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Book Details
Abstract
Entertaining, provocative, lively, well-written text, which is must read for people who are passionate to drive change in health care.
• Well- researched book on health care reforms that captures wealth of insights, serving as comprehensive source of up-to-date information and facts
• Offers interesting insights into the health of India’'s population and makes a passionate appeal for political priority to be given to universal health coverage and for an upstream pre-emptive approach to health
• Contains thought provoking ideas and reform proposals, which are of global relevance
• Must read for everyone interested in the Health Care System of India
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | Cover | ||
| Health Care Reforms in India | i | ||
| Copyright page | iv | ||
| Preface | v | ||
| Acknowledgements | vii | ||
| Table of contents | viii | ||
| 1 Prioritizing health | 1 | ||
| Why prioritize health care – ‘all for health’ to ‘health for all’ | 1 | ||
| The politics of health | 1 | ||
| Health care as a unique electoral proposition (UEP) | 1 | ||
| United kingdom | 1 | ||
| United states of america | 2 | ||
| Canada | 2 | ||
| India | 2 | ||
| Parliament and health care | 6 | ||
| Health care – a pre-requisite for peace, national stability and security | 6 | ||
| Health - a constitutional and legal mandate | 7 | ||
| Health in the constitution | 7 | ||
| Health care in the courts of law | 8 | ||
| Health and human rights | 9 | ||
| Nhrc and health | 9 | ||
| Nhrc and mental health | 10 | ||
| The health care burden | 10 | ||
| India’s share in the global disease burden | 10 | ||
| India VS the world: A grim scenario | 10 | ||
| Chronic disease burden in india | 11 | ||
| The high price of not paying attention to NCDs | 11 | ||
| Abcde of health care | 12 | ||
| Arthritis/musculoskeletal disorders | 14 | ||
| Blood pressure - hypertension | 14 | ||
| Bronchial – respiratory disorders | 16 | ||
| Cancer | 16 | ||
| Cardiovascular disease | 16 | ||
| Diabetes | 18 | ||
| Epilepsy | 23 | ||
| Beyond abcde | 24 | ||
| Anaemia | 24 | ||
| Blindness | 26 | ||
| Deafness | 26 | ||
| Geriatric health | 26 | ||
| Hiv/aids | 28 | ||
| Mental health | 29 | ||
| A grim scenario despite seven decades | 29 | ||
| Obesity | 29 | ||
| Tuberculosis (TB) | 34 | ||
| Morbidity due to ncds and its economic implications | 35 | ||
| Nutritional deficiencies: Malnutrition, undernutrition and micronutrient deficiencies | 35 | ||
| Iodine deficiency | 40 | ||
| Communicable diseases | 40 | ||
| Chikungunya | 42 | ||
| Dengue | 42 | ||
| Filariasis | 42 | ||
| Japanese encephalitis | 42 | ||
| Kala azar | 43 | ||
| Leprosy | 43 | ||
| Malaria | 43 | ||
| Disability and burn injuries | 44 | ||
| Disability | 44 | ||
| Burn injuries | 44 | ||
| Child health | 44 | ||
| Tuberculosis and children | 48 | ||
| Childhood blindness | 49 | ||
| The way forward | 49 | ||
| Women’s health | 51 | ||
| Mother’s health | 51 | ||
| Outlook towards girl child | 54 | ||
| Health care challenges of the millennium: Lifestyle and economic growth | 56 | ||
| Alcohol and tobacco | 56 | ||
| Economic growth | 60 | ||
| The economics of health | 61 | ||
| Health care: The road to prosperity or poverty | 61 | ||
| Poverty, health and health care | 61 | ||
| Health for a privileged few or health for all | 63 | ||
