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EDITORIAL
Year : 2021  |  Volume : 10  |  Issue : 5  |  Page : 1801-1803  

Protecting national interest through public health policy - Why does India need to shift from selective primary health care (disease focused vertical programs) to a comprehensive health care model; lessons from COVID 19 pandemic!


National President, Academy of Family Physicians of India

Date of Submission23-May-2021
Date of Acceptance23-May-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Raman Kumar
049, Crema Tower, Mahagun Mascot, Crossing Republic, Ghaziabad, Uttar Pradesh, PIN 201016

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_950_21

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  Abstract 


The COVID virus and the pandemic are defying the general laws of epidemiology and virology. The pandemic shows how the economy can be crippled due to health care. Health is a key area which directly drives the economy. Incapacity in health policy leaves us vulnerable as a country. Global organizations and development partners have been too keen to lend technical help, policies, and procedures to India. Gone are the days when India used to receive any international funding in the health sector but at present most of the money is our own. We often take stewardship for implementation of these surrogate policies and procedures countrywide. The International donors and development partners pushed India on the path of selective primary care - disease based vertical programs. It was part of a geopolitical strategy. It is not resources but capacity. Capacity to make any innovation or change. There is a need for a new public health order in India. A massive change; a massive reform. Covid is an opportunity to think, push for institutional capacity building. As far as COVID pandemic is concerned, we need to strengthen the general health system in India, and not yet another vertical National Covid Control Program (NCCP) - Eliminate Covid by 2050; committing all national resources to one disease only. There is an urgent need for India to shift from selective primary health care to a comprehensive health care model. We have capacity and resources, we only need a national resolve! It is time to protect national interest. We cannot keep ourselves artificially vulnerable for ever.

Keywords: COVID I9, Comprehensive Primary Care, Health policy, National Interest of India, National Security, Selective Primary Care, Vertical Health Programs


How to cite this article:
Kumar R. Protecting national interest through public health policy - Why does India need to shift from selective primary health care (disease focused vertical programs) to a comprehensive health care model; lessons from COVID 19 pandemic!. J Family Med Prim Care 2021;10:1801-3

How to cite this URL:
Kumar R. Protecting national interest through public health policy - Why does India need to shift from selective primary health care (disease focused vertical programs) to a comprehensive health care model; lessons from COVID 19 pandemic!. J Family Med Prim Care [serial online] 2021 [cited 2021 Jun 21];10:1801-3. Available from: https://www.jfmpc.com/text.asp?2021/10/5/1801/317315




  Health policy: A National Interest Top


The Covid situation in India is indeed challenging. The virus and the pandemic are defying the general laws of epidemiology and virology. The pandemic shows how the economy can be crippled due to health care. Health is a key area which directly drives the economy. Incapacity in health policy leaves us vulnerable as a country. The Government of India Act was first passed in 1935 in the British parliament. Later India Independence Act was passed in 1947; as the transfer of power is celebrated as India's independence. Finally on 26th January 1950, the parliament of India adopted a new constitution and became a sovereign republic. Since 1947 international health agencies and donors have taken keen interest in shaping India's health policies directly and indirectly; a former colony of the British Empire. Every year, 26th January should remind us of our national interests. Health sector is a foremost National Interest.


  India's trajectory to selective primary care healthcare: Not a natural choice Top


In spite of having a blueprint for a comprehensive health care system in the form of the Sir Bhore Committee report recommendation, the International donors and development partners pushed India on the path of selective primary care - disease-based vertical programs. It was part of a geopolitical strategy. For the same reason, we do not teach PUBLIC HEALTH as a discipline to our medical students in India. Any regular Indian medical graduate in India or in most of the so-called developing world would never understand the difference between Public Health and Community Medicine. Community medicine's sole purpose was to produce compliant supporters, supervisors, and managers of vertical disease-based National Programs.


