Practices of Health

Management: Selective
Experiences

BLOCK 4
HEALTH CARE: PLANNING , POLICY AND
MANAGEMENT

201
Health Care: Planning, Policy
and Management BLOCK 4 HEALTH CARE: PLANNING ,
POLICY AND MANAGEMENT
Introduction
Health policy is undertaken to achieve specific healthcare goals within a society.
Health policy has a vision for the future; it outlines priorities and the expected
roles of different groups; and builds consensus and informs people. The policy
process encompasses decisions made at a national or state level that affect whether
and how services are delivered. Health care planning has undergone changes in
its structure, personnel and in its access of the populace on the basis of
recommendations made by different committees. The history of healthcare is
replete with pioneers whose discoveries led to strong opposition and sometimes
violent rejection by conservative elements and vested interests in medical, public
or political circles. The boundaries of healthcare have changed over time with
the perception of new health and social problems and with political, economic
and ideological shifts within the government and nations.

This block can be seen more as a planning, policy and implementation of health
care in rural India.

Unit 13 describe the Alma Ata Declaration and the turnaround of events in health
sector. It also explain the term primary health care and right to health in terms of
its postulates. This also critically analyse some of the major developments in the
history of health care and explain its significance in today’s world.

In Unit 14 development of health policy is elaborated. Health policy and planning

in India in different phases has been evaluated. Delivery of various National
Health Programmes under planning are critically evaluated. The challenges in
India’s health policy are looked in terms of accessibility, affordability is also
looked into.

Understand the existing role of technology in shaping rural health is explained

in Unit 15. Health Information Systems, Hospital Information System, Electronic
Health Records, telemedicine, e-health which are technology driven measures
health care are dealt. In this unitthe challenges and scope of health related
technologies, especially for rural India are also identified.

Unit 16 explain the role of government organizations in providing holistic

healthcare to its population. It also describe non-governmental healthcare
initiatives in India. It critically analyse how government and non-government
organizations can work together for ‘Health For All’.

In the end in this Block you will be able to understand the interface of technology
in health care. Technology made people constantly search for information about
their health on the internet now they have already got knowledge of the disease
before consulting a doctor. Pharmaceuticals are selling their products online,
hospitals are buying their products online, and billing insurance companies using
the internet, therefore the need for a drastic shift from the normal way of
conducting health affairs. The utilization of information technology can’t be
ignored within hospitals.

202
 Health Care: Historical
UNIT 13 HEALTHCARE: HISTORICAL Perspective

PERSPECTIVE

Structure
13.0 Objectives
13.1 Introduction
13.2 Evolution of the Concept of Health
13.3 Declaration of Alma Ata
13.3.1 The Rise and Fall of Alma Ata Declaration
13.3.2 Health Sector Reform: The World Bank Report, 1993
13.4 Right to Health
13.5 Sustainable Development Goals
13.6 National Health Policy, India
13.7 International Health Regulations (2005)
13.8 Let Us Sum Up
13.9 Key Words
13.10 References and Suggested Readings

13.0 OBJECTIVES
After reading this Unit, you should be able to:
explain the concept of health and the evolution and significance of holistic
healthcare;
describe the Alma Ata Declaration and the turnaround of events in its rise
and fall;
explain the term ‘primary health care’ and some of its postulates or
understanding;
explain the term ‘right to health’; and
critically analyse some of the major developments in the history of health
care and explain its significance in today’s world.

13.1 INTRODUCTION
Health is a positive multi-dimensional concept involving a variety of features,
ranging from ability to integrity, from fitness to well-being. Although science
has provided a foundation for healthcare, social values have shaped the system.
The history of healthcare is replete with pioneers whose discoveries led to strong
opposition and sometimes violent rejection by conservative elements and vested
interests in medical, public or political circles. The boundaries of healthcare
have changed over time with the perception of new health and social problems
and with political, economic and ideological shifts within the government and
nations.

203
Health Care: Planning, Policy
and Management 13.2 EVOLUTION OF THE CONCEPT OF HEALTH
The history of health has been one of identifying health problems, developing
knowledge and expertise to solve problems with rallying political and social
support around the solutions. According to the first principle of the constitution
of the World Health Organization “Health is a state of complete physical, mental
and social well-being and not merely the absence of disease or infirmity”. This
constitution was adopted by the International Health Conference held in New
York in 1946 and became operative in April 1948. This classical, seventy-year
old definition of the World Health Organization is now considered a historical
one and stands as a fundamental milestone.

The 1960s and 1970s wasan era of newly won independence from former colonial
powers for many countries. This independence was accompanied by an
enthusiasm to provide high-standard healthcare, education and other services
for the people. Governments moved to establish teaching hospitals and medical
and nursing schools, often with the assistance of donor nations. These tertiary
services consumed the largest portion of the country’s healthcare budget and
were available mostly in urban areas, creating access problems for the
predominantly rural societies. Healthcare services to the rural majority were
supplied by missionary hospitals and clinics or by touring services provided
from urban hospitals. There was a wide variety of services of varying standard
and quality in the rural areas with most of the population visiting traditional
healers. By the 1970s, the morbidity and mortality for rural communities was
not improving, and in some places they deteriorated. Developments such as oral
rehydration solutions, showed that early and appropriate intervention by carers
and village volunteers could avoid referral and admission to hospital and if
combined with an effectively organised vaccination program, would address the
major causes of death and illness. China, Tanzania, Sudan and Venezuela initiated
successful programs to deliver a basic but comprehensive program of primary
care health services covering poor rural populations. This new methodology for
healthcare service delivery incorporated a questioning of top-down approaches
and the role of the medical profession in healthcare provision and was known as
‘primary health care’.

During the 1970s, World Health Organization and UNICEF together addressed
the need for a fundamental change in the delivery of healthcare services in
developing countries, with an emphasis on equity and access at affordable cost
and emphasising prevention while still providing appropriate curative [Link]
was after that it was understood that primary health care reflects and evolves
from the economic, sociocultural and political conditions of the country and its
communities and is based on relevant application of social, biomedical and health
services research. Primary healthcare requires and promotes maximum
community and individual self-reliance and participation in its planning,
organization, operation and control, making fullest use of local and national
resources. It relies, at local and referral levels, on health workers, including
physicians, nurses, midwives, auxiliaries and community workers, traditional
practitioners and technical health teams to respond to community needs. It should
be sustained by integrated, functional and mutually supportive referral systems,
leading to progressive improvement of comprehensive health care with priority
to those most in need.
204
 Health Care: Historical
Check Your Progress I Perspective
1) Explain the concept of health as it is understood in the contemporary
times.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
2) How the concept of health has evolved over the years?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

13.3 DECLARATION OF ALMA ATA

While there had been a recognition of the importance of health as a reflection of
social determinants, this recognition was formalised into policy in 1978 with134
national government members of the World Health Organisation. The Declaration
made Primary Health Care the official health policy of all members countries
with health as a human right based on the principles of equity and community
participation. Alma Ata broadened the perception of health beyond doctors and
hospitals to social determinants and social justice. It is a history that started with
a consensus of the United Nations agencies supporting a view of health as a
human right and as a result of social determinants to a narrower view defining
universal health coverage as a focal point of policy implementation. The Alma
Ata Declaration stated that governments have a responsibility for the health of
their people which can be fulfilled only by the provision of adequate social
measures and that the people have the right and duty to participate individually
and collectively in the planning and implementation of their health care.

The Alma-Ata Declaration defined health as a state of complete physical, mental

and social well-being and not mere absence of diseases. This definition of health
along with the concepts of primary health care formed the two core principles of
this declaration. It recognised health as a human right – and to attain the same,
several social and economic sectors in addition to the health sector need to be
actively involved and show results.

The Declaration further affirmed the crucial role of primary health care, which
addresses the main health problems in the community, providing promotive,
preventive, curative and rehabilitative services accordingly. It stresses that access
to primary health care is the key to attaining a level of health that will permit all
individuals to lead a socially and economically productive life and to contributing
to the realization of the highest attainable standard of health through the following
key postulates: 205
Health Care: Planning, Policy 1) Healthis a state of complete physical, mental and social well-being and not
and Management
merely the absence of disease or infirmity. It is a fundamental human right
and the attainment of the highest possible level of health is the most important
world-wide social goal whose realization requires the action of many other
social and economic sectors in addition to the health sector.

2) The existing gross inequality in the health status of the people particularly
between developed and developing countries as well as within countries is
politically, socially and economically unacceptable and is, therefore, of
common concern to all countries.

3) Economic and social development, based on a New International Economic

Order, is of basic importance to the fullest attainment of health for all and to
the reduction of the gap between the health status of the developing and
developed countries. The promotion and protection of the health of people
is essential to sustained economic and social development and contributes
to a better quality of life and world peace.

4) People have the right and duty to participate individually and collectively
in the planning and implementation of their health care.

5) Governments have a responsibility for the health of their people which can
be fulfilled only by the provision of adequate health and social measures.

6) Primary health care is essential health care based on practical, scientifically

sound, socially acceptable and technologically accessible to communities
wrapped in the spirit of self-reliance and self-determination. It forms an
integral part of the country’s health system and the overall social and
economic development of the community. It is the first level of contact of
individuals with health care brought as close as possible to where people
live and work.

7) All governments should formulate national policies, strategies and plans of

action to launch and sustain primary health care as part of a comprehensive
national health system.

8) All countries should cooperate in a spirit of partnership and service to ensure

primary health care for all people since the attainment of health by people
in any one country directly concerns and benefits every other country.

A multi-sectorial approach was a strong pillar of Alma Ata Declaration. It declared

that unequal social and economic status within the country itself as well as among
the countries contribute to ill health and pronounced the urgent need to break or
at least reduce these huge gaps. Perhaps, the most important declaration was that
it held the governments responsible for taking care of the health of its citizens. It
envisaged universal coverage of basic services such as education on methods of
preventing and controlling prevailing health problems, promotion of food security
and proper nutrition, adequate safe water supply and basic sanitation, maternal
and child health, family planning, vaccination, prevention and control of locally
endemic diseases, appropriate treatment of common diseases and provision of
essential drugs. The emphasis changed from the larger hospital to that of
community-based delivery of services with a balance of cost-effective preventive
and curative programmes. The approach has been intersectoral, involving
206
agriculture extension officers, school teachers, women’s groups, youth groups Health Care: Historical
Perspective
and the community itself in the implementation of its own healthcare services
after being trained as a formal part of the healthcare system.

The conference went on to address the economic and political steps needed to
fund the initiative of an acceptable level of health for all people of the world by
the year 2000. It believed to attain the same through a fuller and better use of the
world’s resources and a genuine policy of independence, peace and disarmament
towards the acceleration of social and economic development of which primary
health care, as an essential part, should be allotted its proper share. National
governments throughout the world adopted PHC as their official blueprint for
total population coverage and goals and targets were set for achieving ‘Health
for All’ by the Year 2000. In the initial stages, nurses and health extension
officers were trained in clinical and preventive PHC interventions to work in
community health centres. Where there were gaps in the healthcare system, village
health workers were with community representatives having a central role in
planning and overseeing their healthcare services.

13.3.1 The Rise and Fall of Alma Ata Declaration

The Alma-Ata Declaration was endorsed by the 32nd World Health Assembly
held in Geneva in 1979, which approved a resolution acknowledging the key
role of primary health care for the attainment of acceptable health levels for
all. However, despite the initial enthusiasm, it was difficult to implement
healthcare in accordance with Alma-Ata principles. Early efforts at expanding
primary health care in the late 1970s and early 1980s were overtaken in many
parts of the developing world by economic crisis, sharp reductions in public
spending, political instability and emerging disease. The social and political goals
of Alma Ata provoked early ideological opposition and were never fully embraced
in market oriented, capitalist countries.

The efforts to dismantle Alma-Ata Declaration brick by brick began in the year
1979 when the Rockefeller Foundation sponsored a conference in Italy, wherein
it was argued that Alma-Ata’s Primary Health Care concept was expensive and
unrealistic. The cornerstone of Alma-Ata, which was community participation,
was struck down, and instead, a selective, politically sanitised version of PHC
reduced to a few highly prioritised technological interventions, determined not
by communities but by international health agents and experts was strongly
advocated. This came under the new label as Selective Primary Health [Link]
governments that largely catered to the interests of the rich were quick enough to
grab this as they had vested interests in the form of preserving status quo of the
unequal economic and social conditions. It was in response to this that in the
year 1983, UNICEF adapted ‘GOBI-FFF’(Growth monitoring, ORS,
Breastfeeding, Immunisation, Family planning, Food supplements and Female
education). Many governments just selected ORS and immunisation, which the
UNICEF proclaimed as ‘twin engines’ of child survival revolution. Several
corporate-friendly countries, USAID and World Bank which had shown scant
respect for the Alma-Ata Declaration, suddenly jumped onto the bandwagon and
pledged major financial support. By mid 1980s, virtually every underdeveloped
countries had launched GOBI-FFF intervention.

Politicians and aid experts from developed countries could not accept the core
PHC principle that communities in developing countries would have responsibility 207
Health Care: Planning, Policy for planning and implementing their own healthcare services. The concept of
and Management
‘Selective Primary Health Care’ advocated providing only PHC interventions
that contributed most to reducing child (< 5 years) mortality in developing
countries. The advocates of SPHC argued that comprehensive PHC was too
idealistic, expensive and unachievable in its goals of achieving total population
coverage. By focusing on growth monitoring, oral rehydration solutions,
breastfeeding and immunisation, greater gains in reducing infant mortality rates
could be achieved at reduced cost. In effect, SPHC took the decision-making
power and control central to PHC away from the communities and delivered it to
foreign consultants with technical expertise in these specific areas. These technical
experts, often employed by the funding agencies, were subject to the policies of
their agencies, not the communities. SPHC reintroduced vertical programmes at
the cost of comprehensive PHC.

The PHC versus SPHC debate continued throughout the 1980s with the following
arguments among others:
Many ordinary people felt PHC was a cheap form of healthcare and bypassed
this level to attend secondary and tertiary centres because of a lack of staff
and essential medicines at the PHC level.
Civil war, natural disasters and HIV affected the ability of PHC to maintain
comprehensive services, especially in many sub-Saharan countries.
Political commitment was not sustained after the initial euphoria of Alma-
Ata. Politicians saw PHC as a way to reduce expenditure in health and lacked
the political will to ensure that services were equitable.
Issues of governance and corruption in the use of resources resulted in donors
becoming very wary of funding comprehensive, broad-based programs.
Vertical, definable, time-limited programmes that could be changed every
few years suited both donor agencies and governments.

By 1990, many developing countries had started initiating privatisation and

liberalisation processes under the duress of World Bank and IMF. But when
‘Health For All by 2000’ was not achieved, several health activists from all over
the world sat down at Savar, in Dhaka leading to the People’s Health Movement,
with its presence in 70 countries campaigning for Health Rights, through People’s
Health Charter as a hope to revive the Alma-Ata Declaration.

Check Your Progress II

1) What was the Declaration of Alma Ata? State two of its postulates.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
208
 Health Care: Historical
2) Why did the Alma Ata Declaration fail? Perspective
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

13.3.2 Health Sector Reform: The World Bank Report, 1993

Changes in political and economic philosophy in the late 1980s and 1990s marked
a major change in how government services were delivered throughout the world.
The fall of the socialist eastern European bloc and China’s adoption of many
aspects of liberal economics were major features of this period. These reforms
had their roots in placing the emphasis on reducing government involvement in
all aspects of society. Market forces became the dominant model for service
delivery. Governments in resource-poor countries, which had already reduced
their expenditure on health as their foreign debt mounted, had to contend with
the new economic philosophy. International donors insisted these governments
adopt the market-driven economic reforms if they were to receive foreign aid
and debt relief.

It was against this background that the World Bank’s World Development Report
of 1993, ‘Investing in Health’, was [Link] reflected a marked change in
the orientation of how healthcare services in resource-poor countries would be
delivered with little reference to the term Primary Health Care. It considered the
delivery of healthcare services in terms of the economic benefit that improved
health could deliver. The report revolves around healthcare sector activities in
improving health with scant recognition to the role of other sectors, in stark
contrast with the original PHC’s multisectoral [Link] World Bank
approach came to be known as Health Sector Reform. This heralded an emphasis
on using the private sector to deliver healthcare services while reducing or
removing government services. User pays, cost recovery, private health insurance
and public–private partnerships became the focus for delivery of healthcare
[Link] did not give communities in developing countries a say directly or
indirectly in their health services with a sense of inequity, marginalisation and
frustration.

13.4 RIGHT TO HEALTH

The Right to Health is not new and is a fundamental part of the human rights.
Internationally, it was first articulated in the 1946 Constitution of the World Health
Organization as ‘the enjoyment of the highest attainable standard of health is
one of the fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition’.

Article 25.1 of the Universal Declaration of Human Rights deems that “Everyone
has the right to a standard of living adequate for the health of himself and of his
209
Health Care: Planning, Policy family, including food, clothing, housing and medical care and necessary social
and Management
services.”

Right to Health is fundamentally important in order to have a transparent and

quality health care service in the country and address health crisis as well as
scenarios like medical terrorism. Additionally, it bestows financial protection
for a vast majority of health care needs, bring down their out-of-pocket expenditure
on health care, keeping the sanity of right to freedom of healthcare intact.

The right to health is an inclusive right that includes safe drinking water and
adequate sanitation; safe food; adequate nutrition and housing; healthy working
and environmental conditions; health-related education and information and
gender [Link] right to health also mandates freedom including the right to
be free from non-consensual medical treatment such as medical experiments
and research or forced sterilization and to be free from torture and other cruel,
inhuman or degrading treatment or punishment. Further, the right secures non-
discriminatory health services, goods and facilities to the highest attainable
standard of health. Though not surprisingly, traditionally discriminated and
marginalized groups often bear a disproportionate share of health problems.

The right to health is also recognized in several regional instruments, such as the
African Charter on Human and Peoples’ Rights (1981), the Protocol of San
Salvador (1988) and the European Social Charter (1961, revised in 1996). The
American Convention on Human Rights (1969) and the European Convention
for the Promotion of Human Rights and Fundamental Freedoms (1950) also
contain provisions related to health, such as the right to life, the prohibition on
torture and other cruel, inhuman and degrading treatment and the right to family
and private life. The right to health or health care is recognized in at least 115
constitutions with six other constitutions that set out duties, such as the duty on
the State to develop health services or to allocate a specific budget to them.

