Realizing the Right to Health: Societal Efforts, Responses and Responsibilities .

Realizing the Right to Health: Societal Efforts, Responses and Responsibilities. The Role of Public Health Policy, Programmes and Health Financing. Dr. Thelma Narayan Community Health Cell, Bangalore.

Shrivastava Report 1975, 6th Plan, ICSSR & ICMR report on Health for ALL. National Health Policy – 1982- based on Primary Health Care principles, reflected in 5 year plans. National Population Policy 2000 National Health Policy 2002-promotes medical tourism, privatisation, commercialisation. National Pharmaceutical Policy 2002 Public Health Policy Explicit & Implicit Policies- National Level

State Health Policies Karnataka and Orissa Adopted by Karnataka State Cabinet in 2004 • Constitutionally Health is a State subject • Karnataka Task Force on Health & FW • Orissa Health strategy

Important Policy Influencespower & strategic positioning Political Party Manifestos & willingness to be influenced Corporate Interests Pharmaceutical and Industrial Lobbies PHM/JSA JAAK/MNI, Networks, Movements, Civil Society, Media Professional bodies & lobbies Ministries and Directorates of Health Patient Groups & Consumer Groups

Placebo Policies • Those with no intention of being implemented. • Keeps people happy and hopeful. • Masks the situation • Allows for capture of policy space by elite • Occurs with a passive population, disempowered.

Policy Gaps • Lack of a strong enough countervailing power to articulate, demand and ensure policy & practice with a social justice, equity and rights based approach. • Thus was born the Peoples Health Movement globally and the Jan Swasthya Abhiyan, India in Dec 2000.

Policy Processgiving direction, sustaining, building • Revitalizing the social goal of Health for All at all levels- Global, National, Local • Reviving the Spirit of Alma Ata • Policy Briefs for political parties • Critical Engagement with government • Creating Inclusive Networks & State units • community awareness and involvement, working with social movements -women’s movement, dalit movements, Right to Food Campaign etc.

National Rural Health Mission 2005-2012 • Strengthening Health Systems Integration • Communitisation (Community action for Health) village health and sanitation committees, ASHAs, village health plans, village health days, PRI role; community monitoring. • Financing: budgets;untied funds; demand side financing • Better Management- Programme management units, Indian Public Health Standards

Implementation: The Black Box • Framework of Implementation approved by Cabinet; • Budget earmarked, state and district health societies, District Health Plan, State PIP, Reviews-concurrent, CRM,JRM. • National Health System Resource Centre, SHRC, RRC • Health and health related service staff • Motivation, morale • Capacity, Quality of Care • Integrity, Accountability, Transparency • Governance • Using a public health/community health approach • Strengthening comprehensive primary health care.

Eleventh Five Year Plan- 2008 • Health Sector Allocation : Rs. 1,36,147 crores of which Rs. 89,478 crores for flagship NRHM. • Approved by National Development Council , Dec 9th 2007. • Three times increase for NRHM component. • State Budgets to increase by 10% annually

Peoples Rural Health Watch State Health Assembly - 3March 21st 2007, Bangalore • JSA working from the ground up -8 states. • State reports • Annual reports • Community monitoring in NRHM

Impacts • The measure of our efforts on health indicators –(NFHS, DLHS,SRS, NGOs) on Mortality, Morbidity, Disability, (Quality of Life) • Improvement in Health Services at district and taluk level with better governance • Ongoing policy change reg. emerging PH issues – tobacco, alcohol, environment • Strengthened civil society involvement

Thank You!

Realizing the Right to Health: Societal Efforts, Responses and Responsibilities .