Health4All

Public Health Policy

“The government is responsible for the people's health but the people themselves are the government"

 Dr Bamgboye Afolabi. 

How can I disagree with Dr on above statement. Its true that we have far more generalist in the health care system , be its secretary level or minister etc. Public health system is a complex system. Programs must be meticulously designed. In developing country like India we start to fail from planning itself. And loop hole are so numerous in number, some time i feel programs are designed in order to siphon off money. Very small amount reaches to the needy once. In India the biggest problem is poverty, next to it is corruption. So its not shocking that India has poor population equal to population of USA. 

When designing public health system, question comes is of financing. who has to pay the bills. Who it should be financed ; is it through public or private or both. This is question which has been debated from the start. But its also true that every thing is not free, some one has to pay some where. However ,it happens some times that ,Not all people has to pay, but certain amount of population have to pay and remaining will get benefit from it. Its unrealistic to have 100% universal health program without paying. And arguing that poor people cant pay and those will be left out ,is passive thinking. Differentiated paying could work. Govt must pay for poor and must allow other to pay for them-self , off course it should be minimal. We have seen far more cases of "Tragedy of common". Health care system must not be made one. Same boot doesnt fit all. Certain disease which have spillover effect ,hence needs a system where every one can be made to pay same or some times nil. But in some circumstances differential paying could be brought in . People must be given option in health care services; some will opt private; some who cant pay, will and must be serviced by Govt. Its about right to differencial choice. Person with ability must not be stopped from paying more if he wish to pay. Mosquito may not make difference while biting because its mosquito but our treatment is in human world not in mosquito's world. Here differentiation exist and if i wish to apply for it, i must be allowed.

Motivation, Spending and Health 

Not spending on health sector is bad idea. I dont agree with core idea of "not increase cost". Our spending on public health is at abysmal level(1.2% of GDP). As health and education are state subject, its state responsibility to increase spending. If motivation was the only factor then soviet union would have collapsed. We have far ignored the incentive part. Incentivisation of health sector is good, salaries has to go up. Bureaucratic red tape must be at higher level of administration not at lower level.

It must also be noted that front-line worker join system not by motivation but for living , hence it has to be kept that way. Their lives must be made worth while by providing incentives, be its their children education or salary or health insurance. Its might be shocking to put forward that in most state govt, govt dont even provide health insurance to Health Department worker. Its laughable, however some state have recently started providing insurance. We also have departmental co ordination problem. Departmental work of one fall in the other; example Women and Child welfare dept has same mandate as Health department in some programs. As i have seen , the former dept more like dead, and coordination in pathetic . Most programs are not implemented. All are cooked books except in TB program and polio program. Most PHC are under employed with ANMs and ASHA workers. There is systemic problem, and Not spending more is part of that problem. For sustainable health system we need both ideological motivation as well as incentive based motivation along with systemic reforms. We have had Civil service reforms but why cant we have Public Health System Reforms.