The 1948 Universal Declaration of Human Rights mentioned health as part of

the right to an adequate standard of living in its Article 25. The right to health
was again recognized as a human right in the 1966 International Covenant on
Economic, Social and Cultural Rights. Since then, other international human
rights treaties have also recognized or referred to the right to health or to elements
of it (such as the right to medical care). The right to health is relevant to all states
and every state has ratified at least one international human rights treaty
recognizing the right to health. Moreover, states have committed themselves to
protecting this right through international declarations, domestic legislation and
policies and at international conferences. In recent years, increasing attention
has been paid to the right to the highest attainable standard of health, for instance
by human rights treaty- monitoring bodies, WHO and the Human Rights Council
to clarify the nature of the right to health and how it can be achieved.
The Right to Health contains the following entitlements:
The right to a system of health protection providing equality of opportunity
for everyone to enjoy the highest attainable level of health.
The right to prevention, treatment and control of diseases.
Access to essential medicines.
Maternal, child and reproductive health.
210
 Equal and timely access to basic health services. Health Care: Historical
Perspective
The provision of health-related education and information.
Participation of the population in health-related decision making at the
national and community levels
The term Right to health is mentioned as a fundamental right under Right to life
enshrined in Article 21 of the Indian Constitution. There are multiple references
in the Constitution to public health and on the role of the State in the provision of
healthcare to citizens:
Article 39 lays down principles of policy to be followed by the State:
that the health and strength of workers, men and women, and the tender age
of children are not abused and that citizens are not forced by economic
necessity to enter avocations unsuited to their age or strength;
that children are given opportunities and facilities to develop in a healthy
manner and in conditions of freedom and dignity and that childhood and
youth are protected against exploitation and against moral and material
abandonment.
Article 42 directs the State to just and humane conditions of work and
maternity relief.
Article 47 informs the State of its duty to raise the level of nutrition and the
standard of living and to improve public health.
The State regards the raising of the level of nutrition and standard of living of its
people, improvement of public health, bring about prohibition of the consumption
except for medicinal purpose of intoxicating drinks and drugs which are injurious
to [Link], the Constitution does not only oblige the State to enhance
public health, it also endows the Panchayats and Municipalities to strengthen
public health under Article 243G .
Human rights are interdependent, indivisible and [Link] the right
to health may actually impair the enjoyment of other human rights too. The
importance given to the underlying determinants of health beyond health services,
goods and facilities, shows that the right to health is dependent on and contributes
to the realization of other human rights. These include the rights to food, to
water, to an adequate standard of living, to adequate housing, to freedom from
discrimination, to privacy, to access to information, to participation and the right
to benefit from scientific progress and its applications.

Check Your Progress III

1) Explain the right to health. Highlight it in the context of Indian Constitution.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

211
Health Care: Planning, Policy
and Management 13.5 SUSTAINABLE DEVELOPMENT GOALS
The United Nations Millennium Declaration was signed in September 2000
towards committing world leaders to combat poverty, hunger, disease, illiteracy,
environmental degradation and discrimination against women. The Millennium
Development Goals were derived from this Declaration as a set of 8 goals that
all 189 UN Member States agreed to try to achieve by the year 2015. Each MDG
had targets set for 2015 and indicators to monitor progress from 1990 levels. At
the United Nations Millennium Summit in September 2001, heads of 147 states
endorsed the MDGs, nearly half of which concern different aspects of health.
India’s progress towards health related MDGs was mixed. The nation achieved
the required trend reversal in the fight against HIV/AIDS.

While on the worldwide platform, deliberations regarding MDGs were going on

as it was realised that they created by only a few stakeholders without adequate
involvement by developing countries and overlooking development objectives
previously agreed upon. It was understood that MDGs were unachievable and
simplistic, not adapted to national needs, do not specify accountable parties and
reinforce vertical [Link] MDGs have been superseded by the
Sustainable Development Goals, a set of 17 integrated and indivisible goals that
build on the achievements of the MDGs but are broader, deeper and far more
ambitious in scope, including new, interdependent challenges such as climate
change, economic inequality, sustainable consumption, peace and justice, among
others. Contrary to the MDGs, this inclusive agenda launched in September 2015
by the UN General Assembly, applies to all countries, rich and poor, although
each country is expected to push forward the different targets in accordance with
its own priorities.

Health has a central position in the agenda through SDG 3, and is closely linked
to over a dozen targets in other goals related to urban health, equal access to
treatments, and non-communicable diseases, among others. SDGs represent a
unique opportunity to promote public health through an integrated approach to
public policies across different sectors. While only SDG 3, to ensure healthy
lives and promote well-being for all at all ages, focuses on human health, all
goals are interrelated. For example, better education for girls (goal 4.1) would
improve maternal health (goal 3.1); tackling child malnourishment (goal 2.2)
would have a great impact on child health (goal 3.2); and ensuring access to safe
water (6.1) or tackling ambient air pollution (11.6) will evidently have a direct
impact on several SDG3 targets. On the other hand, using coal to improve energy
access (goal 7), would have a negative impact on health. The achievement of the
health goals will need policy coherence to reinforce synergies between certain
SDGs and minimise trade-offs.

Check Your Progress IV

1) Explain the significance and objective of good health in terms of the
Sustainable Development Goals.
.................................................................................................................
.................................................................................................................
.................................................................................................................
212
 Health Care: Historical
13.6 NATIONAL HEALTH POLICY, INDIA Perspective

The Ministry of Health and Family Welfare, Government of India, evolved a

National Health Policy in 1983 based on the preventive, promotive, public health
and rehabilitation aspects of healthcare. The policy stressed the need for
establishing comprehensive primary health care services to reach the population
in the remote areas of the country and recommended a decentralized system of
health care, the key features of which were low cost and participative with an
aim to reduce the government’s burden.

Going ahead, a revised health policy for achieving better health care and unmet
goals was brought out by government of India as the National Health Policy
2002 with the following objectives and key Strategies:
Primary Health Care Approach.
Decentralized public health system.
Convergence of all health programme under single field umbrella.
Strengthening and extending public health services.
Enhanced contribution of private and NGO sector in health care delivery.
Increase in public spending for health care.
Further in 2017, the Indian government revised the National Health Policy to
attain the highest possible level of health and well-being for all at all ages through
a preventive and promotive health care orientation in all developmental policies,
in line with the SDG-3 with support from the United Nations.

It is commendable that NHP-2017 recognizes the SDG’s to be of pivotal

importance, identifying seven priority areas outside the health sector which can
have an impact on preventing and promoting health, those being air pollution,
better solid waste management, water quality, occupational safety, road safety,
housing, vector control, and reduction of violence and urban stress.

With regard to the improvement of maternal and child health, the policy seeks to
address the social determinants through developmental action in all sectors. It
states that research on social determinants of health will be promoted, combining
this with neglected health issues such as disability and transgender health; while
giving importance on Panchayati raj institutions to play an enhanced role at
different levels for health governance, including the social determinants of health.

In highlighting the need for an empowered public health cadre, the NHP explains
the need to address social determinants of health effectively, by enforcing
regulatory provisions. The insertion of gender based violence in national
programmes, and the call for increased sensitization of health systems to provide
care free and with dignity in the public and private sector, are innovative
contributions to better health care. NHP is patient centric and quality driven
policy that addresses health security and Make-In-India for drugs and devices.
The policy proposes raising public health expenditure to 2.5 per cent of the GDP
in a time bound manner. It advocates extensive deployment of digital tools for
improving the efficiency and outcome of the healthcare system. It looks at
problems and solutions holistically with private sector as strategic partners. It
seeks to promote quality of care focusing on emerging diseases and investment
213
Health Care: Planning, Policy in promotive and preventive healthcare. It envisages private sector collaboration
and Management
for strategic purchasing, capacity building, skill development programmes,
awareness generation, development of sustainable networks for community to
strengthen mental health services, and disaster management. The policy also
advocates financial and non-incentives for encouraging private sector
participation.

The primary aim of the NHP 2017 is to inform, clarify, strengthen and prioritize
the role of the Government in shaping health systems in all its dimensions-
investment in health, organization and financing of healthcare services, prevention
of diseases and promotion of good health through cross sectoral action, access to
technologies, developing human resources, encouraging medical pluralism,
building the knowledge base required for better health, financial protection
strategies and regulation and progressive assurance for health. With NHP 2017
and related regulatory frameworks there is a sense of optimism that India will
make Sustainable progress towards attaining “Health for All” and the SDG targets.

Check Your Progress V

1) Explain the evolution of the National Health Policy of India over the
years.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

13.7 INTERNATIONAL HEALTH REGULATIONS

(2005)
The International Health Regulations (IHR), first adopted by the World Health
Assembly in 1969 are a legally binding instrument of international law that aims
for international collaboration to prevent, protect against, control and provide
a public health response to the international spread of disease in ways that are
commensurate with and restricted to public health risks and that avoid unnecessary
interference with international traffic and trade.

While the original International Health Regulations were founded in 1969, but
its underpinnings can be traced to the mid-19th century, when measures to tackle
the spread of plague, yellow fever, smallpox and cholera across borders, with as
little interference to global trade and commerce, were debated. To address the
realisation that countries varied with regards to their sanitary regulations and
quarantine measures, the first of these series of early international sanitary
conferences, convened in Paris in 1851. In 1948, the World Health
Organization Constitution came about and in 1951, issued their first infectious
disease prevention regulations, the ‘International Sanitary Regulations’, which
214
focussed on six quarantinable diseases; cholera, plague, relapsing Health Care: Historical
Perspective
fever, smallpox, typhoid and yellow fever. These were revised and renamed the
‘International Health Regulations’ in 1969.

In 2005, following the 2002–2004 SARS outbreak, changes were made to

overcome the following challenges against the backdrop of the increased travel
and trade characteristic of the 20th century:
narrow scope of notifiable diseases with the emergence of new infectious
agents (Ebola Haemorrhagic Fever in Zaire and the re-emergence of cholera
and plague in South America and India, respectively).
lack of a formal internationally coordinated mechanism to prevent the
international spread of disease.
With the signing of the revised International Health Regulations (IHR) in 2005,
the international community agreed to improve the detection and reporting of
potential public health emergencies worldwide. The 2005 IHR came into force
in June 2007, with 196 binding countries that recognised that certain public health
incidents, extending beyond disease, ought to be designated as a Public Health
Emergency of International Concern, as they pose a significant global threat. Its
first full application was in response to the swine flu pandemic of 2009.

IHR better addresses today’s global health security concerns and are a critical
part of protecting global health. The regulations require that all countries have
the ability to detect, assess, report and respond to public health events.
Detect: Make sure surveillance systems can detect acute public health events
in timely matter.
Assess and report: Assess public health event and report to WHO through
their National IHR Focal Point.
Respond: Respond to public health risks and emergencies.
While disease outbreaks and other acute public health risks are often unpredictable
and require a range of responses, the International Health Regulations provide
an overarching legal framework that defines countries’ rights and obligations in
handling public health events and emergencies that have the potential to cross
borders. The International Health Regulations represent an agreement between
196 countries who have agreed to build their capacities to detect, assess and
report public health events. WHO plays the coordinating role in IHR and, together
with its partners, helps countries to build capacities.

International Health Regulations also includes specific measures at ports, airports

and ground crossings to limit the spread of health risks to neighbouring countries
and to prevent unwarranted travel and trade restrictions so that traffic and trade
disruption is kept to a minimum. While previous regulations required countries
to report incidents of cholera, plague, and yellow fever, IHR (2005) is more
flexible and future-oriented, requiring countries to consider the possible impact
of all hazards, whether they occur naturally, accidentally or intentionally.

In spite of broader global agreement to the importance of IHR (2005), only about
1/3 of the countries in the world currently have the ability to assess, detect, and
respond to public health emergencies, leaving them vulnerable.

215
Health Care: Planning, Policy
and Management Check Your Progress IV
1) How do the International Health Regulations help its member countries
to fight public health responses?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

13.8 LET US SUM UP

The last few decades have seen the move of a consensus on a global health
policy across a wide range of experiences in successes and failures of policy
implementation. In today’s interconnected society, it’s more important than ever
to make sure all countries realise and understand the concept of health care to be
able to respond to and contain public health threats:

There is no ‘blue print’ for universal implementation of PHC policy. PHC is not
a biomedical intervention that is linear and generalisable. Unlike programmes to
eradicate specific diseases focusing on the need for specific personal behaviours
such as accepting immunisations or accessing clean water, PHC addresses a range
of approaches that support a change of both opinions and behaviours that only
happen over a long period of time and reflect a specific context amenable to
these changes. It depends on the ability of governments to raise funds, on the
availability of funds for the health sector and competing interests for their
allocation. It also depends on the availability of human resources to support
health programmes and on the structures to allocate and apply these resources to
specific programmes. Further, it depends on the organisation and management
of health care delivery in both government and non-government programmes.

National governments that have established Primary Health Care as a policy

focus and implemented this policy do not have the same programmes. For
example, Thailand has pursued Primary Health Care focused on Universal Health
Coverage. India and Ethiopia have focused on Community Health based Workers
(CHWs) programmes while Brazil created Family Health Teams composed of
one doctor, one nurse, one nurse assistant and between four to six CHWs.
Countries choose and develop programmes that best suit their context and needs.
Despite obstacles and limitations, these programmes have been sustainable and
have been noted as successes in getting health care to poor populations over a
long time period.

PHC policy implementation is a process that develops over time and with
experience. The process of primary health care planning and implementation
involves trial and error, learning from mistakes and responding with flexibility
to meet problems and needs. Seeing the implementation of PHC as a process
highlights the dynamics of the application of the intervention. It also highlights
the factors that encourage or limit the its acceptance or rejection. It demands a
recognition and investigation into both intended and unintended outcomes. It
216 demands a continual monitoring of what works, why does it work and how it
works. It also demands a continual interaction between policy makers, programme Health Care: Historical
Perspective
managers, health providers, intended beneficiaries and other stakeholders such
as non-government organisations and individuals and communities. When
programmes make achievements, health outcomes are seen in sustainable health
programmes particularly at the community level that have been able to address
issues around equity and community acceptance, involvement and support for
health improvements and health care delivery.

‘Health for All’ will remain a dream as long as it is formulated in purely

technocratic terms – drugs, nurses, doctors, vaccines and X-ray equipment. One
needs to look beyond the four walls of the hospitals where the real causes of ill-
health lurk. It could be unemployment, underemployment, poor housing with
overcrowding, lack of access to nutritious food and safe water, illiteracy and
gender inequalities. To overcome all this, people will need to be involved in
planning health programmes. And for that, a minimum understanding of health
is essential. So, in essence, social awareness and health go hand in hand.
Identifying this being an important component is known as community
involvement.

13.9 KEY WORDS

Health: Health is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity.
Healthcare: Health care is the maintenance or improvement of health via
prevention, diagnosis, treatment, recovery or cure of disease, illness, injury or
physical and mental impairments in people.
Primary Health Care: The healthcare service delivery model that reflects and
evolves from economic, sociocultural and political conditions of the country and
its communities with maximum community and individual participation is called
Primary Health care.
Declaration of Alma Ata:The Alma Ata Declaration was the recognition of the
importance of health as a reflection of social determinants, formalised into policy
in 1978 with 134 members countries of the World Health Organisation. It made
Primary Health Care the official health policy of all these countries with health
as a human right based on the principles of equity and community participation.
Right to Health: The Right to Health the enjoyment of the highest attainable
standard of health is one of the fundamental rights of every human being without
distinction of race, religion, political belief, economic or social condition. It is a
fundamental part of the human rights.

Millennium Development Goals: The United Nations Millennium Development

Goals (MDGs) are 8 goals that UN Member States have agreed to try to achieve
by the year 2015.

Sustainable Development Goals: The Sustainable Development Goals (SDGs)

were adopted by all United Nations Member States in 2015 as a universal call to
action to end poverty, protect the planet and ensure that all people enjoy peace
and prosperity by 2030.

217
Health Care: Planning, Policy International Health Regulations: The International Health Regulations (IHR),
and Management
first adopted by the World Health Assembly in 1969 are a legally binding
instrument of international law that aims for international collaboration to prevent,
protect against, control and provide a public health response to the international
spread of disease in ways that are commensurate with and restricted to public
health risks and that avoid unnecessary interference with international traffic
and trade.

13.10 REFERENCES AND SUGGESTED READINGS

Dabade, G. (2018, September 01). 40 Years After Alma-Ata, What Can We Do to
Achieve ‘Health for All’? Retrieved September 21, 2020, from [Link]
health/alma-ata-declaration-who-india-healthcare
Gillam, S. (2008). Is the declaration of Alma Ata still relevant to primary health
care? Bmj, 336(7643), 536-538. doi:10.1136/[Link]
Hall, J. J., & Taylor, R. (2003). Health for all beyond 2000: The demise of the
Alma Ata Declaration and primary health care in developing countries. Medical
Journal of Australia, 178(1), 17-20. doi:10.5694/j.1326-5377.2003.tb05033.x
Harrison, M. (2015). A Global Perspective: Reframing the History of Health,
Medicine, and Disease. Bulletin of the History of Medicine, 89(4), 639-689.
doi:10.1353/bhm.2015.0116
Healthcare Crisis: Healthcare Timeline. (n.d.). Retrieved September 25, 2020,
from [Link]
Home. (n.d.). Retrieved October 1, 2020, from [Link]
India’s National Health Policy 2017 and 2030 Agenda for Sustainable
Development. (n.d.). Retrieved November 5, 2020, from [Link]
publications/blog/indias-national-health-policy-2017-and-2030-agenda-for-
[Link]
International health regulations. (n.d.). Retrieved September 28, 2020, from https:/
/[Link]/health-topics/international-health-regulations
Millennium Development Goals (MDGs). (2017, October 17). Retrieved
November 06, 2020, from [Link]
development_goals/en/
The Right to Health [PDF]. (n.d.). WHO.

218
 Health Care: Historical
UNIT 14 HEALTH POLICY IN INDIA Perspective

Structure
14.0 Objectives
14.1 Introduction
14.2 Meaning of Health Policy
14.3 Health Policy and Planning in India Just After Independence
14.4 Health for All by the Year 2000 AD
14.5 Health Policy -1983:An Appraisal
14.6 National Health Policy-2002
14.7 National Rural Health Mission (NRHM) -2005
14.8 National Health Policy-2017
14.9 Ayushman Bharat Yojna
14.10 Delivery of National Public Health Programmes
14.11 Challenges and Management of Health Care
14.12 Let Us Sum Up
14.13 Key Words
14.14 References and Suggested Readings

14.0 OBJECTIVES
After studying this Unit, You will be able to:
understand the meaning of health policy;
discuss health policy planning in India over a period of time;
delivery of National Health Programmes; and
find out the challenges in health policy.

14.1 INTRODUCTION
Health care planning has undergone changes in its structure, personnel and in its
access of the populace on the basis of recommendations made by different
committees. After independence, India has initiated several policies and
programmes and global partnership has been introduced, so far expected results
has been not shown, therefore without the realization of the goals of the
programme of action of the millennium development which combines clear
theoretical thinking with realistic application. Though multi-sectoral approach
has been adopted at various stages, but still there is a need to be percolated these
aspects in the grass-root through trained and well skilled workers for sustainable
impact of health and family welfare programmes. In reality, the vast infrastructure
in health care facilities is able to cater only twenty per cent of the population and
eighty per cent of the people’s health needs are met my private health care
provision. Restricted access to health facilities leads to higher incidence of
morbidity and mortality. Further, it also forces people to have out-of-pocket
219
Health Care: Planning, Policy expenses which often lead to indebtedness. In rural areas and poor people in
and Management
urban areas are victim of the vicious circle of poverty, malnutrition and poor
health reinforcing each other.