| Per capita income versus cost of major treatments and interventions | 64 | ||
| Poor spend more on health? | 68 | ||
| Health and savings | 69 | ||
| Health: The top priority of rurban (rural-urban) india! | 69 | ||
| Economic loss due to the disease burden | 71 | ||
| Health and capital formation | 76 | ||
| Health and commercial impact | 81 | ||
| Health care and economic recession | 82 | ||
| Health sector, job creation and gdp | 83 | ||
| Health, human development index and economic growth | 85 | ||
| Health and development | 85 | ||
| Glaring gaps | 86 | ||
| Health service coverage | 86 | ||
| Quality of doctors | 86 | ||
| Life expectancy | 87 | ||
| Drinking water, sanitation and hygiene | 89 | ||
| Medicines – accessibility and affordability | 89 | ||
| From ‘disease capital of the world’ to ‘death capital of the world’? | 90 | ||
| Isn’t it already too late? | 90 | ||
| How many more deaths and decades do we need to change the reality on ground? | 90 | ||
| Suggested reading | 95 | ||
| 2 Health care in india: Market size and administrative set-up | 102 | ||
| Size of health care market | 102 | ||
| Organizational structure | 102 | ||
| Structure of health care system in india | 105 | ||
| Health care decision-making in india | 107 | ||
| Health care financing | 110 | ||
| Shortfall | 122 | ||
| Pac and nrhm – important perspective | 124 | ||
| Suggested reading | 126 | ||
| 3 National programmes | 128 | ||
| National rural health mission | 128 | ||
| Objectives | 128 | ||
| Expected outcomes of nrhm | 129 | ||
| Key strategies | 129 | ||
| National programme for health care of elderly | 130 | ||
| National urban health mission | 131 | ||
| National programme for prevention and control of deafness | 132 | ||
| National oral health care programme | 132 | ||
| National AIDS control programme | 133 | ||
| National AIDS control programme – control of stis/rtis | 134 | ||
| National family planning programme | 134 | ||
| Janani shishu suraksha karyakaram | 135 | ||
| National programme on janani suraksha yojna | 135 | ||
| Navjaat shishu suraksha karyakaram (ministry of health & family welfare, government of india, 2013) | 136 | ||
| Reproductive and child health programme | 136 | ||
| Indira gandhi matritva sahyog yojana | 137 | ||
| Child health | 137 | ||
| School health programme | 137 | ||
| Mid-day meal scheme | 138 | ||
| Rashtriya bal swasthya karyakaram | 139 | ||
| National vector borne disease control programme (nvbdcp) | 139 | ||
| National programme on malaria | 139 | ||
| Nvbdcp – filaria | 140 | ||
| Nvbdcp – kala azar | 140 | ||
| Nvbdcp – japanese encephalitis | 141 | ||
| Nvbdcp – dengue and chikungunya fever | 141 | ||
| National guinea worm eradication programme | 141 | ||
| Integrated child development scheme | 142 | ||
| Other schemes | 143 | ||
| Nutrition programme for adolescent girls (npag) | 143 | ||
| Rajiv gandhi scheme for empowerment to adolescent girls (rgseag) – sabla | 143 | ||
| Igmsy | 143 | ||
| National iodine deficiency disorders control programme | 144 | ||
| National programme for prevention and control of fluorosis | 144 | ||
| Universal immunization program | 144 | ||
| Vitamin a prophylaxis programme | 145 | ||
| National nutritional anaemia prophylaxis programme | 145 | ||
| Zinc supplementation | 146 | ||
| Adolescent health – menstrual hygiene | 146 | ||
| National programme for control of blindness | 146 | ||
| National tobacco control programme | 147 | ||
