident, especially at the state level and is a driver of increased public expenditures for health. The schemes face a number of operational challenges that have emerged during implementation and are examined in the book. They will need to strengthen institutional and governance arrangements, purchasing and contracting capacities, monitoring systems, and cost containment mechanisms. They need to use their financial leverage to improve the quality of network providers. Beneficiaries also appear to have insufficient information on enrolment, benefits and providers. The book recommends a series of corrective measures to address these shortcomings. The book outlines a ?pragmatic pathway? toward achieving universal coverage that takes as a starting point the current configuration of health financing and delivery arrangements in India, recent trends in government health financing as well as innovations and lessons from the recent GSHISs analyzed in this book. The book concludes with a review of issues for further research.
                    ...
                    Twitter: @RonanKelly13
                    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                    Comment


                    • #11
                      Re: India: Towards Universal Health Coverage Series 1-7

                      Universal Health Coverage: Is India Up For The Challenge?
                      by GUEST AUTHOR on DECEMBER 20, 2012 ? LEAVE A COMMENT ? in ARTICLES, EMERGING VOICES
                      By Mridula Shankar & Radhika Arora (EVs 2012)

                      Universal Health Coverage currently stands as the front-runner for the Health goal in the post MDG development agenda. India is at the crossroads. Are we going to prioritize health for all?



                      As the deadline for the achievement of the Millennium Development Goals (MDGs) is fast approaching, global, national and sub-national consultations are well underway for the development of a new global agenda for action. Notwithstanding the fair criticism that the MDGs have received, the progress that countries have made towards their realization has demonstrated that political commitment towards shared goals of human development can be sustained over time. The next phase of sustainable development is especially pertinent in an era where we are faced with the collective threats of environmental degradation, economic crises and growing social inequalities.

                      Health, no doubt, will continue to remain a priority and mounting evidence, the latest of which is the passing of the resolution on Universal Health Coverage (UHC) at the UN General Assembly, points to UHC winning as the global health goal. Among other aspects, establishing UHC as a desired target will: a) emphasize the significance of health and access to healthcare both as a precursor to and an outcome of development, b) serve as a shared aspiration for donor nations/regions and aid recipients alike, c) allow for greater versatility of fund usage based on burden of disease patterns within countries, d) focus on the development of robust sustainable health systems rather than the creation of targeted health programs alone.

                      A vision of UHC is of particular importance in the Indian context where a burgeoning healthcare crisis looms large. Since independence, the trend in health policy within the country has shifted gradually from the provision of free, universal care by the government, to the state being the chief financier of care (primarily through targeted insurance schemes for the poor) in a rapidly growing unregulated private healthcare market that provides the lion?s share of services. More recently, under the National Rural Health Mission (NRHM), the Indian government has made a concerted effort to promote primary public health care provision. Yet issues around weak governance, management and health workforce inadequacies have prevented the program from reaching its full potential. Overall, public expenditure on health stands at approximately 1.2% of GDP1 and hence unsurprisingly, 70% of healthcare costs are financed through out-of-pocket payments1 leading to catastrophic expenditures for households. Growing inequalities in health status are clearly evident across the various axes of economic class, gender and geographies.2 Finally, the country is faced with having to deal with the rising burden of non- communicable diseases (NCDs), whilst still battling an unfinished agenda of combating high rates of maternal and infant mortality and communicable illnesses. In short, the time is ripe for India to adopt a comprehensive framework for equitable healthcare provision in the form of UHC to promote health among its citizens.

                      ...
                      continues at; http://e.itg.be/ihp/archives/univers...dia-challenge/
                      Twitter: @RonanKelly13
                      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                      Comment


                      • #12
                        Re: India: Towards Universal Health Coverage Series 1-7

                        Universal Free Health Coverage





                        The Twelfth Plan strategy seeks to strengthen initiatives taken in the Eleventh Plan to expand the reach of health care and work towards the long term objective of establishing a system of Universal Health Coverage (UHC) in the country. The Plan envisages substantial expansion and strengthening of the public health systems both in rural and urban areas, with robust provision of primary health care.

                        Several of the on-going initiatives like Reproductive and Child Health, Control of Communicable and Non-communicable Diseases, have the features of universal coverage through public health facilities for the target population, which encompass the following:


                        ? Free Maternal Health Services, which include antenatal check up including free investigations and Iron-Folic Acid (IFA) supplementation, post-natal care, safe abortion services and Reproductive Tract Infection (RTI)/ Sexually Transmitted Infections (STI) services including investigations and treatment. Recent initiatives such as Janani Shishu Suraksha Karyakaram (JSSK) guarantees free and no expense delivery including c-section in public health facilities, entitlements include free to and fro transport, free drugs, consumables, diagnostics, blood and diet and similar guarantees for sick neonates.