14.2 MEANING OF HEALTH POLICY

Health policy can be defined as the decisions, plans, and actions that are
undertaken to achieve specific healthcare goals within a society. According to
WHO, an explicit health policy can achieve several things: it defines a vision for
the future; it outlines priorities and the expected roles of different groups; and
builds consensus and informs people. The policy process encompasses decisions
made at a national or state level that affect whether and how services are delivered.
Policy is in way national law that support different programmes related to it and
make intervention accordingly. When health policy is made, it is followed by the
operational policies. Operational policies are the rules, regulations, guidelines,
and administrative norms that governments use to translate policies into the field
situation whether they are to be delivered.

Health policy can be defined as the decisions, plans, and actions that are
undertaken to achieve specific healthcare goals within a society.

Check Your Progress I

1) What do you mean by health policy?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

14.3 HEALTH POLICY AND PLANNING IN INDIA

JUST AFTER INDEPENDENCE
With the advent of British Rule, every facet of Indian life– including the medical
and public health services– was subordinated to commercial, political and
administrative interests of the imperial (state) government in the United Kingdom
and its representatives in India. However, along with their own, the Britishers
also permitted native Indian elite also to avail of modern health care. Keeping in
view the constitutional directions aiming at elimination of poverty and ill health,
the Government of India, soon after Independence, planned several approaches
for health-care delivery. The basis of the health development policy in India was
laid in the recommendations of the Health Survey and Development Committees,
namely, Bhore Committee as early as in 1946, Mudaliar Committee (1961),
Chadah Committee (1963), Mukherjee Committee (1965), Jungalwala Committee
(1967), Jain Committee (1968), Kartar Singh Committee (1973), and Srivastava
220
Committee (1975). Besides the Committees, inputs have been provided by some Health Policy in India
studies on health policy, which were conducted by the autonomous institutions
like the ICSSR and the ICMR. The important recommendations by these
committees can be thematically grouped under the following: (a) for improving
the existing institutional structure of health care delivery system, (b) to improve
the supporting services for a proper and quick delivery of medi-care facilities,
and (c) to improve the quality of the delivery system thereby improve the health
standard of the masses (Nagla: 1993). Health care planning has undergone changes
in its structure, personnel and in its access of the populace on the basis of
recommendations made by different committees. Nagla (1993) has highlighted
the enormous efforts made by the various committees to chart out the growth of
health manpower in India. The works of these committees have, however, been
subject to serious data limitations. Information on different categories of health
personnel, their priorities and distribution (especially in respect to professionals
outside the public sector) has been rather scanty. The various committees and
even institutions like the ICSSR/ICMR study group have been focusing on
providing expert opinions rather than garnering accurate statistical data. No
committee has been able to take into account the contribution of non-governmental
health institutions and that of professionals in rendering health care services.
Perhaps more importantly, the committees have been unable to assess the health
care needs of the people through field surveys and ascertain the extent of utilization
of health care institutions and practitioners (Yesudin: 1981). Introduction of
economic reforms and liberalization has created space for social insurance
schemes introduced by public sector Life Insurance Corporation and by private
insurance companies, introducing medical insurance policies. This was the
initiation of public-private mix for health-care support in India.

14.4 HEALTH FOR ALL BY THE YEAR 2000 AD

In order to provide minimum basic health facilities, it was resolved by the Health
Assembly of the WHO to launch a movement known as “Health for All by the
Year 2000 AD”. In 1978, the Alma- Ata Conference reaffirmed Health for All as
the major social goal of all governments. In 1981, a global strategy for this
programme was adopted by the WHO, which was later endorsed by the United
Nations General Assembly. India is a signatory to those declarations and has
made efforts to extend health facilities to the vulnerable sections of its society.

Health for All has been defined as attainment of “a level of health that will enable
every individual to lead a socially and economically productive life” (Government
of India: 1982). The concept of “Health for All by 2000 AD implied a substantial
change in basic health policies and in the approaches to health care. In order to
provide minimum health facilities, the government of India along with state
governments increased the allocation to the health sector. A group set up jointly
by the ICSSR and ICMR with an alternative strategy to achieve health for all
citizens. It suggested certain steps for restructuring the health care service
infrastructure based on the principle of promoting the preventive and curative
aspects of health. This group felt that, “the growth of health care services in the
country has been haphazard and unrelated to the needs of poor and rural people
who stand most in need of health care”. The group remarked that several
assumptions on which present system is based were wrong. For instance, there
221
Health Care: Planning, Policy was no distinction between planning for health and that for health services so
and Management
that little or no attention has been paid to the social, economic, political and
cultural dimensions of health. The recommendations of the study group were
more practical and provided details of health services up to the village level. It
emphasized that most common illnesses can be self-cured and need only
symptomatic treatment with simple remedies, be it herbal, indigenous or allopathic
medicine. The diseases, which are communicable, can be controlled by preventive
measures, and can be readily diagnosed and treated with the help of cheap and
highly effective drugs. The group, therefore, proposed that primary health services
should be extended to the community through a trained and involved community
health volunteer preferably male or female, for a population of 1,000. To lift the
status of preventive and promotive aspects of medical services, the working group
has suggested that greater emphasis be given to departments of preventive and
social medicine.

14.5 HEALTH POLICY -1983: AN APPRAISAL

National Health Policy-1983, framed in a spirit of optimistic empathy for the
health needs of the people, particularly the poor and under-privileged, had hoped
to provide ‘Health for All by the Year 2000 AD’, through the universal provision
of comprehensive primary health care services. The genesis of health sector
reforms and its various dimensions are in built in Indian policy instrument and
its developmental framework. However, several pertinent issues in health sector
reforms have a bearing on our constitutional provisions– like equity, accessibility
of poor, efficiency in using resources and inadequacy of resources, gender bias,
quality of health care, impact of liberalization etc. It has been observed after
analyzing the health policy that the financial resources and public health
administrative capacity is inadequate and therefore the set goals for the policy
could not be achieved. The main recommendation of NHP is to increase the
broad-based availability of health services to the masses on the basis of realistic
considerations of capacity.

14.6 NATIONAL HEALTH POLICY-2002

The main objective of the NHP-2002 is to achieve an acceptable standard of
good health amongst the people especially the poor people. To make health
services available to the people, the decentralization of public health system is
targeted. It can be done by establishing new infrastructure in deficient areas and
by upgrading the infrastructure in the existing institutions. Importance was given
to the equitable access to the health services across all sections of society and
particularly the poor people and people living in remote areas. It was also
emphasized that aggregate public health spending will be increased by the central
government. In turn, this initiative can strengthen the capacity of the public health
administration at the State level to render effective service delivery. In NHP,
importance was given to the preventive and first-line curative initiatives at the
primary level through increased sectoral share of allocation. The rational use of
drugs within the allopathic system is also preferred. Increasing use of generic
drugs over the branded drugs is also pushed on particularly in the government
health facilities. Access to tried and tested systems of traditional medicine was
also ensured.
222
 Health Policy in India
The total expenditure in health expenditure is around 5.2 per cent of Gross
Domestic Product (GDP). However, the between 2012 and 2013 aggregate health
spending is expected to reach a rate of 5.5 per cent by 2013. Looking to these
figures it is concluded that the expenditure on public health services is very
meagre and below from the desirable standard. However, under the Constitutional
structure, public health is the responsibility of the States. Under the federal
structure it is the states that provide the health services to their population and
central government helps them in certain National programmes and national
Health initiatives. In NHP-2002 it was proposed that the central government
will spend 6 per cent of GDP, with 2 per cent of GDP being contributed as public
health investment by the year 2010. However, it is the failure of the government
that it has not done what it envisaged in the NHP-2002 (National Health Policy:
2002). To reduce these inequalities and imbalances at inter regional level, rural-
urban level, between different economic classes, caste groups, the primary health
sector is targeted. Primary health sector has been given importance over tertiary
and secondary health sector. The NHP- 2002 also projected that the increased
aggregate outlays for primary health sector will boost the existing facilities and
also opens the door for new primary health centres and sub-centres according to
the norms of such facilities. The policy for the eradication and elimination of
disease requires a major role of the central government with the active
participation of the State governments. In the public health facilities, the outdoor
funding is insufficient. The medical and para-medical personnel are also much
less of the prescribed norms. The availability of consumable items is negligible.
The equipment in many public health facilities is outdated or obsolescent and
unusable. Buildings are in the dilapidated. Some facilities are in the rented
accommodations. In the indoor facilities, there is insufficiency of beds, equipment
are obsolescent. Availability of essential drugs is minimal and the capacity of
facilities is grossly inadequate. Over-crowding is another feature in the public
health facilities which results into the steep deterioration of quality of health
services delivered to the people. This results into the decreasing use of public
health facilities i.e. around 20 per cent. Only less than 20 per cent seek out door
patient service and less than 45 per cent avail indoor facilities in the public health
facilities. This is the situation in spite of peoples’ inability to pay for the private
services and results into the out-of-pocket payments. In principle, this Policy
welcomes the participation of the private sector in all areas of health activities –
primary, secondary or tertiary. The policy is encouraging the private insurance
companies for increasing the coverage of secondary and tertiary sector under
health insurance packages. In the National Health Framework, the alternative
systems of medicine like Ayurveda, Yoga, Unani, Siddha and Homeopathy
(AYUSH) are also put under one umbrella to have their substantial role in the
health care.

14.7 NATIONAL RURAL HEALTH MISSION

(NRHM)-2005
National Rural Health Mission was launched in April 2005 in to provide health
care to the rural people particularly to the vulnerable section, children and women.
The basic aim is to provide comprehensive and integrated health care to the rural
masses. In this mission, there is a provision to provide every village with trained
223
Health Care: Planning, Policy female community health activist, known as Accredited Social Health Activist
and Management
(ASHA). She works as mediator between the community and the public health
system. These ASHA workers would not get any remuneration, rather they would
be provided only performance-incentives for promoting universal immunization,
referral and escort services for reproductive and child health and other
programmes. The Central government has framed this Rural Health Care Mission
at policy level, but it is the responsibilities of the State governments to executed
and support it.

14.8 NATIONAL HEALTH POLICY: 2017

The basic aim of National Health Policy- 2017 is to improve health status through
concerted policy action in all sectors and expand preventive, promotive, curative,
palliative and rehabilitative services provided through the public health sector
with focus on quality. The policy envisages as its goal the attainment of the
highest possible level of health and well-being for all at all ages, through a
preventive and promotive health care orientation in all developmental policies,
and universal access to good quality health care services without anyone having
to face financial hardship as a consequence. This would be achieved through
increasing access, improving quality and lowering the cost of healthcare delivery.
The policy gives importance to the Sustainable Development Goals (SDGs).
The policy aims to draw upon the diverse systems of medicine practiced in India
and the different sectors of healthcare provider. The policy acknowledges the
need for raising the level of public financing for health and determines to raise it
to 2.5 per cent of the GDP by 2025. It affirms that 70 per cent of funding should
go to primary healthcare, which is needed for comprehensive care and promotion
of well being. Health and wellness Centres are established which connects the
family on the basis of family cards. Health and Wellness Centre provides basic
health services, referral linkages and perform a gatekeeper function for advanced
care. More advanced care is opened for secondary and tertiary level medical
centres. ‘Fee for service’ model is adopted for secondary and tertiary care.
‘Capitation mode’ of payment will be there for primary care. Expanded
institutional capacity, and new courses and cadres are proposed to overcome the
shortages of skilled human resources in the health system. Essential drugs and
diagnostic are provided free of cost at public facilities.

14.9 AYUSHMAN BHARAT YOJNA

Ayushman Bharat (Long Life to India) was launched in 2018 and renamed as
Pradhan Mantri Jan Arogya Yojna (PMJAY). It proposes to convert 1,50,000
primary health sub-centres into Health and Wellness Centres (HWC). These
centres will be redesigned to provide a wide range of essential primary health
services close to home and will have both facility-based and community outreach
services. It will become a platform for health services related to maternal and
child health, communicable and non-communicable diseases, mental health and
common disorders. It is proposed that each HWC will serve 5000 persons. A
Primary health Centre (PHC) will have six HWCs connected to it. Along with
wellness promotion through integration of other systems f medicine, promotion
of healthy diets, regular physical activity, yoga, advocacy of tobacco avoidance
and substance abuse, vector control, sanitation, hygiene and clean water
224 programmes will be promoted.
 Health Policy in India
Check Your Progress II
1) Summarize the health policy just after independence.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
2) What was the basic goal of Health for All?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
3) What was the goal of National Health Policy of 1983?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
4) What is the main objective of National Health Policy of 2002?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
5) What is National Rural Health Mission?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
6) Give the critical point of National Health Policy of 2017.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
225
Health Care: Planning, Policy
and Management 14.10 DELIVERY OF NATIONAL PUBLIC HEALTH
PROGRAMMES
It is self-evident that in a country as large as India, which has a wide variety of
socio-economic settings, national health programmes have to be designed with
enough flexibility to permit the State public health administrations to craft their
own programme package according to their needs. Also, the implementation of
the national health programme can only be carried out through the State
Governments’ decentralized public health machinery.

Over the last decade or so, the Government has relied upon a ‘vertical’
implementational structure for the major disease control programmes. Through
this, the system has been able to make a substantial dent in reducing the burden
of specific diseases. However, such an organizational structure, which requires
independent manpower for each disease programme, is extremely expensive and
difficult to sustain. Over a long time-range, ‘vertical’ structures may only be
affordable for those diseases, which offer a reasonable possibility of elimination
or eradication in a foreseeable time-span.

It is a widespread perception that, over the last decade and a half, the rural health
staff has become a vertical structure exclusively for the implementation of family
welfare activities. As a result, for those public health programmes where there is
no separate vertical structure, there is no identifiable service delivery system at
all. The Policy will address this distortion in the public health system.

This policy envisages a key role for the Central Government in designing national
programmes with the active participation of the State Governments. Also, the
Policy ensures the provisioning of financial resources, in addition to technical
support, monitoring and evaluation at the national level by the Centre. However,
to optimize the utilization of the public health infrastructure at the primary level,
NHP-2002 envisages the gradual convergence of all health programmes under a
single field administration. Vertical programmes for control of major diseases
like TB, Malaria, HIV/AIDS, as also the RCH and Universal Immunization
Programmes, would need to be continued till moderate levels of prevalence are
reached. The integration of the programmes will bring about a desirable
optimization of outcomes through a convergence of all public health inputs. The
Policy also envisages that programme implementation be effected through
autonomous bodies at State and district levels. The interventions of State Health
Departments may be limited to the overall monitoring of the achievement of
programme targets and other technical aspects.

The Policy envisages that apart from the exclusive staff in a vertical structure for
the disease control programmes, all rural health staff should be available for the
entire gamut of public health activities at the decentralized level, irrespective of
whether these activities relate to national programmes or other public health
initiatives.

14.11 CHALLENGES AND MANAGEMENT OF

HEALTH CARE
The provision of health under Indian constitution is fall in State subject. Today
226 every state is free to formulate their health programme and strategy. In fact,
India was the first country in the world, who introduce family planning programme Health Policy in India
in 1952. Since Independence, we have invested lot in the health infrastructure
and created 1,45,000 sub centres, 2,3000 Public Health Centres (PHCs) and 3222
Community Health Centres (CHCs). However, this infrastructure is still
insufficient for the vast population, as still approximately eighty per cent of the
population is receiving health care from the private sector. Poor, access to public
health facilities heads to higher incidence of morbidity and mortality.

The poor people have an out-of-pocket expense which often leads to indebtedness.
The vicious circle of indebtedness leads to poverty, malnutrition and poor health.
They reinforce each other. In India, private households’ contribution to healthcare
is 75 per cent. Most of these costs are out-of-pocket costs. Private Expenditure
on Health (PHE) as a per cent of per capita income has almost doubled since
1961. Private Expenditure on Health has increased at much higher rate than the
per capita income over the period of time.

The ‘vertical’ or; categorical’ programmes were not properly conceived, too
techno-centric programmes, which are imposed by the western countries over
the poor developing countries without understanding of their specificity.
International Monetary Fund (IMF), while giving the loans has also imposed
certain conditionalities in the form of imposition of international initiative in
early phase of 1990s. The Structural Adjustment Programme (SAP) enabled the
entry into most important elements of the governance of the country in the form
of influencing budgetary allocations in the country. SAP has also given break
through to the market of private health sector rapidly. There is a sharp decline in
the government’s commitment to public health services which is reflected in
various plan outlays. India’s public Health expenditure in terms of its percentage
from the GDP, it is the fifth lowest in the World. Private sector has been provided
many subsidies and rebate in the import of medical instruments and for drugs.
India has the largest and least regulated private healthcare industry in the world.

The increasing role of the state in delivering health care services and the
consequent bureaucratization of health care delivery has created a divergence
between governmental goals and targets for collective health status and the
individual’s efforts to maintain health and well-being. While the lack of
governmental health care is found to adversely affect the health status of a
population, greater interference of medical services through the government
bureaucracy and the rapid diffusion of privatised medical care lead to inequality
of health status.

Universalization of health care is at the heart of health policy in India science

Independence in 1947. Since then, the country has experienced different models
to improve access to health services and ensure universal care to entire population.
Despite the proliferation of governmental and private initiatives, the majority of
the Indian population still has great difficulty in obtaining appropriate health
services. Along problems of spatial distribution of health services, other barriers
stand between patients and health care services.

Weaknesses in the public sector are noted across the entire chain of facilities,
from sub-centres to medical college hospitals. This has been due to inadequate
investment in infrastructure, human resources and equipment, compounded by
poor management.
227
Health Care: Planning, Policy The private sector has flourished due to the void created by the dwindling capacity
and Management
and competence of the public sector and aided by mismanagement and weak
regulatory system. The large corporate hospitals are charging high cost of care
and insensitive to human sufferings due to crass commercial considerations.

The models or public-private partnership (PPP) deployed so far have not worked
well because of poorly designed contracts, vaguely defined deliverables and
inadequately enforced accountability. The dependence on the private sector for
service delivery in government-funded health insurance schemes has yielded
valuable lessons on how unregulated partnership can lead to unintended
consequences of induced demand and unnecessary procedures.

The success or failure of the policy is mainly judged in its equity component. In
the framework of equity dimension, a marked emphasis has been given to the
expansion and improvement for the primary health facilities including the new
concept of provisioning of essential drugs through central funding. The
improvement in the health status of the people depends upon the quality of health
services. Increase in financial and material input is not only sufficient for
improvement in the health status but it also depends on more empathetic and
committed attitude in the service providers in the private and public sectors.
Ultimately it is the quality of the health services which matters for the enhanced
health status. In this backdrop, it needs to be recognized that any policy in the
social sector is critically dependent on the service providers treating their
responsibility not as a commercial activity, but as a service, albeit a paid one. In
the public health sector, an enhanced standard of governance is a prerequisite for
the success of any health policy.

