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Chapter # 27. Public Health Management and Action

Objectives 

To revamp radically the public and preventive health system in the nation through the following strategic interventions:

  • Mobilize public health action through an integrated, inter-sectoral and pan-stakeholder approach, targeted at communities and individuals as well as grassroots organizations, aimed at creating an unprecedented people-led movement for health and wellness.
  • Operationalize vital enablers – a) public health and management cadre, b) public health agency with capacitated supporting institutions (c) municipalities and panchayati raj institutions.

Current Situation

Public health, i.e., the science of keeping communities healthy through the prevention of disease and promotion of health and wellness, has historically been a low priority in India. Of the total current expenditure on health classified by healthcare functions, preventive care accounts for 6.7 per cent.

The money spent on curing people on the other hand is 51 per cent of the expenditure1 with the remaining money being spent on pharmaceuticals, other medical goods and patient transportation.

Although India accounted for only 18 per cent of the global population in 2016, we accounted for 34 per cent of the global tuberculosis burden and 26 per cent of the premature mortality due to diarrhoea, lower respiratory and other common infectious diseases.2

At the same time, non-communicable diseases (NCDs), including cardiovascular conditions, chronic obstructive respiratory diseases, diabetes, mental health conditions and cancers are now the leading cause of health loss, with 55 per cent morbidity and premature mortality attributable to these conditions. The range of health loss3 across states is wide. Kerala and Goa have the lowest rates while Assam, Uttar Pradesh and Chhattisgarh have the highest rates.4

Public health action and management is a scientific and professional endeavour which should not be left to untrained employees relying on common sense alone.

A suboptimal public health system:

  • Makes it challenging to tackle NCDs, which, in the first place, is all about prevention and early detection.
  • Causes us to resort to high-cost secondary and tertiary health care in many cases.
  • Diminishes our preparedness for new and emerging threats such as bioterrorism.
  • Compromises our ability to harness the demographic dividend.

The nations with whom we compete or aspire to emulate have achieved health and wellness outcomes on the foundation of strong public health systems. Thus, it is an absolutely essential ingredient for building a New India.

During the last four years, the government has taken several steps to strengthen public health in the country including the launch of Mission Indradhanush and Intensified Mission Indradhanush as well as the National AYUSH Mission.

Efforts have also been intensified for eliminating Neglected Tropical Diseases like Kala Azar and Lymphatic Filariasis. Further, the war against Tuberculosis has been escalated through the launch of the National Strategic Plan in 2017.

Constraints

  1. Diseases need to be prevented first, a concept that has historically been inadequately acknowledged in India. The large burden of NCDs requires lifestyle and community-level interventions. Ensuring people eat right, sleep right, maintain good hygiene, exercise, and adopt a healthy lifestyle necessitates concerted interventions at various levels of the system.
  1. In most states, population health management positions are staffed by doctors, trained primarily in the provision of curative services, or by generalist civil servants. They have limited public health training, which includes an understanding of the causes and linkages between risk factors and diseases as well as disciplines including epidemiology, biostatistics, social and behavioural sciences and management of health services. Likewise, hospitals are run by clinicians with little expertise in managing health facilities.
  1. The following preventable risk factors are causes for a major proportion of diseases in the country: maternal and child malnutrition, air pollution, unhealthy diets, high blood pressure, high blood glucose, tobacco consumption, unsafe water, and poor sanitary practices; of these, nutrition, environment, water and sanitation are outside the purview of the health ministry. Therefore, accountability for ensuring vital public health actions is spread thin.
  1. There is no single authority responsible for public health that is legally empowered to enforce compliance from other public authorities and citizens, even though several factors may require inter-sectoral action to achieve a measurable impact on population health.

Way Forward

  1. Mobilize public health action at multiple levels 
  • Public funding on health should be increased to at least 2.5 per cent of GDP as envisaged in the National Health Policy, 2017.
  • Create an environment, through appropriate policy measures, that encourages healthy choices and behaviours:

o Make the practice of yoga a regular activity in all schools through certified instructors.

o Increase taxes on tobacco, alcohol and unhealthy foods such as soda and sugar sweetened beverages.