| National programme for prevention and control of cancer, diabetes, cvd and stroke | 148 | ||
| Services offered under npcdcs | 149 | ||
| Achievements so far | 149 | ||
| National mental health programme | 150 | ||
| National organ transplant program | 151 | ||
| Drug de-addiction programme | 151 | ||
| National rural drinking water programme | 151 | ||
| National leprosy programme | 152 | ||
| National TB control programme | 153 | ||
| Yaws eradication programme | 154 | ||
| National leptospirosis control programme | 154 | ||
| National programme for prevention and control of human rabies | 154 | ||
| Integrated disease surveillance project | 155 | ||
| National program for control & treatment of occupational diseases | 155 | ||
| National nutrition programmes | 156 | ||
| Rashtriya arogya nidhi | 157 | ||
| Rashtriya swasthya bima yojna | 158 | ||
| Essential medicines and program of rational use of drugs | 160 | ||
| National programme for rehabilitation of persons with disabilities | 160 | ||
| National program for prevention of burn injuries | 161 | ||
| Suggested reading | 161 | ||
| 4 History of health care ‘reforms in india and the evolution of health care in india | 163 | ||
| National health committees | 164 | ||
| Timelines | 166 | ||
| Various committees, commissions, and working groups on health | 172 | ||
| Health survey and development committee – bhore committee, 1946 | 172 | ||
| National planning committee – sokhey committee, 1947 | 178 | ||
| Lt. col. rn chopra committee 1946 (report published in 1948) | 182 | ||
| Pandit committee | 183 | ||
| Dave committee | 183 | ||
| Udapa kn committee on ayurveda research evaluation, 1958 | 184 | ||
| Pharmaceutical enquiry committee | 186 | ||
| Shetty committee, 1954 | 187 | ||
| Balwant rai mehta committee, 1957 | 188 | ||
| Lakshmanswami mudaliar committee, 1959 | 188 | ||
| Renuka roy committee, 1960 | 194 | ||
| Chadha committee, 1963 | 194 | ||
| Mukherjee committee 1966 (mukherjee committee report, 1966) | 196 | ||
| Jain committee, 1966 | 199 | ||
| Committee on integration of health services – jungalwalla committee, 1967 | 199 | ||
| Mukherjee committee report on basic health services (mukherjee committee report, 1968) | 200 | ||
| Kartar singh committee, 1973 | 203 | ||
| Consultative committee of experts to determine the alternative strategies under nmep, 1974 | 204 | ||
| Shrivastav committee – group on medical education and support manpower, 1975 | 206 | ||
| Hathi committee report, 1975 | 208 | ||
| Siddhu committee, 1977 | 210 | ||
| Alma-ata, 1978 | 211 | ||
| Working group on population policy, 1980 | 212 | ||
| Krishnan committee, 1982 | 214 | ||
| Working group on ‘health for all’ by 2000 A.D. | 214 | ||
| The medical education review committee (mehta committee), 1983 | 221 | ||
| Expert committee on health manpower, planning, production and management – bajaj committee, 1987 | 226 | ||
| High power committee on nursing and nursing profession, 1989 | 228 | ||
| Report on the state of india’s health, 1992 | 230 | ||
| Expert committee on public health system (bajaj committee), 1996 | 232 | ||
| The independent commission on health in india (ICHI), 1997 | 235 | ||
| Task force on the conservation and sustainable use of medicinal plants, 2000 | 236 | ||
| DGHS committee report on spurious drugs, 2001 | 239 | ||
| Expert committee on a comprehensive examination of drug regulatory issues, including the problem of spurious drugs – mas ... | 239 | ||