Check Your Progress III

1) How vertical programmes are used for the disease control?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
2) Mentions the challenges encountered in health care.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

14.12 LET US SUM UP

This unit briefly summarizes the health policy and planning in India since
independence. Health care planning has undergone changes in its structure,
personnel and in its access of the populace on the basis of recommendations
made by different committees. After independence, India has initiated several
policies and programmes and global partnership has been introduced, so far
228 expected results has been not shown, therefore without the realization of the
goals of the programme of action of the millennium development which combines Health Policy in India
clear theoretical thinking with realistic application. Though multi-sectoral
approach has been adopted at various stages, but still there is a need to be
percolated these aspects in the grass-root through trained and well skilled workers
for sustainable impact of health and family welfare programmes. The
infrastructure in health still insufficient for the vast population, as still
approximately eighty per cent of the population is receiving health care from the
private sector. Poor, access to public health facilities heads to higher incidence
of morbidity and mortality. The poor people have an out-of-pocket expense which
often leads to indebtedness. The vicious circle of indebtedness leads to poverty,
malnutrition and poor health. They reinforce each other. In India, private
households’ contribution to healthcare is 75 per cent. Most of these costs are out
-of- pocket costs.

14.13 KEY WORDS

Health Policy: Health policy is a vision document for the future; it outlines
priorities and the expected roles of different groups; and builds consensus and
informs people.
Health for All: It has been defined as attainment of a level of health that will
enable every individual to lead a socially and economically productive life.
Out-of-Pocket Cost: Individual’s inability to pay for the private health services
results in out-of-pocket cost.
Fee-for-Service: It means providing payment for each hospitalization which
includes medical consultation, procedure or test performed.
Capitation Model: It is a fixed payment for a whole set of health services covering
a person or a family in year or any other defined period to cover healthcare costs
incurred for a person in a year.

14.14 REFERENCES AND SUGGESTED READINGS

Banerji, D. (1988), “New Public Health”, Journal of Sociological Studies,
Vol.7,pp.160-67.
Government of India (1946), Report of the Health Survey and Development
Committee (Bhore Committee), Report Vol.2, Delhi: Manager of Publications.
Government of India (1961), Report of the Survey and Planning Committee
(Mudaliar Committee), Vol.1, New Delhi: Ministry of Health.
Government of India (1963), Report of the Survey and Planning Committee
(Chadah Committee), New Delhi: Ministry of Health.
Government of India (1965), Report of the Health Survey and Planning Committee
(Mukherjee Committee), New Delhi: Ministry of Health.
Government of India (1975), Health Services and Medical Education: A
Programme for Immediate Action Report (Srivastava Committee), New Delhi:
Ministry of Health and Family Welfare.

229
Health Care: Planning, Policy Government of India (1985), National Health Policy, New Delhi: Lok Sabha
and Management
Secretariat.
Government of India (2002), National Health Policy 2002, New Delhi: Ministry
of Health and Family Welfare.
Government of India (2005), National Rural Health Mission: Indian Public health
Standards for Community Health Centres, New Delhi.
Nagla, Madhu (1993), “Health Policy and Planning in India”, in [Link] (ed.)
Development and Transformation: Themes and Variations in Indian Society,
Jaipur: Rawat Publications.
World Health Organisation (2001), Report of the Commission on Macroeconomics
and Health-Macroeconomics and Health: Investing in Health for Economic
Development, Geneva: WHO.
Yesudin, C.A.K. (1981), “Health Manpower Planning in India”, The Indian
Journal of Social Work, [Link], No.11, April.

230
 Role of Technology: Health
UNIT 15 ROLE OF TECHNOLOGY: HEALTH Statistics, GIS and Health
Information Systems
STATISTICS, GIS AND HEALTH
INFORMATION SYSTEMS

Structure
15.0 Objectives
15.1 Introduction
15.2 Conceptual Background of Technology
15.3 HIS (Health Information System)
15.3.1 Components of HIS
15.3.2 Evolution
15.3.3 Indicators
15.3.4 Uses and Purpose
15.3.5 Examples
15.4 Clinical Information System
15.5 GIS (Geographical Information System)
15.6 Health Statistics
15.6.1 Purpose and Sources
15.7 Planning for Rural Health Using GIS, HIS and Health Statistics: Some
Examples
15.8 Let Us Sum Up
15.9 Key words
15.10 References and Suggested Readings

15.0 OBJECTIVES
After reading this Unit, you will be able to:
understand the existing role of technology in shaping rural health and the
future ahead;
define HIS, GIS, telemedicine, e-health; and
identity the challenges and scope of health related technologies, especially
for rural India.

15.1 INTRODUCTION
Most of the developing countries are facing a significant problem within the
sector of health care. Technology made people constantly search for information
about their health on the internet now they have already got knowledge of the
disease before consulting a doctor. This change has not only affected the patients
but also other stakeholders too. Pharmaceuticals are selling their products online,
hospitals are buying their products online, and billing insurance companies using
the internet, therefore the need for a drastic shift from the normal way of
conducting health affairs. Hence the utilization of information technology can’t
be ignored within hospitals. 231
Health Care: Planning, Policy The healthcare sector represents an enormous opportunity to leverage technology
and Management
to enhance critical processes that today pose a huge challenge within the delivery
of quality [Link] include reaching millions who are geographically spread
across the country, providing a far better and more accurate diagnosis, managing
operations, and facilitating effective collaboration and dialogue between doctors
and healthcare workers. The health care condition is very poor and it is a
challenging issue mostly in proving health care services to people living in rural
and remote areas. The application of technology has brought tremendous signs
of progress in the health care sector. Especially the Information Communication
and Technology (ICT) have a growing influence on all areas of human life. In an
effort to cope up with the growth, the developing countries have endeavoured to
transform the healthcare industry by use of Information Technology in different
ways. The technologies can improve the quality, safety, and efficiency of health
services and delivery. The health information units within the nation should get
provided and actively engaging other sectors such as education, planning,
statistics, finance, ICT to accelerate reliable health information. Health
information is a national asset, balancing affordability, accessibility and efficiency
are important to universal health care systems.
Approximately 70 per cent of India’s population residing in rural areas. Rural
and urban areas differ in several ways, including demography, environment,
economy, social construction, and availability of resources. There are significant
health disparities and access to care issues that are specific to rural areas. The
state of local communities in rural areas is often considered inadequate since the
standard of medical care provided in rural areas has generally been appeared to
be substandard to that of the urban settings. The reason being that the rural
inhabitants are in general more likely than urban inhabitants to have the lower
educational achievement, experience high unemployment, live in poverty, and
additionally are more likely to be ineligible for welfare benefits. Additionally,
when it involves accessing to health care, the rural population has been viewed
as vulnerable with reference to access to healthcare due to poorly established
and fragile health infrastructures, the high prevalence rate for chronic illness and
disability, socio-economic hardships, and physical barriers like distance including
lack of public transportation.
Growing up in India, where the mainstream has minimal access to basic public
amenities like healthcare, one develops an appreciation for the significance of
enabling such technologies that assist and scale service delivery within the context
of developing countries. Technology is often transformative in delivering
healthcare services, where the density of doctors is one per 1,000. A strong
imbalance exists where urban areas have fourfold as many medical practitioners
compared to rural areas, making rural India grossly underserved. The quality of
education of providers (allopathic, ayurvedic, unani, and homeopathic) isn’t
similar between rural and urban areas. When 58 per cent of the doctors in urban
areas had a medical degree, only 19 per cent of these in rural areas had that
qualification. The country is 81 per cent in necessity of specialists at rural
Community Health Centers (CHCs), and therefore the private sector
interpretations for 63 per cent of hospital beds, reliable with government health
and family welfare statistics.

232
E-health are often termed as any electronic exchange of health-related data through Role of Technology: Health
Statistics, GIS and Health
electronic connectivity for enlightening competence and effectiveness of health Information Systems
care delivery. The solutions that are provided through e-health initiatives within
hospitals include Hospital Information Systems (HIS), telemedicine services,
Electronic health records, and Internet services. Telemedicine is a powerful tool
that permits medical experts to be received beyond the boundaries of a medical
facility. It saves many of dollars in patient travel costs and missed appointments.
However, telehealth isn’t new to India and has been around for over a decade
now. Health systems across the country have the chance to make a meaningful
impact by adopting scalable telemedicine technologies.

Today, we are living healthier and longer lives. Building a healthcare system
that effectively manages care for the people is inevitable. Even though we’re
among the youngest country within the world, this is often a particular state and
is merely a matter of time before it becomes a priority. If planned and implemented
well, technological progress can make a significant contribution to India’s
healthcare needs. Such an investment would impact generations to return with
lower healthcare costs and put India on the world map as a rustic to be reckoned
as an idea leader in adopting digital health.

15.2 CONCEPTUAL BACKGROUND OF

TECHNOLOGY
Technology plays an important role within the maintenance and tracking of service
quality. The health information is a crucial tool to enhance the quality, safety,
effectiveness, and delivery of healthcare services in rural communities. Health
Information System can connect rural patients and providers in remote locations
to specialists in urban areas. Implementing, maintaining, updating, and optimizing
HIS can be an ongoing challenge for rural facilities and providers with limited
resources and expertise. It uses technology to store, secure, retrieve, and transfer
protected health information electronically within healthcare systems and
community settings. Health information technology is a broad term encompassing
a compilation of technologies and programmes to research, house, and share
health information.

The health information technology has some important components they include
Electronic Health Records (EHR) for patients, rather than paper records, secure
digital networks to send and deliver up-to-date records whenever and wherever
the patient or clinician may need them, electronic transmittal of medical test
results, telehealth applications to increase access to providers, tele monitoring
applications that allow patients to transmit vitals or diagnostic information to
providers remotely, confidential and secure patient health portals for patients to
access their personal health information online, transmission between healthcare
providers, also patients, electronic prescribing and ordering to help avoid medical
errors, decision support systems to provide clinicians with information on best
practices and treatment options to improve quality of care, mobile devices and
tablets to update patient records in real time and document at the point of care.
Adoption of technology features a long-term impact on cost, and hence there
must be more intentional effort to take a position in technology and adopt this
high up-front. It means investing in training and hiring manpower, paying for
servers, adoption and implementation costs at the healthcare facilities, which
can buy themselves within the future. 233
Health Care: Planning, Policy In rural areas health information technology works to make sure efficient,
and Management
coordinated, and secure healthcare information exchange for patients who receive
healthcare services from multiple providers or in multiple locations. It allows
patients the opportunity to engage in the provision of their healthcare by tracking
health conditions, accessing provider visit notes, and test [Link] diversity
and vastness of the country can pose some of the hardest problems to tackle, but
the adoption of technology also comes with its share of challenges. The
convergence of technological solutions with data analytics, cloud computing,
telecommunications, and wireless technologies will improve accessibility and
manage labour shortages more efficiently within the healthcare industry. Benefits
derived include easy accessibility regardless of geographical location, fewer
errors, fast response for emergencies, and improved patient experience. The cost
of providing medical services has also been rising steadily. As technological
innovation better incorporates with healthcare delivery, it will enable scale and
lower costs, driving up adoption. And adoption are going to be further focused
by the automation of critical processes at hospitals in administration, finance,
billing, patient records and pharmacies. Policies have always been the most
important influencers to implement behavioural change, but technology are often
as impactful when it involves changing the way services are delivered.

15.3 HEALTH INFORMATION SYSTEM (HIS)

A Health Information System is a system considered to manage healthcare data
and it refers to a system that captures, stores, transmits or then manages health
data or activities. These systems are used to collect, process, practice, and report
health information. A health information system as the information processing
and information storing subsystem of a health care organization, which can be a
single institution, for instance, a hospital, or a group of health care institutions
sort of a health care network. As an integrated effort, these could also be leveraged
to enhance patient outcomes, inform research, and influence policy-making and
decision-making. Because health information systems commonly access, process,
or maintain large volumes of sensitive data, security is a principal disquiet. Health
information technology (HIT) encompasses the development of health information
systems. The main functions of a health information system are to monitor, inform
and evaluate a health system and to form clinical and management decisions.
HIS for improving the efficiency of any health system, there is a requirement of
relevant, timely, and accurate information on its current performance. The purpose
of HIS is to provide this information HIS is a tool of management, HIS may be in
place at various levels, it may be for one single hospital, a single district, state,
and national level and international level. It is defined as a mechanism for the
collection, processing, analysis, and transmission of information required for
organizing and operating health services and also for research and training. The
primary objective of HIS is to provide reliable, relevant up-to-date, adequate
timely, and reasonably complete information for health managers at all levels.
Early detection of suspected disease outbreak to enable timely initiation of
response efforts, this will reduce the number of cases and deaths during an
outbreak. Monitor trends in health status and identify changing health care
priorities, the monitoring health status allows health managers to observe trends
in the health profile of a population, detect the emergence of new health problems
and continually address public health priorities and also evaluating the
effectiveness of programmes. The ultimate objective of HIS is not to gain
234 information but to improve action.
Health Information Systems is a broad category that encompasses several specific Role of Technology: Health
Statistics, GIS and Health
and here is some of the most common HIS types are: a) Strategic or Operational Information Systems
Systems are typically used for information classification. Provisions are made
for information systems based on the type of information they’re handling. A
pyramid classification system allows organizations to assess the spread of
digitization. Because operational systems are generally developed before
executive information systems or management information systems, this is easily
achieved. The ability to evaluate dependencies can help to identify system
deficiencies, as well. For example, a properly configured information system
should pull data from a clinical system rather than require nurses and clinicians
to collect and document data manually. b) The Clinical and Administrative
Systems for Managing Patient Information on an Administrative Level that is
the clinical systems are dependent on administrative data. The foundation of an
integrated HIS is a master index developed around the most basic patient
information with links to different clinical systems, and the clinical system
contains the electronic patient record (EPR), diagnostic data, outcomes, and
processing. c) Electronic Health Record (EHR) and Patient Health Record, the
open EHR aims to enable semantic interoperability for health information systems
between various EHR systems in a non-proprietary format to prevent vendor
lock-in. Knowledge concepts are stored outside the EHR as archetypes, which
support the recording of clinical information. Archetype building blocks include
instructions, evaluations, observations, and actions, and information built using
these building blocks is stored in the EHR. d) Subject- and Task-Based Systems
are related to patients or healthcare professionals in any type of healthcare
organization. Task-based systems, on the other hand, are associated with particular
tasks such as admission or discharge. Subject-based systems are often preferred,
as they reduce data duplication. In a task-based system, the same subject could
be related to various tasks, with basic information such as the patient’s ID being
duplicated across each task. In a subject-based system, this basic information is
entered only once and flows with the subject through various tasks. For example,
an EHR is a subject-based system. e) Financial and Clinical Health Information
Systems these systems provide easy access to patient financial information, such
as costs and payors, and they also aid in monitoring patient usage of different
departments or services. Financial systems typically include invoicing capabilities
as well as tools for following up on non-payment. f) Decision Support Systems
convert data to clinically relevant information and present it in the actionable
form to clinicians, aiding in adherence to regulatory guidelines and best practices.
These systems can give results for several data manipulations to mimic cognitive
processing. For example, a decision support system may provide a list of
medications for a particular condition appropriate for the patient’s demographics,
such as the patient’s age and weight, as well as any comorbidities. Decision
support systems can also facilitate next step in the workflow, such as submitting
a prescription to the pharmacy and scheduling a follow-up appointment for the
patient.

Information is crucial at all management levels of the health services from the
periphery to the center. It is required by policy makers, managers, health care
providers, health workers. The HIS is important to a country because good
management is a prerequisite for increasing the efficiency of health services and
an improved HIS is clearly linked to good management.

235
Health Care: Planning, Policy
and Management
15.3.1 Components of HIS
Health Information System are part of the extensive statistical system, which
includes non-health sectors like education and employment. Utmost traditional
HIS collect data at a granulated level by various means such as surveys, clinical
observation, diagnostic testing or through management and financial information
systems. They concentrate on individuals (citizens, patients, health care
providers), features of the services they need, use or deliver, the resources required
to deliver those services and the impacts that they attain. Those data are then
combined, analysed and reported in several ways to generate summary information
for use by service providers, managers, planners, researchers, commentators and
others with an interest in the health sector. Collecting, analysing and sharing
health information is a complex process that requires a clear understanding of its
underlying components and how these components interact. The Components
and standards of a Health Information System includes the following:
1) HIS resources, such as appropriately trained staff, fiance, logistics support
and context-specific technologies. These resources (or inputs) must be
situated within the broader legislative, regulatory and planning framework
of a country.
2) Indicators, the basis of a HIS strategic plan must include a core set of
indicators and related targets that can provide a picture of the determinants
of health, health system condition, and the status of population health.
3) Data sources,like civil and vital registration (births, deaths and cause-of-
death), censuses and surveys, medical records, service records and financial
and resource tracking.
4) Data management, includes data collection, storage, quality, flow, processing,
compilation and analysis.
5) Information products, the transformation of data into information and
therefore into a tool for evidence based decision-making that will lead to
improved health.
6) Dissemination and use, increasing the value of health information by making
it accessible to decision-makers and providing incentives for the use of health
information.

The HIS is composed of several related subsystem which are: 1) Demography

and Vital events (D), 2) Environment and health statistic (E), 3) Health Status:
mortality, morbidity, disability and quality of life (S), 4) Health Resources:
facilities, beds, map power (R), 5) Utilization and non-utilization of health
services: attendance, admissions, waiting lists (U), 6) Indices of Outcome of
medical care (O), 7) Financial Statistics (cost, expenditure) related to the particular
objective (F).

15.3.2 Evolution
Healthcare information systems that can record and locate important information
quickly have become a standard practice in many healthcare organizations. Here
summarizing the milestone of development for HIS were considered as important:
(1) the shift from paper-based to computer-based processing and storage, as well
as the increase of data in health care settings; (2) the shift from institution centered
236
departmental and, later, hospital information systems towards regional and global Role of Technology: Health
Statistics, GIS and Health
HIS; (3) the inclusion of patients and health consumers as HIS users, besides Information Systems
health care professionals and administrators; (4) the use of HIS data not only for
patient care and administrative purposes, but also for health care planning as
well as clinical and epidemiological research; (5) the shift from focusing mainly
on technical HIS problems to those of change management as well as of strategic
information management; (6) the shift from mainly alphanumeric data in HIS to
images and now also to data on the molecular level; (7) the steady increase of
new technologies to be included, now starting to include ubiquitous computing
environments and sensor-based technologies for health monitoring.

Eventually the health system is experiencing a paradigm shift, moving from

‘Industrial Age Medicine to Information Age Healthcare’. This ‘paradigm shift’
is affecting healthcare systems and renovating the healthcare patient relationship.
For instance, the World Wide Web has changed the way the public engage with
health information. Here represents show the world level transitions in the Health
information system.

