Issues relating to development and management of Social Sector/Services relating to Health
Development processes and the development industry the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders
National Health Policy 2017
Health is one of basic need of any emerging nation. Especially basic and fundamental health care is a determinant in a nation’s growth and progress. It is in this background that a policy document is necessary to guide resource mobilization, allocation and prioritization.
The National Health Policy 2017, which the Centre announced this week after a nudge from the Supreme Court last year, faces the challenging task of ensuring affordable, quality medical care to every citizen.
With a fifth of the world’s disease burden, a growing incidence of non-communicable diseases such as diabetes, and poor financial arrangements to pay for care, India brings up the rear among the BRICS countries in health sector performance.
Against such a laggardly record, the policy now offers an opportunity to systematically rectify well-known deficiencies through a stronger National Health Mission.
Among the most glaring lacunae is the lack of capacity to use higher levels of public funding for health.
Rectifying this in partnership with the States is crucial if the Central government is to make the best use of the targeted government spending of 5% of GDP by 2025, up from 1.15% now.
Although a major capacity expansion to produce MBBS graduates took place between 2009 and 2015, and more initiatives were announced later, this is unlikely to meet policy goals since only 11.3% of registered allopathic doctors were working in the public sector as of 2014, and even among these, the number in rural areas was abysmally low.
More health professionals need to be deployed for primary care in rural areas.
Availability of trained doctors and nurses would help meet the new infant mortality and maternal mortality goals, and build on the gains from higher institutional deliveries, which exceeded 80% in recent years.
Health care sector specific issues
Contracting of health services from the private sector may be inevitable in the short term, given that about 70% of all outpatient care and 60% of inpatient treatments are provided by it.
But this requires accountability, both on the quality and cost of care.
No more time should be lost in forming regulatory and accreditation agencies for healthcare providers at the national and State levels as suggested by the expert group on universal health coverage of the Planning Commission more than five years ago.
Without such oversight, unethical commercial entities would have easy backdoor access to public funds in the form of state-backed insurance.
It should also be mandatory for all health institutions to be accredited, and to publish the approved cost of treatments, in order to remove the prevailing asymmetry of information.
For the new policy to start on a firm footing, the Centre has to get robust health data.
Currently this is fragmented because inputs from multiple sources and sample surveys are not reconciled, and the private sector is often not in the picture.
To reduce high out-of-pocket spending, early deadlines should be set for public institutions to offer essential medicines and diagnostic tests free to everyone.
This was estimated in 2011 to require a spending increase of only 0.4% of GDP, which is within the 2.5% that the Centre is talking about.
A policy document is important for any sector to be effectively handled and planned keeping future priorities in mind. Health care has long desired a holistic policy. Though there are lacunae a start in right direction will help correct necessary problems.
Connecting the dots:
National Health Policy 2017 is a step in the right direction. Discuss the policy critically in view of the rural health parameters of India and global SDGs.
TOPIC:General Studies 2
Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Conservation, environmental pollution and degradation, environmental impact assessment
Saving the waste water too
March 22nd is celebrated as World Water Day every year to spread awareness among the general public and focus on its importance in sustainable development.
This year, 24th World Water Day is celebrated with the theme ‘Waste Water’
It is easily observed that in any discourse about water, waste water is less talked about as against normal water supply.
Though waste water is the one that is generally wasted, it is an important resource too.
Waste water as a resources in an economy requires safe management as it is an efficient investment in human health and the ecosystem.
Sources: domestic, industrial, commercial, agricultural, surface run-off or storm water, and sewer inflow.
Uses- once treated, it can be recycled and/or reused for drinking purposes, in industry, in the artificial recharge of aquifers, in agriculture, in the rehabilitation of natural ecosystems etc.
Threat of Untreated waste water when used for agricultural crops is high as it is often polluted with urban waste containing a mix of chemical and biological pollutants and also high levels of pathogens from excreta. This generally affects human health.
Hence, waste water should be treated or WHO guidelines should be followed for restricted use of ‘untreated water’.
For example, In WTO guidelines, it is prescribed that irrigation should be discontinued with untreated waste water for a few days before harvesting of crops in order to allow pathogens to die in sunlight.
Globally, 10% of waste water is treated. In India, about 69% India’s water is untreated and 39% of actual operating capacity does not meet the regulatory standards (CPCB 2009).
Here, waste water is discharged directly into water bodies, overloaded rivers, lakes and the ground with toxic chemicals and wastes.
This leads to continuous poison of water resources and supplies.
When this toxins find their way to plants and animals, they cause severe ecological toxicity at various levels, including in the human food chain.
Strategies for waste water development
Ganga receives, in its journey, roughly 500 million litres per day (MLD) of partly treated or untreated industrial effluents from over 700 grossly polluting industries, and about 3,000 MLD waste water from urban bodies.
This shows the pressure on the river to survive itself because of such organic load.
Thus, unless the waste water is treated and discharged, rivers of India like Ganga, will continue to be conveyors of contaminants as against the popular notions of them of being ‘life giving streams’.
Inclusive smart cities
India’s strategy for its new path of development focuses sharply on the development of smart cities as drivers of GDP growth.
In this, recycling of waste water is crucial to the growth of smart cities.
Such recycling is happening in some of proposed smart cities such as Bengaluru, where tertiary treatment of waste water enables the supply of water to airports, parks, industries and construction sites at suitable user fees.
The fresh water supply is limited and along with the growing demand and depleting groundwater levels, the recycling and reuse of waste water opens up big business opportunities.
One of the best international examples in urban water recycling is Yokohama in Japan where more than 99% of Yokohama’s population is connected to sewers.
It considers its waste water precious and is being supplied to various locations of the city.
Waste water business opportunities
The waste water treatment market is unorganised and a sizeable portion is dominated by small and medium-sized domestic players. This market is mainly dominated by municipal segments.
There are varied estimates on the size of business opportunities in India’s water sector. With about 26 billion litres of water going untreated daily, the investment opportunities in this segment are estimated to be in the range of $400 million, assuming a four-year completion cycle of the operating system.
The enforcement of regulatory standards for waste water from industries and municipalities is expected to enhance the size of the waste water market as markets for waste water treatment are expected to grow in value and volume.
In India, there is policy support for recycling and reuse of waste water. The National Water Policy 2012 recognises that “recycle and reuse of water should be the general norm”.
India’s demand for water is going to increase in all sectors, given continuing economic growth and improving lifestyles. The available water supply is finite, and its spatial and temporal variations are well known. The recurring drought incidences also demand availability of water during scarcity. By 2050, it is estimated, India will be water-scarce in terms of per capita availability of water per year. Adding to it, climate change will affect the variability of water supply in many countries, including India. The target of National Water Mission of India to improve efficiency by 20% in all sectors is difficult to achieve unless water is conserved, recycled and reused.
Water is a state subject according to constitution and the centre comes in picture only when there is regulation of inter-State river waters. Thus, recycling and reuse of water comes into the States’ and local bodies’ domain. The governments, at the Centre as well as in the States, should give incentives to various players in this regard. Also, the regulatory norms for maintenance of waste water standards should be strictly enforced. A combination of these instruments will enhance the progress of recycling and reuse of waste water, which is crucial to India’s development.
Connecting the dots:
What is waste water? What are different means to recycle it? Critically examine India’s waste water management plans.