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India’s universal health coverage policy needs to be extensive: Experts

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New Delhi: Speaking at a conference on healthcare here on Sunday, experts opined that India’s universal health coverage policy needs to be extensive, considering the role of the states and the Center and lower than expected performance of healthcare services.

Given the challenges of the policy making environment in the country and the government’s low spending on healthcare, the sector is not performing at the level it should have been to meet the demand of quality healthcare for India’s growing population, said Rakesh Kumar, joint secretary, ministry of health and family welfare.

“18 percent rural population in the country has no access to healthcare,” he said at the inauguration of ‘Delivering on the Promise of Universal Health Coverage in India: Policy Options and Challenges’.

According to Kumar, the burden of non-communicable diseases in the country has increased. “Seventy percent of deaths in India will be caused by non-communicable diseases by 2020.”

“Today’s conference is the culmination of collaboration between Jindal Global University, Harvard Global Health Initiative and the Harvard School of Public Health to examine legal, policy and regulatory issues relating to the universal health coverage in India,”said C. Raj Kumar, professor and vice chancellor, O.P. Jindal Global University.

“The conference brought together academics, policy makers, doctors, lawyers, public health practitioners and government representatives to discuss and debate a central issue of public policy, which is about the efforts to achieve universal health coverage in India,” he added.

Explaining the impact of poor healthcare on the country, Ramanan Laxminarayan, professor, Public Health Foundation of India, said India is “very different from other countries” where “people may go into financial impoverishment because of high primary healthcare cost”.

Laxminarayan said the quality of healthcare services is an important issue and non-harmful care must be ensured for the people.

He highlighted the achievements of public sector undertakings like railways, saying that “public sector in India does deliver”.

Laxminarayan said when public sector banks have an excellent level of accountability, why can’t it be replicated in the healthcare sector.

Highlighting the state of medical education in India, Kesav Desiraju, former secretary, Department of Consumer Affairs and former secretary, Ministry of Health and Family Welfare, said the government has no interest in revising the curriculum of MBBS.

“The problem is much deeper than we think at the undergraduate level,” he said.

Desiraju said of the 416 medical colleges in the country, about 60 percent are in the private sector. “At macro level the numbers could be impressive but we are not getting the desired results.”

“About 28 percent of the rural population and 20 percent of the urban population has absolutely no money to pay for healthcare services,” the former secretary said.

Imrana Qadeer, senior fellow, Council for Social Development and former professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, gave a historical perspective of universal healthcare.

She said “diseases are rooted in poverty” and all healthcare plans in India focus mainly on technology while poverty reduction is never incorporated into them.

Analyzing India’s healthcare initiatives, Peter Berman, professor of the practice of global health systems and economics, Harvard T.H. Chan, School of Public Health and coordinator, India Health Partnership, said the National Rural Health Mission (NRHM) launched in 2005, which has now been renamed as NHM with spending cuts, was an important policy change for the healthcare sector in India.

“NRHM had set the target of spending 2-3 percent of the gross domestic product (GDP) on health by 2012. It had set specific targets for the Center as well as states,” he said.

Rajeev Malhotra, professor, Jindal School of Government and Public Policy and executive director, Centre for Development and Finance, said universal health coverage can be quantified.

“Public and private sectors have mutually reinforcing role in providing healthcare in India,” he said.

Stating that tracking the global impact of diseases is important, he said the breakout of Ebola upset all economic development projections in Africa.

Saying that the AYUSH program of the government has not been tapped properly, he said: “The government has to take a call whether it wants to see itself as a player or a provider…Private sector’s role needs to be strengthened in the value chain.” (IANS)(Photo: healthinsuranceinternational.wordpress.com)

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C-Section Births Doubles In Number, Reaching Epidemic Proportions: Doctors

C-section is a type of major surgery, which carries risks that require careful consideration

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A newborn, one of 12 babies born by C-section, cries inside an incubator at the Bunda Hospital in Jakarta, Indonesia, Dec. 12, 2012. Several hospitals in Indonesia's main cities performed more cesareans than usual with new mothers hoping a 12-12-12 birth date will bring luck to their newborns. VOA

Worldwide cesarean section use has nearly doubled in two decades and has reached “epidemic” proportions in some countries, doctors warned Friday, highlighting a huge gap in childbirth care between rich and poor mothers.