In the 1960s, the main healthcare drivers in this era were Medicare and Medicaid.
The IT drivers were expensive mainframes and storage. Because computers and
storage were so large and expensive, hospitals typically shared a mainframe.
The principal applications emerging in this environment were shared hospital
accounting systems.

During the 1970s one of the main healthcare drivers in this era was the need to
do a better job communicating between departments (order communications,bed
control and results in review) broadened administrative systems, departmental
systems processing and the need for discrete departmental systems (e.g., clinical
lab, pharmacy). Computers were now small enough to be installed in a single
department without environmental controls. As a result, departmental systems
proliferated. Unfortunately, these transactional systems, embedded in individual
departments, were typically islands unto themselves.

In the 1980s the healthcare drivers were heavily tied to DRGs and reimbursement.
For the first time, hospitals needed to pull significant information from both
clinical and financial systems in order to be reimbursed. At the same time, personal
computers, widespread, non-traditional software applications, and networking
solutions entered the market. As a result, hospitals began integrating applications
so financial and clinical systems could talk to each other in a limited way.

The 1990s in this decade, competition and consolidation drove healthcare, along
with the need to integrate hospitals, providers, and managed care. From an IT
perception, hospitals now had access to broad, distributed computing systems
and robust networks with cheaper hardware and storage. Therefore, we created
an integrated delivery networks (IDN)–like integration, including the impetus to
integrate data and reporting.

The 2000s, the main healthcare drivers have increased integration and the
beginnings of outcomes-based reimbursement. We now had enough technology
like more of everything Mobility Emerging cloud computers and cloud-based
big data analytics and bedside clinical applications installed to make a serious
run at commercial, real-time clinical decision support.

237
Health Care: Planning, Policy As the decades passed, the most commonly implemented systems were those
and Management
designed to automate transactions, either in a clinical or administrative context.
An obvious result of more transaction systems installations was the dramatic
increase in readily available digitized data. Another focus of hospital information
system implementation over the years has been reporting. Reporting systems
typically exist as components of transaction systems. Historically, this reporting
provided snapshots of information about the hospital to management, the board,
or other groups. Analytics requires more than mere reporting; health systems
must support the ability to drill down into this comprehensive, merged data to
achieve real insight into operational performance.

Now we find ourselves in the 2010s. The healthcare drivers are accountable care
organizations (ACOs) and other value-based purchasing initiatives, a need for
cost and quality-control systems, and a broadening genomic influence on personal
care. Our main IT driver is pervasive computing. We have microprocessors
everywhere. We’ll be seeing more and more of them, along with the proliferation
of data. IT in the industry has broadly implemented EMRs and operational data
systems, and, ultimately, these EMRs will have pervasive clinical decision
support. Knowledge gained from analyzing an organization’s data in search of
performance improvement insights will complete the operational systems cycle
by refining the rules essential for successful clinical decision support. These
efforts are highly complementary.

The concerned authorities must be actively engaged in a strategy that results in

the capture and analysis of comprehensive data, which enables the health system
to become an organization that is constantly improving and learning.

Check Your Progress I

1) Elaborate the role and components of HIS.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

15.3.3 Indicators
Indicators of country health information system performance can be grouped
into two broad types, namely: first one is indicators related to data generation
using core sources and methods (health surveys, civil registration, census, facility
reporting and health system resource tracking); the second one is indicators related
to country capacities for synthesis, analysis and validation of data. Indicators of
data generation reflect country capacity to collect relevant data at appropriate
intervals and using the most appropriate data sources. Scales include periodicity,
timeliness, and contents of data collection efforts and availability of data on key
indicators. Indicators of country capacity measure key dimensions of the
238
institutional frameworks needed to ensure data quality including independence, Role of Technology: Health
Statistics, GIS and Health
transparency and access. Scales include the availability of independent Information Systems
coordination mechanisms, and the availability of micro data and metadata.
The indicators selected represent various areas of the HIS Strengthening Mode:
Some of the Indicators are the following:
1) Country has a national health strategy (year),
2) Country has a health sector monitoring and evaluation plan (M&E),
3) Country has Health Information System policy (year),
4) Country has an HIS strategic plan (year),
5) Country has set of core health indicators (year updated),
6) National HIS coordinating body,
7) Country has master facility list (year updated),
8) Conducted Health Metrics Network (HMN) assessment (year)
9) Population census (within the last 10 years),
10) Availability of national health surveys,
11) Completeness of vital registration (births and deaths),
12) Country has electronic system for aggregating routine facility and/or
community service data,
13) Country has national statistics office,
14) National health statistics report (annual),
15) Country’s ministry of health has an updated website,
16) Data quality assessment (DQA) conducted on prioritized indicators aligned
with most recent health sector strategy (year of most recent),
17) PRISM assessment conducted in any regions/districts,
18) Percentage of facilities represented in HMIS information
19) Proportion (facility, district, national) offices using data for setting targets
and monitoring,
20) Measles coverage reported to World Health Organization (WHO)/UNICEF,
21) Number of institutional deliveries (births) available by district and published
within 12 months of preceding year,
22) Existence of policies, laws, and regulations mandating public and private
health facilities/ providers to report indicators determined by the national
HIS,
23) Availability of standards/guidelines for RHIS data collection, reporting, and
analysis,
24) Presence of procedures to verify the quality of data (accuracy, completeness,
timeliness) reported,
25) RHIS data collection forms allow for disaggregation by gender,
26) At least one national health account completed in last five years,
27) National database with health workers by district and main cadres updated
within the last two years,
28) Annual data on availability of tracer medicines and commodities in public
and private health facilities,
29) e- Health strategy,
30) Completeness of disease surveillance reporting. 239
Health Care: Planning, Policy
and Management
15.3.4 Uses and Purpose
The HIS is mainly used to measure the health status of the people and to quantify
their health problems and medical and health care needs. It is used for local,
national and international comparisons of health status, for such comparisons
the data need to be subjected to rigorous standardization and quality control. For
planning, administration and effective management of health services and
programs and for assessing whether health services are accomplishing their
objective in terms of their effectiveness and deficiency or evaluating the health
services. And also the HIS is using for research into particular problems of health
and disease.

Health information underpins the entire health system: it strengthens stewardship,

can be used in strategic planning and priority-setting, as well as within clinical
diagnosis and management, quality assurance and improvements, and global
epidemics. Healthcare information promotes excellence in care; describes the
types of people using a service and the types of services received; helps coordinate
services; provides meaningful information on the health status of the community;
and ensures accountability. The resolution calls upon the need to identify evidence-
based cost-efficient interventions, and strengthened monitoring and evaluation
systems that, ‘are integrated into existing national health information systems
and include the monitoring of risk factors, outcomes, social and economic
determinants of health, and health systems responses’. Information about the
functioning of the health information system can be obtained from the different
sectors and agencies that have responsibilities for the generation, synthesis,
analysis and use of data at country, regional and global levels.

At country level, Ministries of Health record the timeliness and quality of data
reported through health services and disease surveillance systems. National
Statistics Offices maintain of information about the availability and quality of
data generated through major data collection undertaking such as the decennial
census, large scale household surveys, and the civil registration system. As
custodians of national official statistics, they often have explicit requirements
for the way data are collected, compiled and shared, and adhere to the Fundamental
Principles of Official Statistics. International agencies working in health also
maintain information about the availability and quality of data on international
health goals, including but not limited to the Millennium Development Goals or
Sustainable Development Goals.

The healthcare industry relies on a massive amount of data to make decisions

about patient care, facilitate the delivery of care, and handle the many complex
administrative tasks that go on behind the scenes. Health information systems
are valuable tools that aid clinicians and administrative personnel in ensuring a
seamless patient experience from end-to-end. Additional purpose include: Data
analytics, the HIS help to gather and analyze data to manage population health
and reduce healthcare costs. Supports collaborative care, the HIS facilitates the
sharing of PHI between providers and organizations, making it possible for
patients to receive coordinated care from multiple providers while improving
care delivery and patient outcomes. Cost control, by sharing information, HIS
can eliminate duplicate testing and procedures, reduce time demands on staff
(such as for sending paper copies of patient records), and reduce costly human
errors. Population health management, aggregating patient data can help to
240
identify patterns and trends, predict or prevent outbreaks, identify at-risk Role of Technology: Health
Statistics, GIS and Health
populations, and more. Clinical decision support, integrating a patient’s individual Information Systems
data and medical history with broader population data and research improves
both diagnostics and treatment.

Check Your Progress II

1) How can HIS contribute in achieving Sustainable Development Goal of
Health for all?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

15.3.5 Examples
Health information systems can be used by everyone in healthcare from patients
to clinicians to public health officials. They collect data and compile it in a way
that can be used to make healthcare decisions. The health information systems
run the extent from high-level administrative systems to those that manage
detailed, patient-specific information. Some of the Examples of health information
systems include: Electronic Medical Record (EMR) and Electronic Health
Record (EHR): These two terms are almost used interchangeably. The electronic
medical record replaces the paper version of a patient’s medical history. The
electronic health record includes more health data, test results, and treatments. It
also is designed to share data with other electronic health records so other
healthcare providers can access a patient’s healthcare data. Practice Management
Software: It helps healthcare providers manage daily operations such as
scheduling and billing. Healthcare providers, from small practices to hospitals,
use practice management systems to automate many of the administrative tasks.
Master Patient Index (MPI): It connects separate patient records across
databases. The index has a record for each patient that is registered at a healthcare
organization and indexes all other records for that patient. MPIs are used to
reduce duplicate patient records and inaccurate patient information that can lead
to claim denials. Patient Portals: It allow patients to access their personal health
data such as appointment information, medications and lab results over an internet
connection. Some patient portals allow active communication with their
physicians, prescription refill requests, and the ability to schedule appointments.
Remote Patient Monitoring (RPM): Also known as telehealth, remote patient
monitoring allows medical sensors to send patient data to healthcare professionals.
It frequently monitors blood glucose levels and blood pressure for patients with
chronic conditions. The data is used to detect medical events that require
intervention and can possibly become part of a larger population health study.
Clinical Decision Support (CDS): It’s a system to analyze data from various
clinical and administrative systems to help healthcare providers make clinical
decisions. The data can help prepare diagnoses or predict medical events like

241
Health Care: Planning, Policy medicine interactions. These tools filter data and information to help clinicians
and Management
care for individual patients.

There are many specific health information systems, some of the Specific
examples include: Master Patient Index (MPI),Medical billing software, Patient
portals, Health Information Exchange (HIE), Activity Based Costing (ABC),
Patient Reported Outcomes (PRO), Remote Patient Monitoring (RPM),
Scheduling software, e-Prescribing software, Laboratory information systems,
Hospital Patient Administration Systems (PAS), Human Resource Management
Information Systems (HRMIS).

15.4 CLINICAL INFORMATION SYSTEM

A Clinical Information System (CIS) is a computer-based system that is designed
for collecting, storing, manipulating, and making available clinical information
important to the healthcare delivery process. It may be limited in the extent to a
single area (e.g. laboratory systems, ECG management systems) or they may be
more widespread and include virtually all aspects of clinical information (e.g.
electronic medical records). The CIS provides a clinical data repository that stores
clinical data such as the patient’s history of illness and the interactions with care
providers. The repository encodes information capable of helping physicians
decide about the patient’s condition, treatment options, and wellness activities
also because the status of selections, actions undertaken, and other relevant
information that would help in performing those actions.
The CIS is a computer-based platform that permits healthcare providers and
administrators to collect, store, manage, and retrieve clinical information and
patient data. The system is made of building blocks that address various areas
like the Electronic Medical Records (EMRs), which stores patient’s personal
details and medical record. Clinical Decision Support is a tool that aids physicians
in making accurate evidence-based clinical decisions, and even training and
research, a platform that trains doctors.
The system are often used within a selected perimeter, such as within one
laboratory, or just for management of all clinical imaging like x-rays and MRIs,
but also can be extended and integrated coverage across departments, ultimately
improving the interaction between doctors, nurses, and allied health through
integrated healthcare, and resulting in better provision of look after patients. The
CIS is meant to permit for structured organization of data and automated reports,
like for patient fees and bills, pharmaceutical inventories, management of
medicine approaching expiration dates, insurance reports, and even reports of
adverse drug reactions to be submitted to the Drug Control Authority. The ICT
based CIS reduces paperwork, which saves costs and cuts the necessity for
physical space for storing, especially in countries where it’s legally authorised
for healthcare information to be stored for a minimum number of years.

CISs are crucial to delivering the simplest in evidence-based, and patient-centered

care. It has great potential in reducing medical errors, increasing legibility, cutting
unnecessary healthcare costs, and boosting the standard of healthcare. The main
role of CISs is to capture, store, process, and timely transfer information to clinical
decision-makers or an accurate and rapid decision. For instance, a CIS can easily
import data from different instruments like vital signs monitors, ventilators, and
infusion devices, store them safely and display them in specific tables and formats.
242
One advantage of this sort of system is to interrelate with other subsystems within Role of Technology: Health
Statistics, GIS and Health
the hospital, e.g. pharmacy, different laboratories, radiology, and different image Information Systems
processing storage solutions. A decent CIS pays positively to patient safety,
workflow efficiency, and point-of-care decision support. The progress of CISs
has posed some new challenges and, at an equivalent time, has also generated
new opportunities.
CISs clearly offer excellent opportunities for improving care quality. Nevertheless,
implementing CISs in healthcare organizations poses a series of challenges. The
adoption of IT in healthcare has been particularly slow and lagging behind as
compared to other domains. This is because of the complexity of issues like
interoperability, technological rationality, acceptability, managerial rationality,
data security, data quality, and standards. But more significantly, the CIS improves
patient safety in some ways. Information is well organized, legible, and reduces
the likelihood of medical error owing to illegible writing, enables safer and more
reliable and prescribing, and thus eases communication between allied health
professionals. Patient information is additionally secure and can be safely united
with patients and other clinicians when necessary, enhancing continuity of care
for patients. Eventually, the improved efficiency helps to enhance productivity
and optimize profits within the clinic or hospital, and if integrated across all
facilities, can eventually improve the healthcare system as an entire. Healthcare
organizations should adopt CISs to expand the excellence of care and to be ready
to stay competitive. The fundamental goal is to strike a balance between available
resources, current HIS architecture, and therefore the desired clinical improvement
objectives.

15.5 GIS (GEOGRAPHIC INFORMATION

SYSTEM)
Health is vital for all of us and understanding the causes of a disease, its spread
from person to person and community to community has become increasingly
global. Since health is a geographical phenomenon and various factors attributing
to the health diagnostics and planning are geography dependent, as such, GIS
(Geographic Information System) for health studies assists as an important tool.
GIS can be useful for health researchers and planners because it plays a vital role
in strengthening the whole process of epidemiological surveillance, information
management and analysis. It aids as a common platform for convergence of multi-
disease surveillance activities and it is being used by public health administrators
and professionals, including policy makers, statisticians, regional and district
medical officers.
GIS data sets can be useful for many purposes. They are used primarily to display
data geographically. In public health, applications for GIS are becoming more
accessible as geo-coded health data and environmental exposure data increasingly
become available, and new and easier-to-use GIS software is developed. It
includes database management, planning, risk service area mapping, location
identification, etc. GIS (Geographic Information System) is a useful tool that
aids and assists in health research, health education, planning, monitoring and
evaluation of health programmes that are meant to control and eradicate certain
life threatening diseases and epidemics.
Some of its applications in public health are: (1) geographical distribution and
variation of diseases (2) analysis of spatial and temporal trends (3) identifying 243
Health Care: Planning, Policy gaps in immunizations (4) mapping populations at risk and stratifying risk factors
and Management
(5) documenting health care needs of a community and assessing resource
allocations (6) forecasting epidemics (7) planning and targeting interventions
(8) monitoring diseases and interventions over time (9) managing patient care
environments, materials, supplies and human resources (10) monitoring the
utilization of health centers (11) route health workers, equipment’s and supplies
to service locations (12) publishing health information using maps, etc.

The development of methods for mapping disease occurrence has advanced

noticeably in recent years. This growth in interest has led to a larger use of
geographical or spatial statistical tools in the analysis of data both routinely
collected for public health purposes and in the analysis of data found within
ecological studies of disease relating to explanatory variables. The study of
geographical distribution of diseases can have a multiplicity of uses and can fit
into any of the three classes: Disease mapping, usually the object of the analysis
is to estimate the true relative risk of a disease of interest across a geographical
area. Application of such methods lies in health service resource allocation.
Disease clustering, this aids in public health surveillance, to adopt where it may
be important to be able to assess whether a disease map is clustered and where
the clusters are located. The analysis of disease incidence around an assumed
source of hazard is a special case of cluster detection. Ecological analysis, this
focuses on the analysis of the geographical distribution of disease in relation to
explanatory covariates, usually at an aggregated spatial level.

Check Your Progress III

1) Briefly discuss the application of GIS in health planning?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

15.6 HEALTH STATISTICS

The health statistics are derived from data sets which are collections of logically
related data arranged during a prescribed manner. Data is a piece of information,
discrete observations of attributes or events, especially people who are a part of
the collection to be analysed. Data that is accurate, timely, specific, and organized
for a purpose, presented within a context that provides it meaning and relevance
and may cause a rise in understanding and reduce in uncertainty. Health statistics
and data are important because they measure a good range of health indicators
for a community. Health data provide comparisons for clinical studies, are often
wont to assess the prices of health care.
The general principles of the science of health statistics, as of most others, were
foreshadowed by the ancient Greeks, who carefully observed, recorded and

244
analyzed natural phenomena, and applied the inductive method of reasoning in a Role of Technology: Health
Statistics, GIS and Health
search for natural rather than supernatural causes, treating the unproven with Information Systems
scepticism. Nevertheless, the proper understanding of the behaviour of disease-
how and why disease in a human (or animal) population spreads, waxes and
wanes, or alters its character in response to the ceaseless changes that take place
in its host and environment–had to await the techniques of study and experiment
provided by modern epidemiology, statistics, microbiology, and biochemistry.
Health statistics are numbers that summarize information related to health. It is a
form of evidence or facts that can support a conclusion. Evidence-informed policy-
making, an approach to policy decisions that are intended to ensure that decision
making is well-informed by the best available research evidence, and evidence-
based medicine (EBM), or the conscientious, explicit, judicious, and reasonable
use of modern, best evidence in making decisions about the care of individual
patients are essential to informing how best to provide health care and promote
population health. Not all evidence is or should be, equally convincing in the
support of a conclusion. Evidence varies in quality and whether it is applicable
to a given situation. It is therefore essential that health researchers and
policymakers understand how to assess evidence in a systematic way, including
how to access transparent, high-quality health statistics and information. Health
statistics measure four types of information. The types are commonly referred to
as the four Cs: Correlates, Conditions, Care, and Costs. The first section of this
course examines each type of information.
Basic terms and concepts used to collect and present data are essential to using
health statistics and to assess their quality. Some of the basics of statistical research
as it relates to health care, which includes sampling, confidence intervals, bias,
validity, dependent and independent variables, age adjustment (including direct
standardization), and more. Sampling: Take a look at how a small group of people
can help us estimate information about a large population, Confidence Intervals:
See how to identify how accurate certain data is, Correlation and Causation:
Differentiate between two different types of relationships between variables,
Validity: Find out how to measure the accuracy of statistics, Dependent and
Independent Variables: Identify the different ways variables relate to the people
being studied, Age Adjustment: Learn how to adapt statistics to account for age
differences between communities or groups, Hypotheses: Understand the
language behind experiment design, Normal Distribution: Visualize how data is
normally distributed in populations, Standard Deviation: Learn about the metric
used to describe dispersion of data, Z-score : Learn a formula to determine a data
point’s position along a normal distribution curve in relation to the sample mean,
t-test and Z-test : Determine statistical significance using these statistical tests,
Significance Level : Understand how researchers conceptualize statistical
significance, p-value: The final step, learn the concept behind probability of
error, Incorporation into Health Subjects.

