BRIDGING HEALTH EQUITY GAP BY IMPROVING HEALTH OUTCOMES AMONGST THE POOREST, DISADVANTAGED AND VULNERABLE

Health indicators are not very healthy.The dominant approach towards public health has been to direct resources towards sickness and medical care. Public health is about helping people to stay healthy, and protecting them from threats to their health. Although the sectors requiring attention in public health are time and place dependent, generally they would include improved sanitation, safe drinking water, food security and proper nutrition etc. It involves multiple stakeholders including not only government but also people, private sector and civil society to work towards a collaborative agenda.

The public health capacity building is critical and it requires commitment of resource allocation. India is undergoing epidemiological and demographic transitions; therefore, costs incurred by households in lost income would be significantly higher than health sector expenditures. Some of these costs can be reduced by greater preventive and promotive efforts through effective public health capacity. There is a need to call for investments in four components:

1. Building National Public Health Network for Practice and Policy Action. :It will build an institutional collaborative network platform through establishing Indian Institutes of Public Health Network (IIPHN),catalyzing and strengthening National Public Health Network (NPHN), scaling up Indian Institutes of Public Health (IIPH) in five different regions of India that will operate as regional labs of excellence for public health.
2. Support and Enable Implementation of Universal Health Coverage: Adopt UHC as a national commitment - to be  fulfilled by 2022.
3. Foster Multi sector and Multi stakeholder Action: To deliver health and integrated child health services in a synergistic manner.
4. Strengthen Public Health Workforce and knowledge, adopting multidisciplinary approach and science of delivery: The NPHN should utilize blended e-learning as well as face-to-face learning approaches to enhance competencies of public health managers, public health professionals, community health volunteers (ASHAs) etc. The Network should assist in improving governance, leadership and stewardship.

The Government should establish a ‘Center for Health Care Delivery Sciences’. The primary goal of this center should be to improve health care delivery with focus on poor and marginalized population for promoting health equity. Innovations that radically redefine how a service is delivered can create tremendous value for people and the health system. There is also a need to innovate in (a) staffing (task shifting, new skills, paramedical staff), (b) removing barriers to service delivery (shared vision, skills, supplies, systems and solutions); and (c) developing optimal service delivery network (location, demand/utilization based facility development). The purpose of this center should be to continually discover such evidence-based science and assist in its utilization. An interdisciplinary approach is needed to design, develop and scale up new models of high-quality low-cost health care service delivery. This center should work with selected districts to develop and test scalable and sustainable models of service delivery. Once proven, it will assist in their scale-up. It will seek shared decisions making approaches with the community as well as with individual patients.

A framework for the organizational arrangements for provision of technical support at national, state and district levels shall be worked out. A multi sector, multi stakeholder Stewardship Committee, which comprises of senior officials of the government, leading academics and representatives of private sector and civil society; shall provide guidance and oversight to the entire effort.

The Government shall have a steering committee to provide strategic direction and monitor its activities. Each project component shall have an advisory committee of relevant experts which shall meet periodically and provide direction for implementation of that component.