They said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing C-sections at rates “that have virtually nothing to do with evidence-based medicine.”

In 2015, the most recent year for which complete data is available, doctors performed 29.7 million C-sections worldwide, or 21 percent of all births. This was up from 16 million in 2000, or 12 percent of all births, according to research published in The Lancet.

It is estimated that the operation, a vital surgical procedure when complications occur during birth, is necessary 10-15 percent of the time.

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The Yusuf Dantsoho Memorial Hospital has a high success rate with C-sections. Kaduna, Nigeria. Photo by Chika Oduah, VOA

Varying country rates

But the research found wildly varying country rates of C-section use, often according to economic status: In at least 15 countries, more than 40 percent births are performed using the practice, often on wealthier women in private facilities.

In Brazil, Egypt and Turkey, more than half of all births are done via C-section.

The Dominican Republic has the highest rate of any nation, with 58.1 percent of all babies delivered using the procedure.

But in close to a quarter of nations surveyed, C-section use is significantly lower than average.

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Maternal death and disability rates are higher after C-section Flickr

Reasons to opt for surgery

Authors pointed out that while the procedure is generally overused in many middle- and high-income settings, women in low-income situations often lack necessary access to what can be a life-saving procedure.

“We would not expect such differences between countries, between women by socioeconomic status or between provinces/states within countries based on obstetric need,” Ties Boerma, professor of public health at the University of Manitoba, Winnipeg, and a lead author on the study, told AFP.

Jane Sandall, professor of social science and women’s health at King’s College London and a study author, told AFP that there were a variety of reasons women were increasingly opting for surgery.

These include “a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a vaginal delivery, as well as medico-legal issues.”

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It also identified an emerging gap between wealthy and poorer regions within the same country. Flickr

Doctors are often tempted to organize C-sections to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.

Sandall also said there were often “financial incentives for both doctor and hospital” to perform the procedure.

The study warned that in many settings young doctors were becoming “experts” in C-section while losing confidence in their abilities when it comes to natural birth.

Income a factor

It also identified an emerging gap between wealthy and poorer regions within the same country. In China, C-section rates diverged from 4 percent to 62 percent; in India the range was 7-49 percent.

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Worldwide, more than 11 percent of babies are born premature. Pixabay

While the U.S. saw more than a quarter of all births performed by C-section, some states used the procedure more than twice as often as others.

“It is clear that poor countries have low C-section use because access to services is a problem,” Sandall said. “In many of those countries, however, richer women who live in urban areas, have access to private facilities have much higher C-section use.”

Risks to mother, child

C-sections may be marketed by clinics as the “easy” way to give birth, but they are not without risks.

Maternal death and disability rates are higher after C-section than vaginal birth. The procedure scars the womb, which can lead to bleeding, ectopic pregnancies (where the embryo is stuck in the ovaries), as well as still- and premature future births.

 

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Doctors are often tempted to organize C-sections to ease the flow of patients through a maternity clinic. Flickr

 

The authors suggested better education, more midwifery-led care and improved labor planning as ways of ensuring C-sections are only performed when medically necessary, as well as ensuring women properly understand the risks involved with the procedure.

“C-section is a type of major surgery, which carries risks that require careful consideration,” Sandall said.

Also Read: Novel Blood Test May Predict Autism Risk In Babies During Pregnancy

In a comment accompanying the study, Gerard Visser of the University Medical Centre in the Netherlands, called the rise in C-sections “alarming.”

“The medical profession on its own cannot reverse this trend,” he said. “Joint actions are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate care for their circumstances.”