Health statistics are population based and many are collected and analyze over
time. Statistics often use geographic regions such as zip codes for determining
health care coverage and comparisons of specific disease occurrences. Most
studies focus on variation over time, space and social group. Researchers and
experts from government, private, and non-profit agencies and organizations
collect health statistics. They use the statistics to learn about public health and
health care.
245
Health Care: Planning, Policy
and Management
15.6.1 Purpose and Sources
Statistics starts with numbers that are universally not fixed. The numbers are put
together (in addition, subtraction, multiplication, and division) and conclusions
are drawn. Health statistics are used to understand risk factors for communities,
track and monitor diseases, see the impact of policy changes, and assess the
quality and safety of health care. However, to be of use statistics must be both
reliable and relevant. They need to be compiled correctly, following standard
practices and methodology. They must also meet the needs of users. The ultimate
objective of collecting data is to inform health programme planning as well as
policy-making and, finally, global health outcomes and equity. Well-functioning
health information systems empower decision-makers to manage and lead more
effectively, by providing valuable evidence at the lowest possible cost.

By and large, the purpose of vital and health statistics is to contribute to social
and economic progress. Prevailing levels of health and demographic problems
have to be studied in relation to the situations and factors that influence them.
For this–and for the study of trends and changes in health, conditions–factual
knowledge is essential. The more advanced a country, the more accurate and
penetrating are the studies it has to undertake. For instance, such basic steps as
the improvement of environmental sanitation, the establishment of maternal and
child health services, and health education-to name only a few-may well lead
full statistical analysis of the situation. Nevertheless, even simple varieties of
vital and health statistics, such as those which help in locating areas of high
mortality and indicating the major preventable diseases, would be helpful. These
can be produced relatively easily, either by means of sample surveys or by the
establishment of a national health statistics system. The standard statistical
methods for collecting data are not uniformly applicable throughout the world.

Health Statistics come from diverse sources many countries have their own
systems for reporting data. The main sources of health statistics are surveys,
administrative and medical records, claims data, vital records, surveillance,
disease registries, and peer-reviewed literature. Depending on the measure, data
can be collected from different sources, including medical records, patient surveys,
and administrative databases used to pay bills or to manage care. Each of these
sources may have other primary purposes, so there are advantages and challenges
when they are used for the purposes of quality measurement and reporting. The
organizations generate administrative data on the characteristics of the population
they serve as well as their use of services and charges for those services, often at
the level of individual users. The data is gathered from claims, encounters,
enrolment, and provider systems. Common data elements include the type of
service, number of units (e.g., days of service), diagnosis and procedure codes
for clinical services, location of service, and amount billed and the amount
refunded, available electronically, less expensive than obtaining medical record
data, available for an entire population of patients and across payers, fairly uniform
coding systems and practices are the main advantages of the administrative data.
It also has some challenges such as limited clinical information, questionable
accuracy for public reporting because the primary purpose is billing, completeness,
and timeliness.
A medical record is documentation of a patient’s medical history and care. The
advent of electronic medical records has increased the accessibility of patients’
246 files. Wider use of electronic medical record systems is expected to improve the
ease and cost of using this information for quality measurement and reporting. It Role of Technology: Health
Statistics, GIS and Health
has some notable advantages such as rich in clinical detail and viewed by providers Information Systems
as credible. The challenges of medical records include the cost, complexity, and
time required to compile data when patients receive services across different
sites, particularly if a different record format is used and current use of paper for
most records, which means that trained staff must manually abstract information.
Survey instruments capture self-reported information from patients about their
health care experiences. Aspects covered include reports on the care, service, or
treatment received and perceptions of the outcomes of care. Surveys are typically
administered to a sample of patients by mail, by telephone, or via the Internet.
Captures types of information for which patients are the best source, well-
established methods for survey design and administration, easy for consumers to
understand and relate to survey results these are the advantages of the patient
surveys. The challenges of patient surveys were the cost of survey administration
and possibility of misleading results if questions are worded poorly, survey
administration procedures are not standardized, the population sampled is not
representative of the population as a whole (sampling bias), or the population is
not represented in the responses (response bias).
For Standardized Clinical Data a certain kinds of facilities, such as nursing homes
and home health agencies, are required to report detailed information about the
status of each patient at set time intervals. The Minimum Data Set (MDS), the
required information for nursing homes, and the Outcome and Assessment
Information Set (OASIS), the data required by Medicare for certified home health
agencies, store the data used in quality measures for these provider types. The
advantages of Standardized Clinical Data include uses existing data sets and
characterizes facility performance in multiple domains of care. The major
challenge of Standardized Clinical Data is it may not address all topics of interest.
International Data United Nations Statistics Division; It compiles statistics from
many international sources and produces global updates in specialized fields of
statistics. Free access is provided to country–specific population data. World
Bank Group Data and Statistics–provides data derived, either directly or indirectly,
from official statistical systems organized and financed by national governments.
Click on Data by topic to find several options including health. World Health
Organization – Statistical Information System (WHOSIS), The WHO Statistical
Information System is the guide to health and the health-related epidemiological
and statistical information available from the World Health Organization.
International health statistics provide the necessary world information system.
They are also made use of by various countries to compare their progress in
health with that achieved by similar health action elsewhere. Because of these
national requirements, international agencies have the unique responsibility of
collecting and promptly disseminating statistical information on a worldwide
basis.

15.7 PLANNING FOR RURAL HEALTH USING GIS,

HIS AND HEALTH STATISTICS: SOME
EXAMPLES
Geographic Information System (GIS) provide as a common platform for the
convergence of multi-disease surveillance activities. Public health resources,
247
Health Care: Planning, Policy specific diseases and other health issues can be mapped in relation to their
and Management
surroundings and existing health and community infrastructures. GIS helps to
generate thematic maps that render the intensity of a disease. GIS aids in faster
and better health mapping and analysis than the conventional methods. Using
GIS, helps those working in the health industry manage their information to
make better decision. By tying information to specific locations, including hospital
and surgeries, contaminated land and spread of disease, analysts can produce
maps that help them identify patterns and understand relationships. GIS provides
a common analytical framework within which health authorities can understand
problems and formulate responses, improving incident management and health
planning. GIS is becoming a vital tool in healthcare applications. It includes
database management, planning, risk service area mapping and location
identification, etc.

Geographical Information System (GIS) in a Health Management Information

System (HMIS) can be a powerful tool to make health care delivery more effective
and far more efficient. It includes database management, planning, risk service
area mapping, location identification, etc. One of the causes for this sudden surge
of GIS use in healthcare application is the spatial dependency of health related
factors. Sikkim, a small state in the Eastern Himalayas has shown, in recent
times an obvious increase in the total registered deaths of an emergent nature, in
the form of cardiovascular, accident and other emergency situations. The existing
system is at best, inadequate in terms of equipment and skilled human-power to
deliver Emergency Medical Services. STNM Hospital, the central referral
institution of the state which provides Emergency Medical Care not only to the
urban population of the state capital of Gangtok but also to most of the rural
population of the rest of Sikkim. The alarming increase in the workload due to
faster development and always rising vehicular traffic and frequent natural
calamities calls for the need to expand the facilities. Compounding the problem
of the lack of proper management facilities and prompt attention to emergency
patients is the hilly terrain where invariably the only possible mode of transport
is by road, which in the monsoon season is time and again breached, making
transportation of patients a major problem. This study was carried out to
introduce the general position of the Gangtok area through the Health Information
and Medical preparedness using GIS study. Mapping of essential resources like
road networks, locate the health facility in the study area and find out the
population density using GIS techniques. Health management requirements,
information on a different phase like the occurrence of diseases, facilities that
are available in arranging to take decisions on either creating infrastructure
facilities for taking immediate action to handle the situation and quickly. Medical
preparedness plan requires an integrated approach to disaster site management
and clinical casualty management working in a coordinated technically. Medical
and health response assumes the top most priority in the entire task of disaster
management. GIS is an ideal tool for planning, organizational issues of health
service. Medical preparedness, according to the Medical Preparedness for
Disaster, implies local reinforcement of important medical care functions. It is
invoked when available capacity is or can be expected to be insufficient for
emergency care. Medical preparedness basically implies planning for medical
and health related aspects for meeting disasters.

Hospital Information Systems Implementation: An Evaluation of Critical Success

Factors in Northeast of Iran the implementation of hospital information systems
248
(HIS) is considered as a difficult and sensitive task in terms of its scope and its Role of Technology: Health
Statistics, GIS and Health
mission to collect identity-related, demographic, clinical and managerial data of Information Systems
patients in an integrative manner as well as due to the changes it makes in users’
working practices. Ever-increasing development of technologies and strong desire
to use computers among different user have driven medical centers towards using
information systems. Given the large amount of clinical data generated by medical
centers and the necessity to access such data, manual hospital information systems
(HIS) has encountered numerous problems in a way that access to comprehensive
information is not possible. It should be noted that successful implementation of
a system at hospitals requires a series of issues and measures in a formulated and
relatively long-term program. The success or failure of HIS implementation in
hospital’s organization are muchelaborated. For this complexity HIS
implementationis not similar to other sophisticated technology. Also successful
implementation of HIS is affected by numerous factors. Among the most important
ones were functional factors, project management factors; and human, technical,
and management factors.

Check Your Progress IV

1) What is the role of health technology in managing Covid 19 crisis in
India?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

15.8 LET US SUM UP

Around the world, the health status of people living in rural and remote areas is
generally worse than that seen in people living in urban areas. Rural areas
consistently have lower levels of access to primary health care services, safe
water and sanitation. Eighty per cent of the poor in Latin America, 60 per cent in
Asia and 50 per cent in Africa live on marginal lands of low productivity and
high susceptibility to degradation. Poverty and poor health are found more
commonly in the world’s rural people than in its urban residents. Achieving good
health is a well-proven path out of rural poverty. In order to achieve good health
in rural places, several key principles must be applied. Society needs to reaffirm
its commitment to primary health care based systems, and resources must be
distributed in ways that support rural, as well as urban sites. We must efficiently
utilize existing facilities in ways that promote high quality services. Individual
(personal) health care systems must be closely integrated with public (population
based) health systems.
In an ideal world, we would have more real-time data on incidence of community
level disease prevalence and would be able to do so much to improve the quality
of life for these communities, but the opportunity to do so still stands before 249
Health Care: Planning, Policy [Link] ongoing implementation, maturation, and use of electronic health
and Management
information systems require a complementary and overlapping skill set of
competent HIM and HI professionals to support these systems in practice, making
it difficult to continue to separate the two professions as distinctly different.
As the healthcare sector in India becomes more prominent in terms of its revenue
generation and its need for a strong labour force, innovation in the sector is not
far behind. Building infrastructure so as to leverage data to make healthcare
decisions can be a powerful endeavour. Community level data analysed correctly
could help predict the level of incidence of disease and offer opportunities for
preventative healthcare in the medium to long term. Though more challenging to
implement, electronic medical record systems is another big opportunity for India
to leverage. This makes healthcare more efficient, safer, and cost effective over
time. Having everyone’s medical records electronically saved has far-reaching
impact that outweighs the heavy cost of this transition. India, today, is not far
behind to adopt electronic record keeping in medical facilities and is further
along the pathway of digitising healthcare records.
The Aadhaar card system can be the catalyst to a strong electronic health record
system in India. Even though Aadhaar today focuses much on linking income
taxes, passports, bank accounts etc., this will only serve as a foundation for a
stronger medical record system. Some of the biggest benefits of having access to
electronic health data through an EMR is being able to mine the data at a larger
community level and understand the incidence of chronic diseases. For example,
understanding the prevalence of diabetes and the need to set up dialysis centers
in otherwise out of reach communities in India is invaluable. Similarly,
malnutrition cases among children who live below the poverty line can be analysed
based on location and specific measures can be taken to help those in need.
The private sector needs to be involved in a greater integration and possible
exchange of patient data. Ideally, the patient should administer and own their
own health data and they themselves allow for the access to their information by
health care institutions, be it the public or private system, but in Brazil, there is
still a long way to go as far as the integration of HIS, a hindering factor to this is
the digital exclusion, the Brazilian territory’s immense length, the need to create
integration and exchange of data programs, and investments, among other things.
Efforts to improve health information systems cannot fall on resource-limited
countries alone, or on only a few development partners. A programme for reform
and improvements must build on country ownership and efforts, and increase
the demand for and supply and use of information. Healthcare providers have
reliable and multifaceted information from several authoritative sources through
their Internet connections. Within the reach of the mouse and keyboard, these
rich resources can illuminate a clinician’s local experiences, offer comparisons
in healthcare delivery and outcomes, and provide validated evidence-based
practices.

Few countries have sufficiently effective health information systems even to

adequately monitor the Millennium Development Goals. There has been a chronic
under-investment in systems for data collection, analysis, dissemination and use;
and even when data are available, they are often out of date and unreliable. Efforts
to improve health information systems cannot fall on resource-limited countries
alone, or on only a few development partners. A programme for reform and
250
improvements must build on country ownership and efforts, and increase the Role of Technology: Health
Statistics, GIS and Health
demand for and supply and use of information. Information Systems

With the concentration of poverty, low health status and high burden of disease
in rural areas, there is a need to focus specifically on improving the health of
people in rural and remote areas, particularly if the urban drift is to be slowed.

15.9 KEY WORDS

E-health is termed as any electronic exchange of health-related data through
electronic connectivity for enlightening competence and effectiveness of health
care delivery. The solutions that are provided through e-health initiatives within
hospitals include Hospital Information Systems (HIS), telemedicine services,
Electronic health records, and Internet services.

Telemedicine is a powerful tool that permits medical experts to be received

beyond the boundaries of a medical facility.

Health Information Technology is a broad term encompassing a compilation

of technologies and programs to research, house, and share health information.
Health information technology (HIT) encompasses the development of health
information systems. The main functions of a health information system are to
monitor, inform and evaluate a health system and to form clinical and management
decisions.

Health Information System is a system considered to manage healthcare data

and it refers to a system that captures, stores, transmits or then manages health
data or activities. These systems are used to collect, process, practice, and report
health information.

Clinical Information System (CIS) is a computer-based system that is designed

for collecting, storing, manipulating, and making available clinical information
important to the healthcare delivery process.

Geographical Information System (GIS) is a system designed to capture, store,

manipulate, analyze, manage, and present all types of geographical data.

15.10 REFERENCES AND SUGGESTED READINGS

1) Agency for Healthcare Research and Quality (AHRQ); [Link]
[Link]/talkingquality/measures/understand/[Link].

2) Alfred Winter, Reinhold Haux, ElskeAmmenwerth, Birgit Brigl Nils

Hellrung and Franziska Jahn; Health Information Systems Architectures
and Strategies - Second Edition, Springer ; 2011.

3) Alvaro Rocha, University Fernando Pessoa, Portug; evolution of Information

Systems and Technologies Maturity in Healthcare; International Journal of
Healthcare Information Systems and Informatics, 6(2), 28-36; 2011.

4) Arvind Pandey, Nandini Roy, Rahul Bhawsar and R. M. Mishra; Health

Information System in India: Issues of Data Availability and Quality;
Demography India Vol. 39, No. 1, pp. 111-128; 2010.
251
Health Care: Planning, Policy 5) Ashok Kumar Sharma; Role of GIS in Health Management Information
and Management
System and Medical Plan: A Case Study of Gangtok area, Sikkim, India;
International Journal of Environment and Geoinformatics 2(1), 16-24; 2015.

6) Barry J. Garner, Qiming Zhou and Bruno P. Parolin; The Application of

GIS in the Health Sector: Problems and Prospects; in Proceedings of the 4th
European Conference on Geographical Information Systems, pp 1350-1357;
1993.

7) Catherine R. Selden; Finding Public Health Statistics And Data Sources.

8) Chris Brook; What is a Health Information System?;Datainsider; Digital

Guardians Blog; 2020.

9) C.J. Gibson, B.E. Dixon, and K. Abrams; Convergent Evolution of Health

Information Management and Health Informatics; A Perspective on the
Future of Information Professionals in Health Care;Appl Clin Inform. 2015;
6(1): 163–184; Applied Clinical Informatics.

10) Creating Unity for Action An Action Plan for Rural Health; Draft-2003;
Wonca Working Party on Rural Practice World Organization of Family
Doctors (Wonca) World Health Organization (WHO).

11) Dave Levin; What is a Health Information System?; Datica Blog; 2019.

12) Donte; Clinical Information Systems,Hospital Information Systems,

Technologies; 2018; [Link]
hospital information-systems/clinical-information-systems.

13) Evangelos C. Fradelos, Ioanna V. Papathanasiou, Dimitr a Mitsi,

Konstantinos Tsaras, Christos F. Kleisiaris and Lambrini Kourkouta; Health
Based Geographic Information Systems (GIS)and their Applications; ACTA
INFORM MED. (6): 402-405; 2014.

14) [Link].

15) Fran Turisco and Jane Metzger; Rural health care delivery: connecting
communities through technology; California HealthCare Foundation;
ihealthreports; 2002.

16) Health Information Systems, Toolkit on monitoring health systems

strengthening WHO; 2018.

17) HIS Strengthening Resource Center ; Indicators of the Status of a Health

Information System; [Link]

18) H. S. Gear, Y. Biraud& S. Swaroop; International Work in Health Statistics

1948-1958; WHO Chronicle World Health Organization Palais Des Nations
Geneva (1961).

19) J. Sarivouyioukas and A. Vagelatos; Introduction of a clinical information

system in a regional general state hospital of Athens, Greece; Studies in
health technology and informatics ; 2000.

252
20) Larry Grandia; Healthcare Information Systems: A Look at the Past, Present, Role of Technology: Health
Statistics, GIS and Health
and Future; Analytics and Health Catalyst Products and Services; 2014. Information Systems

21) Lulu K. Wolf; Teaching Health Statistics; The American Journal of Nursing,
Vol. 48, No. 5 pp. 329-333;1948.

