Realizing the Right to Health: Realizing the Right to Health: Societal Efforts, Responses and Societal Efforts, Responses and

ResponsibilitiesResponsibilities..

The Role of Public Health Policy, The Role of Public Health Policy, Programmes and Health Financing.Programmes and Health Financing.

Dr. Thelma Narayan

Community Health Cell, Bangalore.

Public Health Policy Public Health Policy Explicit & Implicit Policies- National LevelExplicit & Implicit Policies- National Level

• Shrivastava Report 1975, 6th Plan, ICSSR & ICMR report on Health for ALL.

• National Health Policy – 1982- based on Primary Health Care principles, reflected in 5 year plans.

• National Population Policy 2000• National Health Policy 2002-promotes medical

tourism, privatisation, commercialisation.• National Pharmaceutical Policy 2002

State Health Policies State Health Policies Karnataka and OrissaKarnataka and Orissa

• Constitutionally Health is a State subject

• Karnataka Task Force on Health & FW

• Orissa Health strategy

Adopted by Karnataka State Cabinet in 2004

Important Policy InfluencesImportant Policy Influencespower & strategic positioningpower & strategic positioning

Political Party Manifestos &

willingness to beinfluenced

CorporateInterests

Professional bodies& lobbies

Ministries and Directorates

of Health

Pharmaceutical and

Industrial Lobbies

PatientGroups &

Consumer Groups

PHM/JSAJAAK/MNI,Networks,

Movements,Civil Society,

Media

Placebo PoliciesPlacebo Policies

• Those with no intention of being implemented.

• Keeps people happy and hopeful.

• Masks the situation

• Allows for capture of policy space by elite

• Occurs with a passive population, disempowered.

Policy GapsPolicy Gaps

• Lack of a strong enough countervailing power to articulate, demand and ensure policy & practice with a social justice, equity and rights based approach.

• Thus was born the Peoples Health Movement globally and the Jan Swasthya Abhiyan, India in Dec 2000.

Policy ProcessPolicy Processgiving direction, sustaining, buildinggiving direction, sustaining, building• Revitalizing the social goal of Health for All at all

levels- Global, National, Local• Reviving the Spirit of Alma Ata• Policy Briefs for political parties• Critical Engagement with government• Creating Inclusive Networks & State units• community awareness and involvement,

working with social movements -women’s movement, dalit movements, Right to Food Campaign etc.

National Rural Health Mission National Rural Health Mission 2005-20122005-2012

• Strengthening Health Systems Integration

• Communitisation (Community action for Health) village health and sanitation committees, ASHAs, village health plans, village health days, PRI role; community monitoring.

• Financing: budgets;untied funds; demand side financing

• Better Management- Programme management units, Indian Public Health Standards

Implementation: The Black BoxImplementation: The Black Box

• Framework of Implementation approved by Cabinet; • Budget earmarked, state and district health societies,

District Health Plan, State PIP, Reviews-concurrent, CRM,JRM.

• National Health System Resource Centre, SHRC, RRC• Health and health related service staff

– Motivation, morale– Capacity, Quality of Care– Integrity, Accountability, Transparency– Governance

• Using a public health/community health approach• Strengthening comprehensive primary health care.

Eleventh Five Year Plan- 2008Eleventh Five Year Plan- 2008

• Health Sector Allocation : Rs. 1,36,147 crores of which Rs. 89,478 crores for flagship NRHM.

• Approved by National Development Council , Dec 9th 2007.

• Three times increase for NRHM component.

• State Budgets to increase by 10% annually

Peoples Rural Health WatchPeoples Rural Health Watch

• JSA working from the ground up -8 states.

• State reports• Annual reports• Community

monitoring in NRHM

State Health Assembly - 3March 21st 2007, Bangalore

ImpactsImpacts• The measure of our efforts on health

indicators –(NFHS, DLHS,SRS, NGOs) on Mortality, Morbidity, Disability, (Quality of Life)

• Improvement in Health Services at district and taluk level with better governance

• Ongoing policy change reg. emerging PH issues – tobacco, alcohol, environment

• Strengthened civil society involvement

Thank You!