                        ? Free Child Health Services which include home based new born care, facility based new born care, Nutritional rehabilitation, Diarrhea management including free Oral Rehydration Solution (ORS) and Zinc, pneumonia management including antibiotics. New Initiatives like Rashtriya Bal Swasthya Karyakram seeks to provide child health screening and early intervention services

                        ? Universal Immunization Programme which guarantees free vaccination of children against 7 diseases, free vaccination (TT) to pregnant women.

                        ? Adolescent Health Services which include adolescent friendly services through Adolescent Reproductive and Sexual Health (ARSH) Clinics, Weekly Iron-Folic Acid Supplementation with deworming (WIFS).

                        ? Family planning activities, which include free services including providing information, supply of contraceptives and other family planning interventions.

                        ? Control of Communicable diseases, which include free investigation and treatment for Malaria, Kala-azar, filarial, Dengue, Japanese Encephalitis and Chikungunya, Tuberculosis and Leprosy etc.

                        ? Control of Non-communicable diseases, which include free cataract surgery for blindness control, free cornea transplant, glaucoma/diabetic retinopathy, free spectacles to children.

                        For these schemes, guidelines have been developed and shared with the States and the Schemes are operational. These are important steps towards achieving UHC which is an incremental process, linked to availability of adequate financial resources.

                        The above information was given by the Union Minister for Health & Family Welfare, Shri Ghulam Nabi Azad in a written reply to a question in the Lok Sabha today.


                        BN/AS



                        (Release ID :92382)
                        Twitter: @RonanKelly13
                        The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                        Comment


                        • #13
                          Re: India: Towards Universal Health Coverage Series 1-7

                          Ministry of Health and Family Welfare 27-August, 2014 17:21 IST
                          Universal Health Assurance to galvanise Health Care sector

                          Dr Harsh Vardhan tells CII to prepare for ?next revolution?

                          Dr. Harsh Vardhan, Union Health Minister, has stated that India?s health care sector is set for unprecedented growth as Shri Narendra Modi government?s Universal Health Assurance (UHA) programme will cause an explosion of demand by making medical treatment affordable for the millions who have been excluded for the past seven decades by prohibitive costs.

                          UHA is in the process of being finalised and will be presented to the nation within the current financial year, the Minister disclosed at the Confederation of Indian Industry (CII)?s 8th Health Insurance Summit, here today.

                          ?I have set up committees comprising the best possible academic, administrative and technical experts on public health, institutional strengths and weaknesses and, above all, health insurance. Their interim reports are with me and I can disclose at this stage that the future indeed looks good,? he added.

                          The health care sector of India is already growing at a CAGR of about 15 percent since 2011 and is today worth about $ 80-85 billion. Independent projections have put the turn-of-decade size in the region of $ 150 billion. But this could have been under-estimation as UHA was not factored in, he said.

                          ?For instance, I am talking about 50 free essential drugs for all, which means demand on an unimaginable scale. What does this mean for India?s pharmaceutical companies? Will they be able to cope given their present, limited capacity utilisation? I ask them to tighten their belts if they want a share of the coming boom because the government will not compromise on quality standards and transparency,? the Minister said.

                          Apart from free drugs, there will be government paid-up health insurance cover for the poor and competitively premiumed health insurance for all. The private sector hospitals and clinics will benefit from far larger volumes than at present, thereby leading to massive spinoffs in terms of business and employment, the Minister stated.

                          Already private hospitals and nursing homes are welcoming patients covered by the Rashtriya Swastha Bima Yojana (RSBY) because government backed insurance is translating into higher footfalls. Once UHA kicks in, the implications will be much more salutary, the Health Minister said.

                          Dr Harsh Vardhan said, ?I believe that India?s health sector will see the same revolution as the one witnessed in mobile telephony in the early 2000s. Back then it was Shri Atal Bihari Vajpayee government?s bold decision to make incoming calls free which kick-started it. Industry contributed by introducing the pre-paid system for small subscribers. Now it will be Shri Narendra Modi?s UHA which will transform the health sector resulting in wide social and economic benefits. I invite you all to come aboard.?

                          The Health Minister said that just as millions of new jobs were thrown open by the mobile telephone revolution, the health care boom will stimulate a huge downstream. The MSME sector will be given special advantages because government will become the biggest marketplace for buying and selling of health care goods and services, he said.

                          He cautioned the private sector of the high benchmarks for transparency, quality and consumer protection in the evolving UHA. At the same time, the government is aware of its own responsibilities, he said.

                          ?The Information Technology component in UHA will be so strong and tamper-proof that corruption and sleaze will be absolutely impossible. The consumer, i.e. the patient, will be treated as king. Anti-competitive practices and consumer rights violation will be dealt with through a regulatory body,? he stated.

                          One of the biggest challenges, Dr Harsh Vardhan observed, would be to keep up the supply of doctors and technical personnel. The present doctor to population ratio -1:1700- needs to be improved. A great number of technical personnel in diagnostics, radiology, etc. are also necessary, he said.

                          ?The expansion of the health sector will be felt in Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH) as well. The 21st century belongs to holistic medicine and I intend making AYUSH a way of life because most of the ailments with which people report to doctors can easily be treated by these forms of therapy. I have already formed a committee to suggest steps for expansion of holistic health care through development of protocols,? Dr Harsh Vardhan said.

                          The Minister disclosed that the government has already firmed up plans to give medical education a fillip. As far as possible existing district hospitals all over India would be provided with funds to add medical colleges to their campuses, he said.

                          ?Please be patient and prepare for the coming explosion of business and jobs,? was Dr Harsh Vardhan?s advice. ?We cannot hope to have Health for All without a social movement at its core. Let government and private sector pool synergies and make making people healthy good business.?

                          He said that Shri Narendra Modi government was swept to power because the people believed it could come out with out-of-the-box solutions for India?s problems. The health care sector is poised to be the stage of the inter-play of government-people-corporate interests, all motivated by the urge to make India a healthy nation, he said.

                          ?In January 2014, we were declared a polio free country. When I first tried the pulse polio project in the early 1990s, many thought I was overreaching myself considering the logistics of that era. This time I am attempting something which is more possible than eradicating polio,? Dr Harsh Vardhan added.

                          *****


                          MV
                          (Release ID :109110)
                          Twitter: @RonanKelly13
                          The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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                          • #14
                            Re: India: Towards Universal Health Coverage Series 1-7

                            ndia should increase healthcare expenditure, Pranab says
                            Bosco Dominique,TNN | Sep 26, 2014, 08.07 PM IST

                            PUDUCHERRY: Public financing for healthcare in India that has one-sixth of world population is less than one percent of world's total health expenditure, regretted President Pranab Mukherjee on Friday.

                            "...this is woefully meager. Our expenditure levels have to rise significantly to ensure universal health coverage," said Mukherjee while speaking at the golden jubilee celebration of Jawaharlal Institute of Postgraduate Medical Education and Research (Jipmer) here.

                            Stressing the need for a holistic healthcare system which is universally accessible, affordable and effective, Mukherjee said there are seven hospital beds per 10,000 population in India when compared to 23 in Brazil, 38 in China and 97 in Russia. Similarly, there are seven physicians per 10,000 population in India compared to 19 in Brazil, 15 in China and 43 in Russia.
                            ...
                            Twitter: @RonanKelly13
                            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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                            • #15
                              India?s national immunisation programme: Moving from policy to action Perspective
                              Posted On: 08 Jun 2015


                              Chandrakant Lahariya
                              World Health Organization
                              c.lahariya@gmail.com
                              About a year ago, the Prime Minister?s Office in India announced the introduction of four new vaccines in the national immunisation programme. In this article, Chandrakant Lahariya, a public health policy expert, discusses the significance of the decision. He highlights gaps between policy decisions and action with respect to the immunisation programme in the past, and emphasises the need for speedy and effective implementation of the announcement.

                              In July 2014, the Prime Minister?s Office (PMO) in India announced the introduction of four new vaccines - Rotavirus vaccine, Injectable Polio vaccine (IPV), Rubella vaccine, and Japanese Encephalitis (JE)1 vaccine (for adults) in the Universal Immunisation Programme (UIP)2. This announcement was a significant event, at least on two accounts: one, it is not routine that the PMO announces a health-related policy decision, and second, the number of vaccines proposed for introduction equals the total number of vaccines that have been added to the programme since its inception in 1985 (Lahariya 2014). In the first 17 years of UIP, until 2002, no new vaccine was added to the programme. This was despite the fact that during this period a number of new vaccines became available, and were licensed and introduced in national immunisation programmes of other countries, and those vaccines were available in the private sector in India as well on pay-for-use basis.

                              Although a number of internal activities have been initiated by the government since the announcement in July 2014, the proposed vaccines have not yet been offered through UIP in any state in India.
                              ...
                              - See more at: http://www.ideasforindia.in/article.....cJmzyVHX.dpuf
                              Twitter: @RonanKelly13
                              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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