HCFI wishes all readers a very Happy Republic Day!

Health Care, Heart Care Foundation of India, Social Health Community Comments Off

To become a healthy republic, the efforts of government and private stakeholders in healthcare need to be supplemented by harm reduction by the country’s citizens

New Delhi, 25th January 2019: According to estimates, great strides have been made by India’s neighboring countries on the health development front. Countries such as Sri Lanka, Bangladesh and Bhutan now have better health indicators and in light of these, India’s health achievements are very modest. This is in comparison to even large and populous countries such as China, Indonesia or Brazil.

India’s investment in health is not enough despite a substantial increase in its fiscal capacity to raise general revenues substantially from 5% of GDP in 1950/51 to 17% in 2016/17. As India celebrates its 70th Republic Day this year, the time has come to ensure equality in the access to quality and affordable healthcare as well – in short, India needs to become a healthy republic.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “At the outset, I wish all the readers a very Happy Republic Day. India is progressing on all fronts and for this growth to manifest on the health front, there must be a 50:50 partnership – between those who provide access to healthcare and those who are availing the services. While the government and private bodies must work towards making the Ayushman Bharat scheme stronger and reach out to those who are not covered yet under the scheme, we as individuals must focus on harm reduction strategies. The stakeholders are doing their job and will continue to. But how are we as citizens helping them? We can ensure our support towards a healthy India by limiting or avoiding habits that make us succumb to disease and illness. Following a healthy lifestyle and adopting a preventive approach to health is key.”

Part IV of the Constitution of India talks about the Directive Principles of State Policy. Article 47 under part IV lists the “Duty of the State to raise the level of nutrition and the standard of living and to improve public health”. States such as Tamil Nadu and Kerala can serve as examples. In these, health services are part of the electoral mandate, and therefore, the quality of services is better.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “The need of the hour is an urgently integrated action on health care to make it universally accessible and affordable at the same time. This will not only help address the health needs but also have a positive effect on poverty and growth levels. A strategy that makes citizens more competitive and act as an asset to the country’s growth is what is required at this juncture.”

While the efforts towards access to better and quality healthcare services continue, each one of us can ensure harm reduction in the following ways.

  • Develop healthy habits including eating, sleeping, and exercising right.
  • Do not overdo anything. From drinking to using the cell phone, everything must be in moderation.
  • Follow ancient wisdom. Do Yoga and Meditation for your mental and spiritual wellbeing and maintain equilibrium. Allow your body to heal itself.
  • Get periodic checkups done. Early detection of most health problems can help in correcting lifestyles to slow the degeneration process and lead a longer and healthier life.

· Both active and passive smoking are harmful for the body. In addition, manage your blood cholesterol, blood pressure as well as diabetes and maintain optimum weight. Limit your salt intake.

On this Republic Day, what constitutional amendments do we need in health sector?

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Tomorrow, the whole country will celebrate the 70th Republic Day, which marks the day when the Constitution of India first came into effect on 26th January in 1950. The Constitution was first adopted by the Indian Constituent Assembly on Nov. 26, 1949, which is observed as the “Constitution Day”.

Amendments are needed to keep pace with the changing times and conditions. This is how the constitution evolves and also how we evolve as individuals and as a society.

The medical profession is going through difficult times. Somewhere along the years, the image of this noble profession has been damaged; trust, which forms the foundation of the doctor-patient relationship, has corroded and must be restored urgently.

The medical fraternity has been awaiting action from the Government for their various demands for the last few years.

On the eve of this national celebration, here are few constitutional amendments that we need with regard to healthcare.

This is an open letter to the Prime Minister and the Health Minister seeking their intervention to expedite matters in this regard.