| National commission on macroeconomics and health (2004) | 241 | ||
| Health sector reforms in india, 2004 | 245 | ||
| High level expert group report on universal health coverage for india (HLEG), 2010 | 249 | ||
| National health policies | 253 | ||
| National health policy 1983 | 253 | ||
| National health policy 2002 | 255 | ||
| Other national policies on health related matters | 261 | ||
| National nutrition policy, 1993 | 261 | ||
| National policy for older persons, 1999 | 261 | ||
| National population policy, 2000 | 261 | ||
| National policy for the empowerment of women (NPEW), 2001 | 262 | ||
| National policy on ism and homeopathy, 2002 | 262 | ||
| National AIDS prevention and control policy, 2002 | 262 | ||
| National blood policy, 2002 | 262 | ||
| National charter for children, 2003 | 263 | ||
| National youth policy, 2003 | 263 | ||
| Committees, complexities and commitments | 263 | ||
| Wild suggestions | 268 | ||
| Community health or committee health? | 270 | ||
| Health under the 12 five-year plans | 270 | ||
| Five-year plans | 270 | ||
| First five-year plan (1951–1956) | 271 | ||
| Second five-year plan (1956–1961) | 272 | ||
| Third five-year plan (1961–1966) | 272 | ||
| Fourth five-year plan (1969–1974) | 273 | ||
| Fifth five-year plan (1974–1979) | 274 | ||
| Sixth five-year plan (1980–1985) | 274 | ||
| Seventh five-year plan (1985–1990) | 275 | ||
| Eighth five-year plan (1992–1997) | 276 | ||
| Ninth five-year plan (1997–2002) | 278 | ||
| Tenth five-year plan (2002–2007) | 279 | ||
| Eleventh five-year plan (2007–2012) | 281 | ||
| Twelfth five-year plan (2012–2017) | 283 | ||
| State of health care in the 12 five-year ‘plans’ – flashback | 286 | ||
| First five-year plan (1951–1956) | 286 | ||
| Second five-year plan (1956–1961) | 286 | ||
| Third five-year plan (1961–1966) | 286 | ||
| Fourth five-year plan (1969–1974) | 286 | ||
| Fifth five-year plan (1974–1979) | 286 | ||
| Sixth five-year plan (1980–1985) | 286 | ||
| Seventh five-year plan (1985–1990) | 286 | ||
| Eighth five-year plan (1992–1997) | 286 | ||
| Ninth five-year plan (1997–2002) | 286 | ||
| Tenth five-year plan (2002–2007) | 286 | ||
| Eleventh five-year plan (2007–2012) | 286 | ||
| Twelfth five-year plan (2012–2017) | 286 | ||
| Disconnected with ground realities | 298 | ||
| Conclusion | 298 | ||
| Foreign influence or ingenious health care reforms? | 299 | ||
| Suggested reading | 301 | ||
| State of Health Care | 304 | ||
| Ground realities of Indian health care – a complex challenge | 304 | ||
| Reasons for the Poor State of Nations’ Health | 308 | ||
| Factors Decimating Health Care Delivery | 310 | ||
| State of Affairs – Government | 317 | ||
| HEALTH AS A STATE SUBJECT | 317 | ||
| SILOED WORKING AND STRUCTURE OF THE HEALTH MINISTRY | 317 | ||
| BUREAUCRACY AND HEALTH | 318 | ||
| POOR PROJECT MANAGEMENT, MONITORING AND SUPERVISION AND REGULATION | 319 | ||
| WRONG POLICIES, MISGUIDED GOALS AND WASTAGE OF RESOURCES | 320 | ||
| LACK OF UNDERSTANDING AND COMMITMENT, CORRUPTION AND INEFFICIENCY | 328 | ||
| Corruption, Circumventing the Regulators and Government by Private Sector | 330 | ||
| Shortage and the problem of distribution is a twin challenge | 331 | ||
| METHODOLOGY | 336 | ||
| RESULTS AND DISCUSSION | 336 | ||
| CONCLUSION | 339 | ||
| Wrong Start: We Have a Doctor-Centric Health Care System | 339 | ||
| Investment without Outcomes | 355 | ||
