Social Justice in Health Sector

Social Justice- Health Sector

Issues related to the provision of Social Sector Services

Privatization of Health Sector

• NITI Aayog and Health Ministry has mooted the ideas of incorporating a PPP model into the provision of health services by allowing private hospitals to run select services within district hospitals by leasing out portions
• The select services included are treatments for cardiac disease, pulmonary disease and cancer care
• PPP model would improve accessibility to specialized health care
• PPP model would provide a mechanism for private sector to engage with the public utilising government facilities and infrastructure of district hospitals. A viability gap funding by the state government needs to be set up for this.
• Private parties would share ambulance services, mortuary services and blood banks with the district hospitals while public hospitals benefit from superior quality of human resources as well as increased capital of private players
• It would ensure timely diagnosis and detection of diseases reducing regional disparity in provision of such services

Concerns

• Health being a state subject, NITI Aayog has limited advisory powers and hence a top-down approach may not be suitable for a subject in the state list
• Increased privatization may lead to further commercialization of the health sector- only BPL and insured patients would be provided access to free health care thus ignoring the majority of the population.
• Private parties would be able to cherry-pick districts with individuals who have high paying capacity thus widening the existing regional disparity in the provision of quality health services
• Handing over public healthcare services to private sector reflects the inefficiency of public health care services and abdication of governments duty from providing free healthcare to all citizens

HIV AIDS UNAIDS REPORT

• India has a high percentage of HIV patients in the world and HIV cases have been reported in new areas of the country
• India is a vital supplier of generic antiretroviral drugs to world pharmacies and hence a coordinated approach on innovation, intellectual property rights and public health is required to tackle AIDS at the global level particular in low and middle-income countries
• UNAIDS focuses on achieving the 90-90-90 target: 90% diagnosed, out of them 90% provided ART and out of those provided treatment 90% are virally suppressed

 HIV AIDS Response by the Govt through AIDS (Prevention and Control Bill)

• Prohibition of discrimination towards HIV patients in provision of education, health facilities, employment, housing and other such services. Any violation of this right due to unfair treatment vetted out to HIV patients will amount to punishment.
• All HIV patients under the state are guaranteed access to preventive, testing, medical and counselling care including ART which is the key feature of the bill aiming to attain 90-90-90 target.
• The state government is required to employ an ombudsman to address grievances relating to the violation of the act
• The status of HIV patients shall not be disclosed unless by a court order

HIV and Hepatitis C Twins

• Similar to HIV, HCV can be transmitted through needles, inadequate sterilisation of needles and by sexual interaction
• Call for integrating HCV into National HIV Control Programme
• Health experts argue that twin testing facilities should be made available for HIV and Hepatitis C as cases of Hepatitis C have been commonly observed mainly in HIV patients
• Early detection of the disease can enable easier treatment with the availability of drugs
• A common infrastructure facility would be a win-win for both the government as well as the public in terms of cost and accessibility

Built-up Drug resistance

• Overuse of antibiotics – Bacteria evolves to resist antibiotics – Government currently addressing the overuse by introducing red line medicines to discourage sale and consumption of antibiotics
• Unnecessary antibiotic usage among livestock
• Discharge of effluents from pharmaceutical industries
• Improper control on infection
• Lack of hygiene: A government report Scoping Report on Anti-microbial resistance in India have proved that mass bathing in the Ganga has caused anti-microbial resistance to build-up
• India faces a challenge of MDR TB and its resolution as a part of the Revised National TB Control Programme
• Currently concerns regarding resistance to antiviral drugs used for treatment of swine flu
• Similar to antibiotic resistance these drugs are antiviral in nature and their uncontrolled usage will build up resistance
• Government has decided to take off 2 drugs used or treatment of Swine flu from the restrictive Schedule X of the Drugs and Cosmetics Rules meaning that they are easily available rendering them vulnerable to misuse
• Antibiotic resistance is also cited as a roadblock in the treatment of the sexually transmitted disease Gonnorhea by WHO

India’s fight against MDR TB

According to WHO, India has 1.7 million new TB cases reported in 2016 and so a decline of 12% TB deaths from last year although there was a 5% increase in new cases (Improved diagnosis?) reported.

India also has a 90-90-90 target in TB ( 90% reduction in disease incidence, mortality and catastrophic expenditure)

India’s policy aimed at achieving this target is centred around improved diagnostics (using GenXpert devices), short term treatment courses (shifting to daily regime from thrice weekly),improved availability of bedaquiline and delamanid and comprehensive preventive strategies (improved nutrition, sanitation and hygiene)

India follow the DOTS (Directly Observed Treatment Short Course) strategy recommended by WHO

Prevention

• Mutual cause effect relationship between TB and malnutrition. People with malnutrition are predisposed to contracting TB and TB itself can result in under nourishment
• Need for provision of nutritional assistance for economically vulnerable TB patients through markets and other alternatives like CSOs facilitating access to low cost fortified foods
• National Strategic Plan (NSP) brought out by the government with an aim to eliminate TB by 2025 focuses on addressing nutritional insecurity of TB patients
• Under nutrition contribute to 55% of TB incidence in India

Diagnosis

• Detection of the disease is key with regard to TB
• India lags behind in detection as most of the public and private sector still make use of smear microscopy which is an ineffective method as it can detect only 50% of TB cases.
• Xpert machines which are better equipped to diagnose TB are not proficiently available within the country; India’s procurement of GeneXpert (a multi-disease detection device) however, is a welcome step to address the same.

Treatment

• When it comes to treatment, India follows the thrice weekly treatment regimen contradictory to WHO’s recommendation of all day treatment; the thrice weekly treatment regime helps build up drug resistant TB.
• Lack of availability of bedaquiline and delamanid which are currently WHO recommended drugs to fight MDR TB. Currently these drugs are available only in select cities of the country.

National Strategy Plan to Eliminate TB by 2025

Detect-Treat-Prevent-Build Approach

• Achieve zero deaths by 2025

Detection

• Focus on early detection of TB cases, both drug-sensitive and drug-resistant in patients without waiting for them to voluntarily get tested
• Using highly sensitive diagnostic tests to ensure that all cases are identified and ensure universal testing for drug-resistant TB

Treatment

• Reaching out to patients seeking care from private doctors and target high-risk populations
• Seeks to make daily regimen universal which is currently followed only in 5 states; elsewhere the thrice weekly treatment regime continues
• Provide anti-TB treatment to all patients seeking the same and put in place soical support systems for patients
• Rapidly upscale availability of bedaquiline and delamanid
• Facilitating nutritional support to TB patients
• Incentivize private sector doctors to notify cases
• Sending customized SMSes to improve drug compliance

Prevention

Prevent emergence of TB in susceptible populations

Paediatric TB

• Rise in MDR TB in children
• Early diagnosis and detection is important to provide treatment
• Drug susceptible TB can be resisted with Fixed dose Combination drugs(FDCs) hence their availability and children’s accessibility to them should be ensured with special focus on targeted areas where TB cases are high
• Use of expert machines to detect TB is a welcome step as it is more efficient compared to the spear microscopy method used earlier
• All household contacts of a TB patient, including children needs to be monitored, tested and put on treatment if required