  • Co-locate AYUSH services in at least 50 per cent of primary health centres, 70 per cent of community health centres and 100 per cent of district hospitals by 2022-23.6
  • Strengthen the Village Health Sanitation and Nutrition Day platform to cover a broader set of health issues across various population groups instead of only focusing on child health.
  • Activate multiple channels (schools, colleges, women’s groups, traditional events like fairs, social media platforms, National Cadet Corps etc.) and prepare communication materials for catalysing behavioural change towards greater recognition of preventive health care.
  • Make nutrition, water and sanitation part of the core functions of panchayati raj institutions and municipalities.
  1. Institute a public health and management cadre in states

Incentivize state governments to invest in creating a dedicated cadre for public health at the state, district and block levels:

  • Characteristics of the cadre

o Train officials in public health related disciplines including epidemiology, biostatistics, demography and social and behavioural sciences.

o Provide training in hospital management to suitably equip personnel responsible for managing large facilities.

o Create a career pathway up to the highest levels within the state health departments for those trained in public health, as well as for those with clinical specialties.

o Allow mid-level providers responsible for managing health and wellness centres delivering comprehensive primary healthcare to rise to higher-level positions within the cadre. Similarly, allow public health functionaries at the block and district levels to enter the cadre.

  • Mandate a master’s level qualification, in addition to specified training, for officials taking on leadership positions.
  • Institutional mechanisms

o Develop a model public health and management cadre by drawing upon best practices and engage with states to adapt, refine and institutionalize the model.

  • Formulate guidelines to create the cadre, primarily by re-aligning the requisite skill sets of existing functionaries with service conditions.
  1. Create a focal point for public health at the central level with state counterparts  
  • Create a designated and autonomous focal agency with the required capacities and linkages to perform the functions of disease surveillance, information gathering on the health impact of policies of key non-health departments, maintenance of national health statistics, enforcement of public health regulations, and dissemination of information to the public. An appropriately empowered and capacitated National Centre for Disease Control may be considered to play this role with support from relevant organizations.
  • Create a counterpart Public Health Agency in each state, where they do not already exist.
  1. Miscellaneous 
  • Explore the need for a Public Health Act to legislatively empower and, if necessary, institutionalise the Public Health Agency discussed above.
  • Redefine the role of the technical directorate (Directorate General of Health Services) and create a Directorate of Public Health.
  • Develop a comprehensive MIS including baseline data for NCDs.



Chapter # 41. Data Led Governance and Policy Making

Objectives Evidence based policy making should be made integral to the overall governance structure in New India, 2022-23. To achieve this, timely gen

Chapter # 40. Optimizing the Use of Land Resources

Optimizing the Use of Land Resources-Ensuring that land markets function smoothly, through efficient allocation of land across uses, provision of secu

Chapter # 39. Modernizing City Governance For Urban Transformation

Objective  City Governance For Urban Transformation To transform our cities into economically vibrant and environmentally sustainable habitats that p

Chapter # 38. Civil Services Reforms

Objective  civil-services-reforms To put in place a reformed system of recruitment, training and performance evaluation of the civil service to ensur

Chapter # 37. Legal, Judicial and Police Reforms

Objective To ensure the safety and security of citizens and ensure access to effective legal systems and speedy delivery of justice. Current Situation

Chapter # 36. The North-East Region

Objectives The North-East Region (NER) should: Have adequate road, rail and air connectivity, waterways, internet connectivity and financial inclusion

Chapter # 35. Balanced Regional Development: Transforming Aspirational Districts

Objective  Balanced Regional Development: Transforming Aspirational Districts Achieve balanced development in India by uplifting 115 districts, curre

Chapter # 34. Scheduled Castes (SCs), Scheduled Tribes (STs), Other Backward Classes (OBCs), Other Tribal Groups and Minorities

SCs, STs, OBCs, De-Notified Tribes (DNTs), Nomadic Tribes (NTs) and Semi-Nomadic Tribes (SNTs) Objective  To accelerate the socio-economic developm

Chapter # 33. Senior Citizens, Persons with Disability and Transgender Persons

SENIOR CITIZENS  Objective To ensure a life of dignity, social security and safety for senior citizens, enabling them to actively participate in econ

Chapter # 32. Gender

Objective  To create an enabling environment, sans institutional and structural barriers. To enhance the female labour force participation rate to at

Chapter # 31. Nutrition

Objectives  Under POSHAN Abhiyaan, achieve the following outcomes by 2022-23, compared to the baseline of 2015-16 (National Family Health Survey-4):

Chapter # 30. Universal Health Coverage

Objectives  On the strong platform of Pradhan Mantri – Jan Arogya Yojana (PM-JAY): Attain a coverage of at least 75 per cent of the population

Chapter # 29. Human Resources for Health

Objectives  Achieve a doctor-population ratio of at least 1:1400 (WHO norm 1:1000) and nurse-population ratio of at least 1:500 (WHO norm 1:400) by 2

Chapter # 28. Comprehensive Primary Health Care

Objectives  Under Ayushman Bharat, scale-up a new vision for comprehensive primary health care across the country, built on the platform of health an

