The road was uneven for health in 2013

Updated: Dec 31 2013, 18:22pm hrs
HealthLack of policy coherence and disconnected programmes contrast with some bold initiatives. Express Photo
Indias health policy sent mixed signals in 2013. The National Urban Health Mission (NUHM) was finally signed off by the Union Cabinet. The NUHM, which prioritises primary health care for the urban poor, will be twinned with the National Rural Health Mission (NRHM) to become the National Health Mission (NHM). However, the overall budgetary allocations for health remained low, belying the 12th Plans promise of even a modest increase. The Plans commitment to Universal Health Coverage (UHC) is not reflected either in the level of public financing for health or in the Centre-State discussions on health sector reform.

The Planning Commissions High Level Expert Group provided a comprehensive framework for UHC in 2011, to be

incorporated in the 12th Plan (2012-17). The National Advisory Council also provided recommendations of a similar nature to the government in 2013. We do not yet have a clear road map, almost mid-way in the 12th Plan period. Will May 2014 provide the needed momentum

Even as we worry about Indias poor health indicators, there are some welcome initiatives to address the shortages in the health workforce. Apart from positioning a million ASHAs in rural health care, training programmes nurse midwives have been strengthened. The Cabinet cleared the plan for training community health officers (CHOs) through a three-year B.Sc. (Community Health) programme.

The shortfall in allied health professionals (ranging from radiographers and lab technicians to physiotherapists and mental health counselors) is huge, with a potential for 64 lakh new jobs. A R1,100-crore central fund has been earmarked towards the establishment of one national and eight regional

allied health institutes as well as the strengthening of medical colleges. A National Board of Allied Health Sciences will soon be constituted, to standardise

allied health professional education across the nation.

There is news to cheer, on the development of indigenous vaccines. In October 2013, India launched its first vaccine against Japanese encephalitis (JENVAC). An inactivated cell culture vaccine based on an Indian viral strain was developed through a public private partnership between Bharat Biotech, Hyderabad and the Indian Council of Medical

Research. Until now, the country has been importing the vaccine from China. JENVAC has shown superior immunogenicity in phase III clinical trials, has been found to be safe and can be administered as a single dose during epidemics for mass vaccination and also as a two-dose schedule during routine immunisation. This will provide much needed protection against a disease that is endemic in 171 districts.

Rotavirus is the most common cause of severe diarrhea in infants and young children worldwide. Studies between 2001 and 2009 in India showed an increase in rotavirus isolation from 24% to 39% among children hospitalised for diarrhea. The WHO estimated in 2008 that one third of deaths from diarrheal disease in Indian children were due to rotavirus gastroenteritis. Rotavirus gastroenteritis results in 880,000 hospital admissions and 1.26 million clinic visits among Indian children annually, with an economic cost of approximately R358 crore.

A locally made low-cost oral rotavirus vaccine, based on an Indian neonatal rotavirus strain (116E), has been developed through a public-private partnership between Bharat Biotech and department of biotechnology. Three doses of this vaccine demonstrated four-fold rise in antibody titres in 90% of infants. At R60 per dose, the vaccination programme would be highly cost effective. The vaccine may be launched in the first quarter of 2014.

Close on the end of 2013, comes the news of a major breakthrough innovation that can transform the treatment of diabetes. Researchers from the National Institute of Pharmaceutical Education and Research in Punjab have reported the development of an oral insulin pill that enables the hormone to evade the digestive barriers to enter the blood stream of experimental rats. If efficacy and safety are confirmed in subsequent human trials, this can be a game changer in the clinical control of diabetes.

As with many other sectors, the road was very uneven for health in 2013. Lack of policy coherence and disconnected programmes contrast with some bold initiatives and technological innovations. Will 2014 provide a smoother road for a steady and speedy progress, with strong political commitment to UHC

The writer is president, Public Health Foundation of India