  International Development Partners: Time to say Gate Out! Top


Global organizations and development partners have been too keen to lend technical help, policies, and procedures to India. Gone are the days when India used to receive any international funding in the health sector but at present most of the money is our own. We often take stewardship for the implementation of these surrogate policies and procedures countrywide. However, it is high time to discard such help and realize that in the long term our own Institutional capacities become sub-optimized. National and regional institutions remain good for implementing programs, but no capacity to develop their own. It is not a lack of resources or budget in India. Within four weeks' time of crisis tested India's capacity. We went out of oxygen, paracetamol, prednisone, pulse oximeter, general doctors, staff. Because in spite of heavy spending we never strengthened our general health system. If we count on papers we have millions of beds and health workers. But of no use when in need. Because our system is disease-focused. It is also time to get rid of the international development partners in the health sector and protect the national interest.


  Vertical Health Programs - Learning from COVID Top


During COVID times lets us look at Tuberculosis as a vertical health program. We aspire to eliminate TB by 2025. But extensive DOTS (Directly Observed Treatment, Short-course) infrastructure cannot treat chronic obstructive pulmonary diseases (COPD), bronchitis, Upper Respiratory Tract Infections (URTI), Smoking cessation, Cough and Cold or Covid or even fever. Undifferentiated febrile illness is the commonest morbidity in India. But we do not acknowledge it ever. In times of COVID pandemic, we had no option but to offer package treatment including doxycycline, azithromycin, and ivermectin along with multivitamins to manage COVID morbidity. A large number of specialists but not capable of handling a multi-system disease presenting as fever.

Did Korea, Singapore, Malaysia have a TB eradication program? All these were poor countries at a time. Did London get rid of cholera by the National Infection Diseases Program? Did Germany have a leprosy elimination program? Did Americans ever have any National Disease Control program? But In India, we continue to follow a selective disease-based vertical program. Cancer and Non-Communicable Diseases (NCD) are prevalent worldwide. But which country has a national control program on NCD or cancer. We have thirty-six national vertical disease-based programs. All these consume huge public health budgets at the cost of the general health system and against the average need of the population. This is the reason when someone goes to a government facility for diabetes he is offered vasectomy. Because funds are available for a vasectomy but not insulin. During COVID times, the system simply became overwhelmed with fever, cough, and cold.


  Health facilities and population coverage Top


One of the prime examples of public health schizophrenia is the national capital Delhi, the most resourceful place in India. Multiple agencies such as a municipal corporation, Delhi Government, Central Government and Cantonment Board are taking care of healthcare. But no coordination among themselves as they all continue offering different packages or services to the scattered population. Only if the Primary Health Centers (PHC) and Community Health Centers (CHC) had been resourced with oxygen and beds on a regular basis; would there have been this severe crisis?. Delhi's health system is in pandemic mode all the time for decades, with no beds available at hospitals. Doubling and tripling of beds at the large hospitals are considered and accepted as normal. All hospitals are overcrowded but dispensaries and health centers lay vacant; only refilling prescriptions of the specialists.


  The way forward: Call for a new public health order in India Top


It is not resources but capacity. Capacity to make any innovation or change. There is a need for a new public health order in India. A massive change; a massive reform. Covid is an opportunity to think, push for institutional capacity building, getting professionals to learn and evolve and develop their own programs and counter the impact of international Global Health initiative for India; that is mostly part of the geopolitical objectives of the dominant developed economies of the world. This is possible only through reforms in education. Public Health should be made a mandatory discipline for the MBBS curriculum which is non-existent at present. The present regulatory bodies of medical education are like granite statues. Within the health sector; the university, colleges have neither capacity nor intent or liberty to start any new independent program of learning. Anything that is not defined under the National Medical Commission Act automatically becomes untenable. Education is not about rotten degrees but about instituting new thinking, allowing minds to think and formulate; all requiring new knowledge creation.

As far as the COVID pandemic is concerned, we need to strengthen the general health system in India, and not yet another National Covid Control Program (NCCP) - Eliminate Covid by 2050; committing all national resources to one disease only. There is an urgent need for India to shift from selective primary health care to a comprehensive health care model. We have capacity and resources, we only need a national resolve! It is time to protect the national interest. We cannot keep ourselves artificially vulnerable for ever.

Disclaimer: The view point presented in this paper are author's own and not representative of any organization.






 

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