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CE's Office > ICDHI > Current Focus
Background
Current Focus
Publications of the Commission
Members of the Commission
The Third Report of the Independent Commission on Development and Health in India, which will be presented to the Government of India, is near to an end with a successful completion of the following studies .

• Mid – Term Review of the National Rural Health Mission
• Financing of the Health Care
• Health and Development Status in India
• Governance of Health Care in India – Has the State Abdicated its Role?
• Mainstreaming AYUSH – The Challenge of Integrative Medicine with special reference to NRHM


Some of the issues, the Commission intends to study in its Fourth Report are:
  • Health Insurance in India
  • Governance of the Health Sector in India – Has the State Abdicated its Role?
  • Role vis-à-vis Tobacco Campaign
  • Review of the Recommendations of the Commission of Macroeconomics and Health
  • Public – Panchayat – Private – Non Profit Partnership in Health Care
  • Social Determinants of Health
  • Voluntary Sector in Health Care – Scaling Up the Voluntary Sector and Assessment of their Role in the Health Care System

A Mid Term Review of National Rural Health Mission
National Rural Health Mission (NRHM) is a unique effort in post-independent India’s Health Sector. The Mission was launched on 12th April 2005, as a flagship programme of the Government to meet the rising concern on the state of rural health in difficult areas of the country with unsatisfactory health indicators.
Independent Commission on Development & Health in India (ICDHI) has played a significant role in highlighting the health concerns and challenges of India over the last decade through its ‘State of India’s Health Report’, Monographs, Investigations and Advocacy. Commission is concerned that the promises of NRHM are met substantially, if not fully. Keeping this in view the Commission decided to do a review of the current state of the art of the Mission.
For this review, eight States were selected on a random basis in discussion with the NRHM Director. Three districts in each State were selected on the basis of their performance on various health and development indices, a well performing district, one medium performing and a district with maximum discordance. Information was collected at the central, the state & district level. Study was done in close collaboration with the state governments, members of VHAI and grassroots level government health functionaries, including ASHA workers.
Findings from the eight states raise some important concerns. The Commission feels that NRHM can make very significant impact in the existing depressing rural health scene in most parts of rural India, if we can address the issues discussed in the Report pro-actively. We feel the Mission has embarked on an important journey of revamping the rural health sector in India and has made some initial progress.
Feedback letters on the Review Report received from eminent figures like Mrs Sonia Gandhi, UPA President, Shri Amar Singh, Member, Rajya Sabha and Chairman, Standing Committee on Health & Family Welfare among others share their reflection on the report findings.
(For further details mail at vhai@vsnl.com)

 
Governance of Health Care in India…Recent Monograph of ICDHI
Governance of Health Care in India – Has the State Abdicated its Role? authored by former Union Health Secretary Javed Chowdhury, is the most recent monograph of the Commission. Governance of Health Care has become a core concern in significantly improving the health status of the country.

Most of the governments globally are now accepting the fact that good governance, accountability and transparency provide critical underpinning to attain national goals in all spheres including health and form a corner stone of the government’s approach to improving public services. read more...
 

Governance of the Health Sector in India: Has the State Abdicated its Role?
Principal Investigator - Javid A. Chowdhury

Governance of Health Care has become a core concern in significantly improving the health status of the country. Most of the governments globally are now accepting the fact that good governance, accountability and transparency provide critical underpinning to attain national goals in all spheres including health and form a corner stone of the government’s approach to improving public services. In this study all the major facets of governance in the health sector have been reviewed to assess how the state is discharging its responsibility. Based on the analysis and other global experience, prescriptive suggestions have been made for the Indian Health System. The study does not believe that effective solutions lie in moving around the bureaucratic endeavors.

Rather it reinforces that regardless of whether health is a fundamental constitutional right or not, it is widely accepted across the globe that it is a central duty of governance. There is the need for an increased role of the state initiatives in the health system to attain the trust of the population. They will be expected to champion the whole of Government projects for advancing preventive and promotive health care, minimizing the burden of curative care. The study commends the discharge of numerous duties of governance in the health sector by the state in order to solve the wicked problems that are endemic to the country’s health system.

Shri Javid Chowdhury has been a proactive Health Secretary, Government of India. His contribution to the formulation of India’s National Health Policy is well known. His analysis of the Governance of the Health Sector of the country will benefit all concerned. He is a member of the Independent Commission on Development and Health in India. The publication will be an important learning tool for health professionals.
For further details contact vhai@vsnl.com.

Financing of Health Care in India: Issues and Concerns

Principal Investigator - Prof. Amit Shovan Ray

The study is based on broad econometric modeling, estimated health production functions. It maps health inputs to health outputs with states as the units of observation. The study comprises of the two state-level analyses (Orissa and Andhra Pradesh).
The study focuses on the following issues:

  1. Trends in health expenditure as % of SDP
  2. Trends in government health expenditure as % state budget
  3. Allocation for AYUSH
  4. Allocation for preventive/promotive versus curative care
  5. Source of funding from centre, state and external agencies
  6. Priorities for externally funded projects – whether donor
  7. Driven and if so how do they match with the "actual" priorities
  8. Extent of loans versus aid in external funding
  9. Debt repayment obligations of the state

It examines what sort of health insurance framework can be a reasonable arrangement for the universalisation of health care, while at the same time ensuring its financial sustainability.
Prof. Amit Shovon Ray is Chairperson, Centre for International Trade and Development, School of International Studies, Jawaharlal Nehru University, New Delhi. He is a member of the Independent Commission on Development and Health in India.