| Policy Making and Patients | 356 | ||
| Technology Adoption and Health | 356 | ||
| Quality of Data: Health Care Data – Planning Based on Incomplete and Outdated Information? | 357 | ||
| Going beyond Affordability and Accessibility – Going Beyond Awareness: Sensitization | 360 | ||
| Pollution and health | 361 | ||
| Income, Life Expectancy, and Mortality Rates | 361 | ||
| The Real Tax Payers | 362 | ||
| Free Health Care? Is it Really Free? The Crisis of Perception | 363 | ||
| Fight between Prevention (Primary and Secondary) and Tertiary Care | 363 | ||
| Public Health versus Medical Interventions | 365 | ||
| Why Health May Not Improve | 366 | ||
| Investing in Child Health and Nutrition | 366 | ||
| Globalization of Challenges – Call for a Global Collaborative Partnership | 369 | ||
| Stakeholders or Influencers | 370 | ||
| WHO – Crisis of Credibility and Existence | 371 | ||
| Universal health coverage: dream and reality ! - health for all | 371 | ||
| UHC Experience | 377 | ||
| HFA Option for India | 378 | ||
| Financing health | 379 | ||
| Private vs Public Health System | 381 | ||
| HEALTH INSURANCE DOES NOT ASSURE – UNIVERSAL HEALTH CARE SANS INSURANCE! | 382 | ||
| Some Facts: Prevailing Trends and Key Considerations | 384 | ||
| Goals | 387 | ||
| VISION FOR HEALTH CARE OF THIS COUNTRY | 388 | ||
| SETTING THE PRIORITIES – URGENT AND IMPORTANT | 389 | ||
| Ideas for debate and consideration | 390 | ||
| Success stories – polio eradication, NACO and RSBY | 390 | ||
| Tamil Nadu – An Outlier | 391 | ||
| Digital Health | 392 | ||
| GROUND REALITIES IN DIGITAL HEALTH – A USER PERSPECTIVE | 393 | ||
| SOCIAL MEDIA | 396 | ||
| PPP in health care | 397 | ||
| How to Make PPPs Successful | 398 | ||
| Recommendations | 399 | ||
| The Way Forward | 400 | ||
| DISEASE CONDITION SPECIFIC TO AGE SPECIFIC | 400 | ||
| POPULATION EMPOWERMENT | 400 | ||
| EXPANDING THE HORIZON OF PRIMARY CARE | 401 | ||
| AWARENESS THROUGH INNOVATIVE ENGAGEMENT | 401 | ||
| DOCTORS, PHARMACISTS AND NURSES - REORIENTING THE ROLE | 401 | ||
| SELF CARE | 402 | ||
| RURAL HEALTH | 403 | ||
| Telemedicine Projects | 404 | ||
| ASSET LIGHT MODEL | 404 | ||
| REJUVENATING AYURVEDA | 405 | ||
| HEALTH REGULATOR | 407 | ||
| MEDICAL EDUCATION AND TRAINING | 408 | ||
| GUIDELINES AND PROTOCOLS-DRIVEN HEALTH CARE | 410 | ||
| IMPLEMENTING UNIVERSAL HEALTH COVERAGE FOR INDIA | 410 | ||
| ACCESSIBILITY AND AFFORDABILITY IS NOT ENOUGH | 417 | ||
| MOVING FROM AVAILABILITY TO UTILIZATION TO OUTCOMES | 418 | ||
| THREE OPTIONS BEFORE INDIA | 418 | ||
| A radical change required | 418 | ||
| Old Paradigm | 418 | ||
| New Paradigm | 420 | ||
| New model of care – the ‘pre-emptive care model’ | 420 | ||
| The Pre-emptive Care Model | 423 | ||
| IMPLEMENTATION OF ‘PRE-EMPTIVE’ CARE MODEL | 426 | ||
| Innovations in implementation: what we cannot change, we must innovate | 428 | ||
| Suggested Reading | 429 | ||
| Abbreviations and definitions used in the book | 439 | ||
| Abbreviations | 439 | ||
| Definitions | 443 | ||
| Index | 452 | ||
| A | 452 | ||
| B | 452 | ||
| C | 452 | ||
| D | 452 | ||
| E | 453 | ||
| F | 453 | ||
| G | 453 | ||
| H | 453 | ||
| I | 453 | ||
| J | 454 | ||
| K | 454 | ||
| L | 454 | ||
| M | 454 | ||
| N | 454 | ||
| O | 455 | ||
| P | 455 | ||
| Q | 455 | ||
| R | 455 | ||
| S | 455 | ||
| T | 456 | ||
| U | 456 | ||
| V | 456 | ||
| W | 456 | ||
| Y | 456 | ||
| Z | 456 |