22) Md. Mohaimenul Islam, Tahmina Nasrin Poly, Yu-Chuan (Jack) Li; Recent
Advancement of Clinical Information Systems: Opportunities and
Challenges; Yearbook of medical informatics; IMIA and Schattauer GmbH;
2018.

23) Mohd. Nabil Almunawar and Muhammad Anshari; Health Information

Systems (HIS): Concept and Technology; 2012; [Link] researchgate.
net/publication/221710863.

24) Nicola Hodge; What are health information systems, and why are they
important?; Pacific health dialog: a publication of the Pacific Basin Officers
Training Program and the Fiji School of Medicine; 2012.

25) Peter EbongueMbondji, Derege Kebede, Edoh William Soumbey-

Alley, Chris Zielinski, Wenceslas Kouvividila, and Paul-Samson Lusamba-
Dikassa; Resources, indicators, data management, dissemination and use in
health information systems in sub-Saharan Africa: results of a questionnaire-
based survey;Journal of Royal Society of Medicine; 107(1 Suppl): 28–
33;2014.

26) Rashmi Kandwal, P.K. Garg and R.D. Garg, Health GIS and HIV/AIDS
studies: Perspective and retrospective; Methodological Review; Journal of
Biomedical Informatics 42 ; 748–755;2009.

27) CSD Working Paper Series: Towards a New Indian Model of Information
and Communications Technology - Led Growth and Development, ICT India
Working Paper #32, Nirupam Bajpai, John Biberman and Manisha Wadhwa,
Retrieved from [Link]
xp8m-ws28/download.

28) Stella Ouma, and M. E. Herselman; E-health in Rural Areas: Case of

Developing Countries; World Academy of Science, Engineering and
Technology 16 2008.

29) [Link]

253
Health Care: Planning, Policy
and Management UNIT 16 HEALTHCARE: GOVERNMENTAL
AND NON-GOVERNMENTAL
INITIATIVES

Structure
16.0 Objectives
16.1 Introduction
16.2 Governmental Healthcare Initiatives
16.2.1 Obamacare
16.2.2 Governmental Healthcare Initiatives in India
16.2.3 Role of Government of India in Preservation and Promotion of Public Health
16.2.4 Healthcare Schemes in India
16.3 Non-Governmental Initiatives
16.3.1 Non-Governmental Organizations in Healthcare System
16.3.2 Global and Local Perspectives
16.3.3 Non-Governmental Global Healthcare Initiatives
16.3.4 Non-Governmental Healthcare Organizations in India
16.4 Let Us Sum Up
16.5 Key Words
16.6 References and Suggested Readings

16.0 OBJECTIVES
After reading this Unit, you should be able to:
explain the role of government organizations holistic healthcare;
describe the governmental healthcare projects and initiatives in India;
explain the role of non-governmental organizations and understanding of
the working of social sector;
describe non-governmental healthcare initiatives in India; and
critically analyse how government and non-government organizations can
work together for ‘Health For All’.

16.1 INTRODUCTION
Health is a fundamental human right and a global social goal. It is pertinent for
the realization of basic human needs and for a better quality of life. As the world
and its economies become increasingly globalized, including extensive
international travel and commerce, it is necessary to think about health in a global
context. Rarely a week goes by without a headline about the emergence or
re-emergence of an infectious disease or other health threat somewhere in the
world.

Globally, the rate of deaths from non-communicable causes, such as heart disease,
stroke, and injuries, is growing. At the same time, the number of deaths from
254
infectious diseases, such as malaria, tuberculosis, and vaccine-preventable Healthcare: Governmental
and Non Governmental
diseases, is decreasing. Many developing countries must now deal with a ‘dual Initiatives
burden’ of disease: they must continue to prevent and control infectious diseases,
while also addressing the health threats from non-communicable diseases and
environmental health risks. As social and economic conditions in developing
countries change and their health systems and surveillance improve, more focus
will be needed to address non-communicable diseases, mental health, substance
abuse disorders, and, especially, injuries. Some countries are beginning to establish
programs to address these issues. For example, Kenya has implemented programs
for road traffic safety and violence prevention.

Additionally, expanding international trade introduces new health risks. A complex

international distribution chain has resulted in potential international outbreaks
due to foodborne infections, poor quality pharmaceuticals, and contaminated
consumer goods. The world community is finding better ways to confront major
health threats. Melting geographic boundaries with easy and frequent travel of a
large number of people and goods across nations, have posed, newer challenges
and health risks.

16.2 GOVERNMENTAL HEALTHCARE

INITIATIVES
Health systems are grappling with the effects of existing communicable and non-
communicable diseases and also with the increasing burden of emerging and
re-emerging diseases. The causes of health inequalities lie in the social, economic
and political mechanisms that lead to social stratification according to income,
education, occupation, gender and race or ethnicity. Health is a causative factor
that affects country’s aggregate level of economic growth. Since development is
a consequence of good health, the governments of even the poorest developing
countries should make it a priority to invest in the health sector.

16.2.1 Obamacare
Obamacare is the Patient Protection and Affordable Care Act (ACA) that has
changed the way the United States delivered health care overall. The term
‘Obamacare’ was first coined by critics of the former president’s efforts to reform
health care, but then, the name stuck.

Before the ACA, insurance companies could exclude people with pre-existing
conditions. As a result, the people with the greatest health expenses sometimes
had to go without insurance or settle for a policy that did not cover a pre-existing
condition. Because they couldn’t afford regular doctor visits, they often ended
up in hospital emergency rooms and unable to contribute to the expense of their
[Link] ACA’s primary goal was to slow the rising cost of health care by
taking steps to make health insurance more available and more affordable to
those who need it the most. The act also required everyone to carry health
insurance or pay a tax penalty.

A notable part of the Affordable Care Act was the individual mandate, a provision
requiring all Americans to have healthcare coverage – either from an employer
or through the ACA or another source – or face increasingly stiff tax penalties.
This mandate served the double purpose of extending healthcare to uninsured
255
Health Care: Planning, Policy Americans and ensuring that there was a sufficiently broad pool of insured
and Management
individuals to support health-insurance pay-outs.

The Act was signed into law in March 2010, designed to extend health insurance
coverage to millions of uninsured Americans. Although Congress made major
changes to Obamacare, the ACA still remains strongly in place. Changes have
been made to the law that have addressed some of the objections raised by
opponents, while still keeping the marketplace open active for users. The Act
expanded Medicaid eligibility, created health insurance exchanges, and prevented
insurance companies from denying coverage or charging more due to pre-existing
conditions. The Act expanded Medicaid eligibility and created a Health Insurance
Marketplace. It prevents insurance companies from denying coverage due to
pre-existing conditions and requires plans to cover a list of essential health
benefits.

Check Your Progress I

1) ‘Obamacare initiative has been a radical step in delivering health care
services’. Justify this statement.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

16.2.2 Governmental Healthcare Initiatives in India

India is one of the fastest growing economies of the world. India presently is the
second-largest populated nation comprising of 18 per cent of the world’s
population. This is approximately combined population of the six countries,
namely the USA, Indonesia, Brazil, Pakistan, Bangladesh and Japan. However,
with large human resource base comes many inherent challenges. India is bearing
the dual burden of diseases where on the lower end, malnutrition, hygiene,
immunization, sanitation and infectious diseases are major concerns; and on the
higher end, environmental health and lifestyle diseases and other non-
communicable diseases have raised alarm. Cardiovascular diseases, tuberculosis,
cancer, diabetics, malaria, dengue fever, chikungunya, respiratory infections,
vector and water-borne diseases continue to be major challenges among the latter
[Link] very essential components of primary health care – promotion of food
supply, proper nutrition, safe water and basic sanitation and provision for quality
health information concerning the prevailing health problems – is often largely
ignored. Access to healthcare services, provision of essential medicines and
scarcity of doctors are other bottlenecks in the primary health care scenario.

The practice of public health has been dynamic in India, and has witnessed many
hurdles in its attempt to affect the lives of the people of this country. Since
independence, major public health problems like malaria, tuberculosis, leprosy,
256
high maternal and child mortality and lately, Human Immunodeficiency Virus Healthcare: Governmental
and Non Governmental
(HIV) have been addressed through a concerted action of the government and Initiatives
other agencies. Social development coupled with scientific advances and health
care has led to a decrease in the mortality rates and birth rates.

Healthcare has become one of India’s largest sector, both in terms of revenue
and employment. Healthcare comprises hospitals, medical devices, clinical trials,
outsourcing, telemedicine, medical tourism, health insurance and medical
equipment. The Indian healthcare sector is growing at a brisk pace due to its
strengthening coverage, services and increasing expenditure by public as well
private [Link] new agenda for Public Health in India includes the
epidemiological transition (rising burden of chronic non-communicable diseases),
demographic transition (increasing elderly population) and environmental
changes. The unfinished agenda of maternal and child mortality, HIV/AIDS
pandemic and other communicable diseases still exerts immense strain on the
overstretched health systems.

School health, mental health, referral system and urban health remain as weak
links in India’s health system, despite featuring in the national health policy.
School health programs have become almost defunct because of administrative,
managerial and logistic problems. Mental health has remained elusive even after
implementing the National Mental Health Program.

On a positive note, innovative schemes through public-private partnerships are

being tried in various parts of the country in promoting referrals. Similarly, the
much awaited National Urban Health Mission might offer solutions with regards
to urban health.

The health sector in India is public, government, private or individual owned.

Private sector healthcare providers, registered under the Clinical Establishment
Act, are owned and run by individuals or a group of individuals. Public sector,
on the other hand, comes under the Ministry of Health and Family Welfare,
Government of India. They too consist of dispensaries, clinics, nursing homes
and hospitals that follow various kinds of medicine systems. Additionally, it
includes all India networks of government health facilities in the form of sub-
centres, primary health centres, community health centres and rural hospitalizing,
urban health centres, municipal and other government hospitals. Charitable
institutions, religious organisations like churches and NGOs and public sector
bodies like atomic energy, railways, port trust, reserve bank and armed forces
also own many of these also.

16.2.3 Role of Government of India in Preservation and

Promotion of Public Health
Public health is concerned with disease prevention and control at the population
level, through organized efforts and informed choices of society, organizations,
public and private communities and individuals. However, the role of government
is crucial for addressing these challenges and achieving health equity. The Ministry
of Health and Family Welfare plays a key role in guiding India’s public health
system, being responsible for the implementation of various programmes related
to health and family welfare, prevention and control of major communicable
diseases and promotion of traditional and indigenous systems of medicines. It
also undertakes research, provides technical assistance and implementation of 257
Health Care: Planning, Policy World Bank-assisted programmes like control of malaria, tuberculosis, AIDS,
and Management
among others. Programmes having implications at the national level come under
the concurrent list like family welfare and population control, medical education
and prevention of food adulteration. Public health, hospitals, dispensaries and
sanitation fall under the State list.

The central government lays down the framework and provides direction to all
programmes to be undertaken like smallpox, malaria, tuberculosis, HIV/AIDS,
leprosy and others, implemented across the country uniformly. It is responsible
to provide funds to the state government for implementation and execution of all
the initiatives. The states also implement all centrally funded programmes like
family planning, Swachh Bharat Abhiyan and universal immunization. Since good
health and wellbeing have overlapped with various other dimensions, many
ministries together have to work for the promotion of healthcare facilities. Various
ministries that directly or indirectly contribute towards good health of the Indian
population. Of the total 58 ministries, 26 are related to provision of healthcare
services and promotion of good health in the country.

16.2.4 Healthcare Schemes in India

Some of the major initiatives taken by the Government of India to promote Indian
healthcare industry are as follows:
In the Union Budget 2020-21, Rs 35,600 crore has been allocated for
nutrition-related programmes and Rs 69,000 crore outlay for the health sector.
The Government of India aims to increase healthcare spending to 3 per cent
of the Gross Domestic Product by 2022
In February 2019, the Government of India established a new All India
Institute of Medical Sciences at Manethi, District Rewari, Haryana at a cost
of Rs 1,299 crore
The Union Cabinet approved setting up of National Nutrition Mission (NNM)
with a three-year budget of Rs 9,046 crore (US$ 1.29 billion) to monitor,
supervise, fix targets and guide the nutrition related interventions across
ministries
In 2018, Government of India launched Pradhan Mantri Jan Arogya Yojana
to provide health insurance worth Rs 500,000 to over 100 million families
every year.
National Health Mission
The NHM envisages achievement of universal access to equitable, affordable
and quality health care services that are accountable and responsive to people’s
needs. Its main programmatic components include Health System Strengthening,
Reproductive-Maternal- Neonatal-Child and Adolescent Health and
Communicable and Non-Communicable Diseases with several schemes as
follows:
1) Reproductive, Maternal, Newborn, Child and Adolescent Health
(RMNCH+A) programme essentially looks to address the major causes of
mortality among women and children as well as the delays in accessing and
utilizing health care and services. It has introduced novel initiatives like the
use of Score Card to track health performance, National Iron + Initiative to
address the issue of anaemia across all age groups and the Comprehensive
258
 Screening and Early interventions for defects at birth, diseases, and Healthcare: Governmental
and Non Governmental
deficiencies among children and adolescents. Initiatives

2) Rashtriya Bal Swasthya Karyakram (RBSK) is an important initiative

aiming at early identification and early intervention for children from birth
to 18 years to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases,
Development delays including disability. Early detection and management
diseases including deficiencies bring added value in preventing these
conditions to progress to its more severe and debilitating form.

3) The Rashtriya Kishor Swasthya Karyakram: The key principle of this

programme is adolescent participation and leadership, Equity and inclusion,
Gender Equity and strategic partnerships with other sectors and stakeholders.
The programme enables all adolescents in India to realize their full potential
by making informed and responsible decisions related to their health and
well-being and by accessing the services and support they need to do so.

4) The Government of India has launched Janani Shishu Suraksha

Karyakaram to motivate those who still choose to deliver at their homes
to opt for institutional deliveries. It is an initiative with a hope that states
would come forward and ensure that benefits under JSSK would reach every
needy pregnant woman coming to government institutional facility.

The National Health Missionen compasses its two Sub-Missions, The National
Rural Health Mission and The National Urban Health Mission.

National Rural Health Mission (NRHM)

NRHM is an Indian health programme for improving healthcare delivery across
rural India. NRHM was launched to address the infirmities and problems,
prevailing across the primary healthcare system in the country. The mission aims
to provide universal access to equitable, affordable, and quality healthcare that
is accountable and at the same time responsive to the needs of the people. The
following are the five planks of the mission:

The Mission is expected to address the gaps in the provision of effective

healthcare to rural population with a special focus on 18 states, which have
weak public health indicators and/or weak infrastructure.

The mission is a shift away from the vertical health and family welfare
programmes to a new architecture of all-inclusive health development in
which societies under different programmes will be merged and resources
pooled at the district level.

The mission aims at effective integration of health concerns, with a focus

on major determinants of health and provision for flexible funding for states
to utilise it in the areas they feel are important.

The mission provides for appointment of Accredited Social Health Activists

(ASHA) in each village and strengthening if the public health infrastructure,
including outreach through mobile clinics. It emphasises involvement of
the non-profit sector, especially in the underserved involvement of the non-
profit sector, especially in the underserved areas. It also aims at flexibility
at the local level by providing for untied funds.
259
Health Care: Planning, Policy The mission, in its supplementary strategies, aims at fostering public-private
and Management
partnerships (PPPs) for improving equity concerns, reducing out of pocket
expenses, introducing risk pooling mechanisms by social health insurance,
and taking advantage of social health traditions.

National Urban Health Mission (NUHM)

The NUHM will meet the health needs of the poor, particularly the slum dwellers
through the availability of essential primary healthcare services by high-calibre
health professionals, appropriate technology, public-private partnership and health
insurance for urban poor.

The NUHM will ensure the following:

Resources for addressing the health problems in urban areas, especially
among urban poor.
Need based city specific urban healthcare system to meet the diverse health
needs of the urban poor and other vulnerable sections.
Partnership with community for a more proactive involvement in planning,
implementation, and monitoring of health activities.
Institutional mechanism and management systems to meet the health-related
challenges of a rapidly growing urban population.
Framework for partnership with NGOs, charitable hospitals, and other
stakeholders.
Two-tier system of sick pooling like:
- Women’s Mahila Arogya Samiti to fulfil urgent hard-cash need for
treatments.
- A Health Insurance Scheme for enabling urban poor to meet medical
treatment needs.

Check Your Progress I

1) What is the goal of National Health Mission of India. What are its two
sub-missions?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
2) Name at least two schemes envisaged under NHM.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
260
In India, approximately about 5.8 million people die because of diabetes, heart Healthcare: Governmental
and Non Governmental
attack, cancer and other non-communicable diseases each year. Since the rate of Initiatives
deaths in the country because of communicable and non-communicable diseases
is increasing at an alarming rate, the government has also introduced various
programmes to aid people against these diseases.

National AIDS Control Organisation

National AIDS Control Organisation was set up so that every person living with
HIV has access to quality care and is treated with dignity. By fostering close
collaboration with NGOs, women’s self-help groups, faith-based organizations,
positive people’s networks, and communities, NACO hopes to improve access
and accountability of the services. It stands committed to building an enabling
environment wherein those infected and affected by HIV play a central role in
all responses to the epidemic – at state, district and grassroots level.

National TB Control Programme

Revised National TB Control Programme is a state-run tuberculosis control
initiative of Government of India with a vision of achieving a TB free India. The
programme provides, various free of cost, quality tuberculosis diagnosis and
treatment services across the country through the government health system

National Leprosy Eradication Programme

National Leprosy Eradication Programme was initiated by the government

for Early detection through active surveillance by the trained health workers and
to provide Appropriate medical rehabilitation and leprosy ulcer care services.

Mission Indradhanush

The Government of India has launched Mission Indradhanush with the aim of
improving coverage of immunization in the country. It aims to achieve at least
90 per cent immunization coverage by December 2018 which will cover
unvaccinated and partially vaccinated children in rural and urban areas of India.

National Mental Health Programme

In order to address the huge burden of mental disorders and the shortage of
qualified professionals in the field of mental health, Government of India has
implemented National Mental Health Program to ensure the availability and
accessibility of minimum mental healthcare for all in the foreseeable future.

Pulse Polio
Pulse Polio is an immunization campaign established by the government of India
to eliminate polio in India by vaccinating all children under the age of five years
against the polio virus.

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

PMSSY was announced with objectives of correcting regional imbalances in
the availability of affordable/ reliable tertiary healthcare services and also to
augment facilities for quality medical education in the country by setting up of
various institutions like AIIMS and upgrading government medical college
institutions.
261
Health Care: Planning, Policy Rashtriya Arogya Nidhi
and Management
Since there are huge income disparities, therefore, the government has launched
Rashtriya Arogya Nidhi which provides financial assistance to the patients that
are below poverty line and are suffering from life-threatening diseases, to receive
medical treatment at any government run super specialty hospital/ institution.