Chapter # 27. Public Health Management and Action

Objectives  To revamp radically the public and preventive health system in the nation through the following strategic interventions: Mobilize public

Chapter # 26. Skill Development

Obejctives  For harnessing the demographic advantage that it enjoys, India needs to build the capacity and infrastructure for skilling/reskilling/up-

Chapter # 25. Teacher Education and Training

Objectives There cannot be a quality education system without quality teachers. Therefore, a thorough revamp of the entire ecosystem of teacher educat

Chapter # 24. Higher Education

Objectives  Increase the gross enrolment ratio (GER) in higher education from 25 per cent in 2016-17 to 35 per cent by 2022-23. Make higher education

23. School Education

Objectives Universal access and retention: o Hundred per cent enrolment and retention at elementary education and secondary education levels; achieve

Chapter # 22. Sustainable Environment

Objective  The objective is to maintain a clean, green and healthy environment with peoples’ participation to support higher and inclusive economic

Chapter # 21. Water Resources

Objectives By 2022-23, India’s water resources management strategy should facilitate water security to ensure adequate availability of water for l

Chapter # 20. Swash Bharat Mission

Objectives The key objectives of the Swachh Bharat Mission include: 1. Making India Open Defecation Free (ODF) by October 2, 2019. 2. Carrying out ext

Chapter # 19.Smart Cities for Urban Transformation

Objectives  Leverage the ‘Smart Cities’ concept in select urban clusters to: Drive job creation and economic growth. Significantly improve effici

Chapter # 18. Digital Connectivity

Objectives Given the relevance of digital connectivity to economic growth and the need to eliminate the digital divide by 2022-23, India should aim to

Chapter # 17. Logistics

Objectives Achieve multi-modal movement of cargo on par with global logistics standards. Reduce the logistics cost to less than 10 per cent of GDP fro

Chapter # 16.Ports, Shipping and Inland Waterways

Objectives  Double the share of freight transported by coastal shipping and inland waterways from 6 per cent in 2016-171 to 12 per cent by 2025. Incr

Chapter # 15. Civil Aviation

Objectives Enhance the affordability of flying to enable an increase in domestic ticket sales from 103.75 million in 2016-171 to 300 million by 2022.2

Chapter # 14. Railways

Objectives By 2022-23, India should have a rail network that is not only efficient, reliable and safe, but is also cost-effective and accessible, both

Chapter # 13. Surface Transport

Objectives Increasing the coverage and quality of roads and highways is critical to enhancing connectivity and internal and external trade. By 2022-23

Chapter # 12. Energy

Objectives The government’s on-going energy sector policies aim “to provide access to affordable, reliable, sustainable and modern energy”. At t

Chapter # 11. Minerals

Objectives Double the area explored from 10 per cent of obvious geological potential (OGP) area to 20 per cent.1 Accelerate the growth of the mining s

Chapter # 10. Travel, Tourism and Hospitality

Objectives  Increase India’s share in global international tourist arrivals from 1.18 per cent to 3 per cent. Increase the number of foreign touris

Chapter # 9. Housing For All

Objectives Provide every family with a pucca house, with a water connection, toilet facilities, and 24×7 electricity supply and access. Build 2.9

Chapter # 8. Financial Inclusion

Objectives Banking for the unbanked  o Bank accounts: Ensuring universal access to bank accounts, which are a gateway to all financial services.  o

Chapter # 7.Doubling Farmers’ Income (III): Value Chain & Rural Infrastructure

Objectives • Transform the rural economy through the creation of modern rural infrastructure and an integrated value chain system. • Leverage the

Chapter # 6.Doubling Farmers’ Income (II): Policy & Governance

Objectives Create a policy environment that enables income security for farmers, whilst maintaining India’s food security. Encourage the participati

Chapter # 5.Doubling Farmers’ Income (I): Modernizing Agriculture

Objectives • Modernize agricultural technology, increase productivity, efficiency and crop diversification. • Generate income and employment throu

Chapter # 4.Industry

Objectives Double the current growth rate of the manufac-turing sector by 2022. Promote in a planned manner the adoption of the latest technology adva

Chapter # 3. Technology and Innovation

Objectives India should be among the top 50 countries in the Global Innovation Index by 2022-23.1 Five of our scientific research institutions should

Chapter # 2.Employment and Labour Reforms

Objectives Complete codification of central labour laws into four codes by 2019. Increase female labour force participation to at least 30 per cent by

Chapter # 1 Growth (India @ 75)

Objectives Steadily accelerate the gross domestic product(GDP) growth rate to achieve a target of about 8 per cent during 2018-23 This will raise the

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