The study has been published in the bimonthly journal Health for the Millions – February – March 2008 Vol. 33 No. 6 & April-May 2008 Vol. 34 No. 1 issue. Other key contributors to this issue of HFM are Mr. Peter Bermen, Lead Economist, World Bank; Dr. H. Sudarshan, Hon. Secretary, VGKK, Karnataka; Prof. Ranjit Roy Chaudhury, former Chair, INCLEN; Prof. Mohan Rao, Centre for Community Medicine and Health, JNU.
For further details contact vhai@vsnl.com.

Mainstreaming AYUSH – The Challenge of integrative Medicine with Special Reference to NRHM

Principal Investigator - Dr. Darshan Shankar

The study offers some prescriptive suggestions on better ways of mainstreaming AYUSH into NRHM

Issues covered under the study

  • Experience of Tamil Nadu of co-location of AYUSH dispensaries to PHCs
  • Assessment of the role of AYUSH, to look at the NGO experiences (Karuna Trust) and others
  • Critical assessment if AYUSH system is making any contribution in preventive and promotive health care (Kerala)
  • Comparative analysis of financial allocations for some indicative diseases of allopathic and ayurvedic systems at the primary level.

Extract from the Study
“Mainstreaming AYUSH” has been a policy commitment of the Government of India since the 9th Five Year Plan. Perhaps it is more appropriate to call it a policy sentiment rather than a commitment because this policy has remained a mere statement of intent for more than a decade. The term mainstreaming implies a widespread application and utilization of Ayurveda, Yoga & Naturopathy, Siddha, Unani and Homoeopathy (AYUSH). It necessarily suggests AYUSH working side by side with its more dominant counterpart viz., allopathy, in a collaborative relationship. Mainstreaming therefore implies supporting initially a regime of functional integration. The term functional integration suggests allopathy and AYUSH systems functioning together under one roof, with an ethical code of cross-referrals and an educated appreciation of each others strengths and weaknesses. In the longer run mainstreaming would also suggest a new pluralistic regime of integrative medicine.

The author, Darshan Shankar is Founder & Advisor of the Foundation for Revitalization of Local Health Traditions (FRLHT), Bangalore. Currently he is Advisor (ISM), Planning Commission, Government of India; Convener, Working Group on Traditional Health Sciences of the National Knowledge Commission, Govt. of India; Member, Executive Board of Global Initiative for Traditional Systems (GIFTS), Oxford, U.K…… Columbia University’s Centre for Complementary & Alternative Medicines in 2002 gave its first International Award to Darshan Shankar & FRLHT, in recognition of FRLHT’s outstanding contributions to revitalization of traditional systems of health-care in India.

The study has been successfully completed and has been published in the VHAI bimonthly journal Health for the Millions – June – July 2008 & August - September 2008 Vol. 34 No. 2&3 issue. Other key contributors to this issue of HFM are Shri Shiv Basant, Joint Secretary to the Govt. of India, Department of AYUSH; Dr. Bhushan Patwardhan, Chief Academics, Manipal Education; Dr. Shyam Ashtekar, Director, YC Maharahtra Open University, Nashik; Dr. Leena Abraham, Associate Professor in Tata Institute of Social Sciences, Mumbai; Dr. Madhulika Banerjee, Reader in Delhi University; Dr. Mira Sadgopal and; Dr. Harish Naraindas, Reader in JNU

For further details contact vhai@vsnl.com.

Health and Development Status in India
Principal Investigator –Prof. Ashish Bose and Ms. Mithu Adhikary

Independent Commission on Development and Health in India every five years gives its report on the State of Health to the Prime Minister’s office, Ministry of Health and Family Welfare, Planning Commission, amongst others. The third report of the Commission is focusing on Governance and Financing of Health Care in India, Review of National Rural Health Mission and Mainstreaming of AYUSH system.

The Commission felt as a backdrop, we must do a thorough district wise analysis of the state of health of the nation. Prof. Ashish Bose, distinguished demographer and a member of the Commission, who has done a similar study in the recent past, was given this prodigious task of conducting an in-depth analysis of the Health Situation in India.

Prof. Ashish Bose and Ms. Mithu Adhikary undertook this massive exercise and conducted an in-depth decentralized analysis of India’s primary health care delivery system at the district level and each district with a colour code in the maps of the respective state so as to enable the policy makers, parliamentarians to identify immediately the degree of vulnerability of the districts. On the basis of his unique methodology, the senior researcher has identified each district in each state on the basis of infrastructure, staff and supply (SIS index) and performance as measured by the five indicators (given later). The data sources for this massive exercise have been, Facility Survey of RCH, DLHS (District Level Household Survey (2002-04) and Facility Survey (2003), Summary Report, (IIPS).

Analyzing the inter-state variations in the health status in India, the present study argues that the improvement in health status is an outcome of better Governance besides the provision of adequate infrastructure. Health status is thus not simply a process of linear progression in various sectors, independent of one another, but an interdependent and integrated process. The focus of study is on the degree of association between various health performance and infrastructure indices which need to be looked together to clearly identify the degree of vulnerability of the districts because sometimes it is really worrying, that inspite of investment in infrastructure, they are virtually non-performing; pointing towards bad governance of the health care.

This study has stopped short of providing solutions to the planners but it does indicate the malfunctioning of the healthcare system in a majority of districts in the country. It sees that building health systems that are responsive to community needs, particularly for the poor, requires politically difficult and administratively demanding choices. Health is a priority goal in its own right, as well as a central input into economic development and poverty reduction.

This study describes the status of the health system, discusses critical areas of management concerns, suggests health sector reform measures, and concludes by identifying the roles and responsibilities of various stakeholders for building health systems that are responsive to the community needs, particularly for the poor.
The study has been published in the VHAI bimonthly journal Health for the Millions – Oct – Nov, 2007 & Dec. 2007 – January 2008, Vol. 33 No. 4 & 5.

For further details contact vhai@vsnl.com.

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