National Tobacco Control Programme

National Tobacco Control Programme was launched with the objective to bring
about greater awareness about the harmful effects of tobacco use and about
the Tobacco Control Laws and to facilitate the effective implementation of the
Tobacco Control Laws.

Integrated Child Development Service(ICDS)

ICDSwas launched to improve the nutrition and health status of children in the
age group of 0-6 years, lay the foundation for proper psychological, physical
and social development of the child, effective coordination and implementation
of policy among the various departments and to enhance the capability of the
mother to look after the normal health and nutrition needs through proper nutrition
and health education.

Rashtriya Swasthya Bima Yojana

Rashtriya SwasthyaBima Yojana is a government-run health insurance
programme for the Indian poor. It aims to provide health insurance coverage to
the unrecognized sector workers belonging to the below poverty line and their
family members shall be beneficiaries under this scheme.

Check Your Progress III

1) List 3 governmental healthcare schemes in India and give at least one
feature of each.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

Modicare

Dubbed as the world’s biggest experiment in universal health care, India launched
its A$2.2 billion universal health care plan in 2018 that gives 100 millions of its
poorest people access to free health care to treat serious ailments. In practice,
each will get a budget of 500,000 rupees, worth of free health care. It is a huge
amount of money by Indian standards, particularly for those lower down the
socio-economic scale. At the same time, 150,000 small doctor’s surgeries and
community health centres will be upgraded and receive better resources, as well
as more government [Link] scheme, known officially as Ayushman Bharat
or the National Health Protection Mission but more popularly as Modicare, aims
262
to cover 1300 illnesses, including cancer and heart disease. It is an enormous Healthcare: Governmental
and Non Governmental
undertaking and a huge financial commitment, particularly for a country that, to Initiatives
date, has a poor record for health spending.

The Ayushman Bharat Yojana – National Health Protection Scheme, which has
now been renamed as Pradhan Mantri Jan Arogya Yojana, aims to make secondary
and tertiary healthcare completely cashless. The PM Jan Arogya Yojana
beneficiaries get an e-card that can be used to avail services at an empanelled
hospital, public or private, anywhere in the country with a coverage of 3 days of
pre-hospitalisation and 15 days of post-hospitalisation expenses.

Check Your Progress IV

1) What has been deemed as the world’s biggest experiment in UHC? Give
at least two of its key elements.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

16.3 NON-GOVERNMENTAL INITIATIVES

Recent years have seen a growing capacity of nongovernmental organizations to
develop patterns of cooperation among themselves locally, nationally, and
internationally, for consultation and exchange of information, or for joint action.
In the area of Primary Health Care and Development NGOs can play pivotal
roles in the two major developmental approaches asIntegrated Human
Development and Community Participation. Non-governmental organizations
(NGOs) are called by various names across the world, such as third sector
organizations, non-profit organizations, voluntary organizations, charitable
organizations, community-based organizations and so on with slightly modified
scope and coverage.

16.3. 1 Non-Governmental Organizations in Healthcare System

Non-governmental organizations typically possess a very distinctive feature as
private institutions serving public purposes (UN 2003). Though their nature and
focus of activities has changed over time, they have gained prominence in a
wide spectrum of activities cutting across economic, social, cultural and scientific
domains. Nowadays, non- governmental sector is recognized as a major social
and economic force in almost all countries.

The importance of evolving non-governmental sector is well explained in the

literature of political economics as government and market failure theories.
Sociological studies emphasize on them as a most important institution improving
social integration and being an integral part of democratic society. The World
Health Organization has acknowledged NGOs in terms of increasing recognition
to complement government programs and creating an effective people’s voice in
respect of health service requirements and expectations. With the adoption of a
263
Health Care: Planning, Policy decentralized framework to improve health sector performance, many countries
and Management
across the globe have opened up the opportunity for participation of NGOs in
providing health services.

However, the tasks of NGOs in healthcare sector are related to specifics of a

particular country, namely the extent of civilization development, institutional
framework, culture and tradition, resources and needs etc. In high income
countries, NGOs are typically more specialized and largely involved in clinical
research, health advocacy and lobbying. In countries with low and middle income,
NGOs activities are focused on service delivery, raising awareness and prevention
campaigns.

16.3.2 Global and Local Perspective

Since the mid-seventies, the non-governmental sector has experienced a
phenomenal growth in both developed and developing countries. This is perhaps
caused by the policy shift towards decentralized agenda of both national and
international development agencies. Decentralization has opened up important
avenues for NGOs to participate in social sector programs. Governments in the
developing world especially found the non-profit sector as increasingly prominent,
innovative and grassroots driven with the desire and capacity to pursue
participatory and people-centred forms of development and to fill up the gaps
left by governments in meeting the needs of vulnerable [Link] working
directly with local communities can play an important role in extending project
uptake and reach and can facilitate greater awareness of diverse stakeholder views.

In India, NGO-run hospitals are heterogeneous and vary in terms of ownership,

financing and costs. In recent past, in about ten health-oriented projects of the
Ministry of Health and Family Welfare, Government of India, NGOs have actively
taken part as health service providers to the financing agent (fund management)
based on their level of capacity. Besides, some NGOs (especially the national
counterparts of international NGOs and faith-based organizations) might have
their own health financing schemes. Those that are present in rural areas and
part of development programs, function for the community by providing primary
and secondary services. For example, SEWA-Rural in Gujarat, was assigned the
responsibility of providing community-based health services in a district covering
40 villages with a population size 35,000. Alongside health care facilities, NGOs
are also involved in several preventive care activities, perhaps more than curative
care.

For over 50 years, USAID’s global health programs have saved lives, protected
people most vulnerable to disease, and promoted the stability of communities
and nations, while advancing American security and prosperity. America is safer
and stronger when people can live healthy and productive lives and when nations
around the world are self-reliant and resilient.

Check Your Progress V

1) List down any two significant features of non-governmental initiatives
in the health care system.
.................................................................................................................
.................................................................................................................
264
16.3.3 Non-Governmental Global Healthcare Initiatives Healthcare: Governmental
and Non Governmental
Initiatives
USAID’s global health efforts grounded in investments in health systems
strengthening and breakthrough innovation, are focused around three strategic
priorities: Preventing child and maternal deaths; controlling the HIV/AIDS
epidemic; and combating infectious diseases. Learn more about our different
health areas below:

Preventing Child and Maternal Deaths

Through efforts in family planning, maternal and child health, malaria,
and nutrition, USAID works to prevent child and maternal deaths by helping
women and children access essential, and often life-saving, health services.

Controlling the HIV/AIDS Epidemic

Since 1986, USAID’s HIV/AIDS program has been on the forefront of the
global AIDS crisis, providing strategic direction, leadership, and expertise
to help control one of the world’s most serious public health challenges.

Combating Infectious Diseases

In an increasingly interconnected society, a health threat anywhere is a threat
everywhere. For decades, USAID has been a leader in the fight against
infectious diseases, including malaria, through the U.S. President’s Malaria
Initiative; HIV/AIDS, through PEPFAR; tuberculosis; neglected tropical
diseases; pandemic influenza, and other global health security challenges.

Health Systems
Strong and resilient health systems are necessary for achieving sustained
positive health outcomes. By linking health issues through integrated
approaches, USAID contributes to sustainable and cost-effective programmes
that leave a lasting impact on country health systems.

Innovation and Impact

USAID supports breakthrough innovations, applies market-based
approaches, and advances efforts in digital health, private sector engagement,
and human-centred design in order to maximize the impact of its global
health work.

Check Your Progress VI

1) How do USAID’s investments and effortsin India contribute to health
care in India?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
................................................................................................................. 265
Health Care: Planning, Policy
and Management
16.3.4 Non-Governmental Healthcare Organizations in India
In India, it was the 1970s which saw rapid growth in the formation of formally
registered NGOs and the process continues to this day. Most NGOs have created
their respective thematic, social group and geographical priorities such as poverty
alleviation, community health, education, housing, human rights, child rights,
women’s rights, natural resource management, water and sanitation; and to these
ends they put to practice a wide range of strategies and approaches. Primarily,
their focus has been on the search for alternatives to development thinking and
practice; achieved through participatory research, community capacity building
and creation of demonstrable models.
Voluntary Health Association of India (VHAI)
Voluntary Health Association of India (VHAI) is a non-profit, registered society
formed in the year 1970. It is a federation of 27 State Voluntary Health
Associations, linking together more than 4500 health and development institutions
across the country. They are one of the largest health and development networks
in the world. VHAI advocates people-centered policies for dynamic health
planning and programme management in India. VHAI promotes health issue of
human right and development. The beneficiaries of VHAI’s programme include
health professionals, researchers, social activists, government functionaries and
media personnel. FSSAI and Ministry of Health & Family Welfare, GOI has
given an appreciation award to VHAI for its remarkable work on Eat Right
Movement and Swasth Bharat Yatra.
HelpAge India
Help Age is one of the leading charitable organizations in India which work for
the well-being of the elderly. It was established in 1978, and has been providing
services for over 4 decades now. They provide free health services for the
unfortunate elderly with cataract surgeries and intensive care to end-stage cancer
patients. HelpAge India has received several awards for his commendable
contribution to society including the Chairman’s Challenge Award, Times Social
Impact Award and NGO Leadership and Excellence Award among several others.
CRY-Child Rights and You
CRYwas started by Rippan Kapur in 1979 aiming to works towards several causes
for children, one of them being malnutrition. It introduced kitchen gardens in
Anganwadis in Chhattisgarh to provide fresh and healthy food to children. This
noble initiative of CRY has helped to see a decrease in the number of malnourished
children by about 9-10 per cent. Over the years CRY has won numerous awards
that recognize their efforts in giving India’s children a happy and healthy
childhood. It holds The Institute of Chartered Accountants of India Corporate
Social Responsibility Award for Best CSR Project in Health, Lakshya
Award, Karve Institute of Social Service for 50 years of excellence etc.
Rural Healthcare Foundation (RHCF)
RCHF strives to provide low cost primary healthcare to the lowest strata of the
socio-economic pyramid and is doing well in achieving its goals. RHCF is
currently a network of 10 clinics, spread across various districts of West Bengal
and has since inception served over 10 lakh patients through its network. Rural
Health Care Foundation been given a Special Consultative Status at the United
Nations and recognition by the Harvard Business School.
266
Udaan Welfare Foundation Healthcare: Governmental
and Non Governmental
Udaan Welfare Foundation was found in 2008 with an objective to work Initiatives
towards quality healthcare and nutrition through several programs. Udaan carried
out a dental health check in the Harikishan English Public School and taught
250 students the importance of the correct brushing techniques and oral care. They
have also regularly provided medicines and monthly ration supply for Anugraha
Children’s Home and Anugraha Vidya Mandir, Ambernath since 2008. It has
received awards and recognition including, the Galaxy Recognition Award, Samaj
Shakti Award, Global CSR Excellence and Leadership Award etc.

Uday Foundation
Established in 2006 by Rahul and Tulika Verma, Uday Foundation is a Delhi
based NGO, supporting children suffering from congenital disorders and
other syndromes. The Foundation also researches new technologies in the
healthcare sector to serve wholesome food and raising donations. It is a very
renowned foundation, featuring in The times of India, NDTV etc.

India Health Action Trust (IHAT)

India Health Action Trust was constituted by the registered Trust Deed in 2003
dedicated to the enhanced health and wellbeing of individuals and communities
in India, irrespective of caste, creed or religion. IHAT originally focused on
providing comprehensive technical assistance and training in programme planning
and management to the states of Karnataka and Rajasthan. Over the years, the
trust has supported the State AIDS Control Societies (SACS) in Maharashtra,
Bihar, Rajasthan, Andhra Pradesh, Tamil Nadu and Goa. IHAT Senior Technical
Advisor awarded with Honoris Causa Recognising the exceptional contribution
towards the society, by the University of Manitoba on their 31st convocation.

Vatsalya NGO
Vatsalya was set-up as a Resource Centre on Health in the year 1995 by medical
professionals with the objective to make consistent efforts towards ensuring
quality health services especially to the poor and marginalized community of
rural areas. Vatsalya has been contributing to Uttar Pradesh for last 17 years
towards enhancing capacity of individuals and communities to understand
comprehensive framework of health in terms of science and art. They received
awards from HSBC Water Programme, for water conservation, and were also
chosen as finalists in the dasra awards in the sanitation category.

Check Your Progress VII

1) List at least two NGOs and how are they contributing alleviate healthcare
in the country.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

267
Health Care: Planning, Policy
and Management 16.4 LET US SUM UP
Within the wide framework of nested health missions, policies, programmes,
acts and statues lie the overarching objective of providing good health and well
being to all. While the role of government needs to be enhanced along with more
revenue allocation for successful results in health sector, contribution to health
of a population derives from systems outside the formal health care system, and
this potential of intersectoral contributions to the health of communities is being
increasingly recognized worldwide. Thus, the role of government in influencing
population health is not limited within the health sector but also by various sectors
outside the health systems.

While a lot has been achieved in the years gone by – the launch of Expanded
Program of Immunisation in 1974, Primary Health Care enunciated at Alma Ata
in 1978, eradication of Smallpox in 1979, launch of polio eradication in 1988,
FCTC ratification in 2004 and COTPA Act of 2005, to name a few, the future of
a healthy India lies in mainstreaming the public health agenda in the framework
of sustainable development. The ultimate goal of great nation would be one where
the rural and urban divide has reduced to a thin line, with adequate access to
clean energy and safe water, where the best of health care is available to all,
where the governance is responsive, transparent and corruption free.

In this changing world, with unique challenges that threaten the health and well-
being of the population, it is imperative that the government and community
collectively rise to the occasion and face these challenges simultaneously,
inclusively and sustainably. Social determinants of health and economic issues
must be dealt with a consensus on ethical principles – universalism, justice,
dignity, security and human rights. This approach will be of valuable service to
humanity in realizing the dream of Right to Health.

NGOs are contributing at all stages of the research cycle, fostering the relevance
and effectiveness of the research, priority setting, and knowledge translation to
action. They have a key role in stewardship (promoting and advocating for relevant
global health research), resource mobilization for research, the generation,
utilization and management of knowledge, and capacity development. Yet,
typically, the involvement of NGOs in research is downstream from knowledge
production and it usually takes the form of a partnership with universities or
dedicated research [Link] is a need to more effectively include NGOs
in all aspects of healthcare in order to maximize the potential impact. NGOs,
moreover, can and should play an instrumental role in coalitions for global health.
With a renewed sense of purpose and a common goal, NGOs and their partners
intend to make strong and lasting inroads into reducing the disease burden of the
world’s most affected populations through effective research and action.

To get to the envisioned future of Sustainable Development Goals’ ‘Health For

All’ , health care providers, governments and other payers, disruptive entrants,
and even consumers should begin working in cohesion driving change across
the ecosystem to lay a solid foundation for the future.

268
 Healthcare: Governmental
16.5 KEY WORDS and Non Governmental
Initiatives
Healthcare: Health care is the maintenance or improvement of healthvia
prevention, diagnosis, treatment, recovery or cure of disease, illness, injury or
physical and mental impairments in people.

Obamacare: An informal term for the Affordable Care Act, a federal law intended
to improve access to health insurance for US citizens.

Modicare: The Ayushman Bharat Yojana - National Health Protection Scheme,

which has now been renamed as Pradhan Mantri Jan Arogya Yojana is India’s
A$2.2 billion universal health care plan that aims to give 100 millions of its
poorest people access to free health care to treat serious ailments.

National Health Mission: The National Rural Health Mission (NRHM), now
under National Health Missionis an initiative undertaken by the government of
India to address the health needs of under-served rural areas.

Non-Profit Organisation: A non-profit organization that operates independently

of any government, typically one whose purpose is to address a social or political
issue.

16.6 REFERENCES AND SUGGESTED READINGS

Affordable Care Act (ACA) - [Link] Glossary. (n.d.). Retrieved
November 27, 2020, from [Link]
act/

Amadeo, K. (2020, September 02). What Is Obamacare? Retrieved November

29, 2020, from [Link]
what-you-need-to-know-3306065

Bajaj Finserv. (2018, October 10). PMJAY - All About Ayushman Bharat Yojana,
Eligibility & Application Process. Retrieved November 29, 2020, from https://
[Link]/insights/ayushman-bharat-yojana-are-you-eligible-for-the-
pmjay-scheme

Betigeri, A. (2018, September 26). India’s game-changing health care initiative.

Retrieved November 29, 2020, from [Link]
interpreter/india-game-changing-health-care-initiative

Brand India. (n.d.). Retrieved November 29, 2020, from [Link]

industry/[Link]

Drishti IAS. (2020, September 25). Role of NGOs. Retrieved November 29,
2020, from [Link]
of-ngos

Ghosh, D. (2013, August 28). Looking at the Role of the Non-Governmental

Organizations in Primary Health Care Field in India to Meet the Millennium
Development Goals. Retrieved November 2, 2020, from [Link]
sol3/[Link]?abstract_id=2316649

269
Health Care: Planning, Policy Global Health. (2020, November 24). Retrieved November 29, 2020, from https:/
and Management
/[Link]/global-health

Global Health. (n.d.). Retrieved November 2, 2020, from https://

[Link]/2020/topics-objectives/topic/global-health

Government Initiatives in the Health Sector of India. (2014, May 17). Retrieved
November 23, 2020, from [Link]
initiatives-in-the-health-sector-of-india/40425

Grover, A., & Singh, R. B. (2019). Health Policy, Programmes and

Initiatives. Advances in Geographical and Environmental Sciences Urban Health
and Wellbeing, 251-266. doi:10.1007/978-981-13-6671-0_8

Joshi, M. K., & Klein, J. (2018). The Role of Non-Governmental

Organizations. Oxford Scholarship Online. doi:10.1093/oso/
9780198827481.003.0006

Kashyap, S. (2019, December 09). India 2020: How Govt’s initiatives will shape
up the healthcare narrative. Retrieved November 22, 2020, from https://
[Link]/india/india-2020-how-govt-initiatives-will-shape-up-the-
[Link]

Krishna, V. (n.d.). Top 20 NGOs contributing to Healthcare Services in India.

Retrieved November 9, 2020, from [Link]
contributing-to-healthcare-services-in-india

Lakshminarayanan, S. (2011). Role of government in public health: Current

scenario in India and future scope. Journal of Family and Community
Medicine, 18(1), 26. doi:10.4103/1319-1683.78635

Ministry of Health & Family Welfare-Government of India. (n.d.). Index4 ::

National Health Mission. Retrieved November 29, 2020, from [Link]
[Link]?lang=1

R. Labonte, J., Currat, L., Keusch, G., JN. Lavis, D., M. Surr, A., Eisenberg, J., .
. . McKenzie, J. (1970, January 01). The role of NGOs in global health research
for development. Retrieved November 29, 2020, from [Link]
[Link]/articles/10.1186/1478-4505-3-3

270