The crisis of COVID-19 vaccines in India is a consequence of government policies dating back decades. Private foundations led by the Bill and Melinda Gates Foundation have engineered a shift in research and manufacture of essential technologies such as vaccines to private biotech labs and factories. Companies such as the Serum Institute of India and Bharat Biotech can dictate terms and prices of vaccines developed with public support because the closure of public vaccine manufacturing units over a decade ago has left the government at the mercy of the private sector.
Following the COVID-19 outbreak, when the recovery of the nation is contingent on doctors and healthcare personnel risking their lives every day, we must examine whether there is an equitable quid pro quo in terms of receiving service and providing protection. The causes of the antagonism between patients and doctors leading to violence against medical professionals are highlighted, and the efficiency of the legislations enacted for the protection of medicare professionals in India is examined. Finally, recommendations to remedy the deficiencies are provided.
Awareness about risk factors is a prerequisite for the prevention of diabetes mellitus amongst diabetic patients. A questionnaire-based survey of diabetic patients adapted from “WHO-STEPS Surveillance” was performed during 2018 in Punjab, using descriptive statistics and multivariate logistic regression. The overall awareness level was found to be 83%, but perception and comprehension regarding risk factors and prevention strategies are still at a nascent stage. There is need for innovative awareness programmes and government campaigns on the consequences of lifestyle modification, sedentary lifestyle, and altering epidemiology of diabetes.
Public and Private Healthcare and Health Insurance in India by Brijesh C Purohit, New Delhi, California, London and Singapore: Sage Publications, 2020; pp xiii + 283, ₹1,195 (hardcover).
India Policy Finance and Policy Report: Health Matters edited by Jyotsna Jalan, Sugata Marjit and Sattwik Santra, New Delhi: Oxford University Press, 2020; pp xvi + 166, ₹1,495 (paperback).
India’s health system is dominated by the private sector and as a result, out-of-pocket expenditure is very high. To provide financial risk protection and avoid catastrophic health consequences, policy emphasis is on the Ayushman Bharat programme which targets to cover 50 crore people. Such a large-scale insurance scheme needs huge infrastructural and administrative support. Unincorporated private healthcare providers comprise 99% of private health providers in India, the majority of them being small scale, employing less than 10 workers and having a strong urban bias. To better promote universal health coverage, policy emphasis on better monitoring, administering regulations, transparency in system, and ensuring quality in delivery of service is needed.
Financing health expenditure through health insurance is currently gaining significance as a strong social policy in countries like India where public health facilities are still inadequate. An attempt to estimate the coverage of health insurance in India shows that the coverage is low and not uniform across states and union territories, despite the fact that several public-funded schemes focus on the below poverty line population. Of the various types of health insurance schemes, public-funded health insurance schemes have a dominant position. Moreover, the likelihood of health insurance coverage is relatively higher among specific social groups and in certain areas.
In the context of India where public expenditure on healthcare is low, the private sector plays an important role in delivering healthcare during childbirth. An analysis of the latest round of National Family Health Survey data to estimate the differential probability of caesarean sections in private medical facilities relative to government facilities, and focusing on unplanned C-sections, reveals that the probability of an unplanned C-section is 13.5–14 percentage points higher in the private sector. These results call for a critical assessment of the role of private sector in healthcare in the context of inadequate public provision, expanding private provision and weak governance structures.
Multiple initiatives going on in India regarding the collection of digital personal health data are analysed, and the question of how the data is being used is examined. While such data could facilitate healthcare and referral services, a strong and sensitive governance structure is needed to be in place to enable its optimal use and to ensure that the data is not used to further the agendas of surveillance and control.
The National Family Health Survey-3 and 4 data show that in the past 10 years, overweight/obesity among women in terms of Body Mass Index has increased quite sharply. In the Indian context, undernutrition and obesity are not separate problems. A large proportion of overweight/obese women are undernourished, with small stature, food transition towards more fats and increasingly sedentary lifestyles making them vulnerable towards being overweight/obese. More diversified diet reduces the risk of overweight/obesity. It is suggested that adequate and good quality diversified diets need to be ensured for comprehensive energy and nutrient adequacy. This requires an overhaul of India’s food programmes.
The intrinsic commitment of the accredited social health activists towards the well-being of the community is unduly exploited by the state in the name of “volunteerism.” It is high time a wholesome definition of work is adopted to understand the inconspicuous contributions made by these front-line healthcare workers, who form a key link in the public health system in India.
After the Bhopal Gas Tragedy, attempts were made to understand the effects of methyl isocyanide so that the victims could avail better treatment. However, time and again, relevant information from medical surveys was kept hidden.
Domestic pharmaceutical firms continue to operate under the influence of the strategy of global integration of the pharmaceutical industry and healthcare. The link between domestic firms and public sector research organisations is the weakest link in the domestic pharmaceutical industry due to misguided policies in competence-building and innovation system-building after India accepted the Trade-Related Aspects of Intellectual Property Rights Agreement in 1995. The government should rethink its strategies to get domestic firms to contribute to system-building activities and prioritise investment into the upgrading of processes of learning and building competence.