No penal provisions for clerical errors in the PCPNDT Act:There is a need for amendment in the PCPNDT Act by which only acts relating to sex selective abortions are penalized and acts such as “clerical errors in Form F, not wearing of apron, non-display of notice board, not keeping a handbook on the PCPNDT Act” should not be equated with criminal offense. Currently, the Act provides for equal punishment for sex determination and aforementioned clerical errors.
Health insurance should be a “must” and not an “option”:Everyone should have health insurance. Govt./PSU employees are automatically insured; corporates also have their insurance policies. Yet there are many who still do not have a health insurance. Ayushman Bharat, launched last year, envisages taking care of more than 50 crore, is a welcome initiative. The govt. should provide 100% insurance in general ward category; those who want private care, higher than this, should opt for private insurance. Once 100% people are insured, health care will become affordable over time to everyone. Treatment costs will automatically reduce. Ayushman Bharat should be implemented across the country and be made mandatory for every hospital.
One India-One Health Policy:Similar to the Goods & Services Tax (GST) which stands for “One Country, One Tax”, there should be “One India-One Health Policy”. All public health initiatives or national health programs need to be routed through the states.
One drug – One company – One price: Uniformity in pricing of medicines in India still remains a distant dream. The answer to high cost of drugs is a “one drug-one price-one company” policy and the govt. should ensure that the manufacturers market drugs under this policy. This has been a major demand of the medical fraternity for quite a long time now.
Central law for prevention of violence on doctors and health establishments: Violence against doctors is escalating across the country. Enactment of a stringent central act against violence making violence against doctors a non-bailable offense punishable with up to 14 years imprisonment on the lines of abatement of a murder is an urgent need of the hour. This was also a recommendation of the inter-ministerial committee in 2015, which is yet to be implemented. About 18 states have acts against violence, but unless there is amendment to the CrPC and police manual through a central act, the state acts could still be weak and ineffective.
In his speech on the occasion of the centenary celebrations of Sabarmati Ashram in Gujarat in June last year, the Prime Minister Shri Narendra Modi had addressed the issue of violence against doctors. “If a patient dies due to an unsuccessful operation, relatives burn down hospitals and beat up doctors. An accident is an accident. When people die or are injured in accidents, a group of people come together and burn vehicles,” he said (Indian Express, June 30, 2017). He had also taken a clear stand against violence, when he had said, “No person in this nation has the right to take the law in his or her own hands in this country.” We still await these words to come to fruition.

Amendment of Section 152 IPC to also include doctors: Section 152 of The Indian Penal Code protects public servants from assaults. It states: “Whoever assaults or threatens to assault, or ob­structs or attempts to obstruct, any public servant in the dis­charge of his duty as such public servant, in endeavouring to disperse an unlawful assembly, or to suppress a riot or affray, or uses, or threatens, or attempts to use criminal force to such public servant, shall be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both.” A similar immunity should be provided to doctors, so that they can work with a free mind without the fear of criminal prosecution.
Capping of compensation:There is a need for amendment in the Consumer Protection Act to cap the maximum allowable compensation awarded in any case of medical negligence. Sometimes, compensation is awarded on emotional grounds and sometimes multiplier method is used to award compensation. There is capping of compensation in sterilisation failures and related deaths, deaths due to natural calamities, plane crash/ train accidents, death occurring in the course of clinical trials etc. so why not in medical negligence cases.
Amendment in Clinical Establishment Act: The CEA Act should be amended to exclude single doctor clinic, family doctors and general practitioners from the purview of the CEA and to facilitate single window registration of medical establishments.
National list of essential devices, equipments, disposables and reagents: Similar to the National List of Essential Medicines (NLEM), a National list of essential devices, equipments, disposables and reagents should be created. It is only through such a list that the govt. can cap the cost of essential drugs.
Uniform age of definition of child under POCSO, for marriage, juvenile act, etc: The POCSO defines child as “any person below the age of 18 years”. The legal age of marriage in India is 18 years for girls and 21 years for boys. The voting age is 18 years. The legal drinking age for alcohol varies from state to state and ranges between 18 and 25 years. There should be a uniform age of definition of child.
Nationalization of disease treatment protocols of diseases of national importance: To eliminate or eradicate diseases, all health programs in the country and diseases of national importance such as TB should be “nationalized” with uniform diagnostic and treatment protocols across the country, whether in the govt. sector or private sector. The only difference may be that in the private sector, the doctors can charge their consultation fee.
Pay parity in govt. and private sectors: A uniform pay scale across the country, in both the govt. and private sectors should be implemented.
All doctors should be covered under CGHS:Not just govt. doctors, doctors in the private sector too should be made beneficiaries of the Central Government Health Scheme (CGHS) and be allowed to seek treatment in empanelled hospitals.
Health in concurrent list: Public health is a state subject. This has been the reason for discordance between the state and the center, when any centralized healthcare scheme is rolled out. The government must pass an ordinance to bring health under the concurrent list.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA