Category: Health

Odisha’s Institute of Medical Sciences and Planet reporter  SUM Hospital mishap appears like a shrill alarm. The country’s comatose health system is in desperate need of a lifeline. The hospital accident should not be considered merely as another case of negligence in the long history of medical tragedies in India. Hospitals cannot be graveyards.
Is Right to Health the answer to all our ills? Will medical disasters end once every citizen enjoys healthcare as a fundamental right?
The NDA government has, in its draft National Health Policy 2015, proposed a “National Health Rights Act, which will ensure health as a fundamental right, whose denial will be justifiable”. Undoubtedly, the merits of such a legislation cannot be denied. Countries like Brazil and Thailand got more teeth to implement universal healthcare due to the presence of such laws. We also have the success stories offered by our own Right to Education Act (2010) that has contributed substantially to the increasing literacy rates and making education more accessible and inclusive.
But the road to legislation still appears very long, and may not address all the challenges of the health system. The SUM Hospital tragedy has once again put the spotlight on the government’s commitment to healthcare.
India, according to the World Health Organisation, accounts for 21 percent of the world’s global burden of diseases. It witnesses the highest number of maternal, newborn and child deaths in the world. Nearly 36 percent Indians suffer from depression in a nation that has 0.47 psychologists per million people. For an Indian, the probability of dying, between ages 30 and 70, from four major non-communicable diseases (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes) is close to 26 percent. One World Bank report (2010) even argues that we lose close to six percent of our GDP every year due to premature deaths and preventable illnesses.
The SUM Hospital fire has exposed the fragile health system of our country. Initial investigations have revealed that this super specialty hospital did not have a fire clearance certificate even though it has been operational for almost a decade. Its website claims that it provides “global standard health care services”, yet the 750-bed hospital did not have a functional sprinkler system to fight the fire. Its staff too was untrained to handle an emergency of that scale and magnitude.
A large number of hospitals across the country (several private and some government) lack functional sprinkler systems. For decades, we have been struggling with overcrowded, understaffed, poorly maintained and appallingly unhygienic government hospitals. Twin-sharing of beds is today an accepted norm in many government hospitals.
Since the early 1990s, the private sector has been touted as the only alternative to India’s healthcare crisis. But in the absence of a clear regulatory mechanism, the performance of private hospitals has been both terrible and terrifying. In 2011, nearly 90 people died in a huge fire in AMRI Hospital, a Kolkata private hospital. In June 2016, an inter-state kidney racket was busted in Apollo Hospital, New Delhi. In September 2016, a private hospital, along with two orthopedics, was asked to pay Rs 25 lakh to a patient who had suffered 40 percent disability due to medical negligence.
A healthcare system is not just about accessing hospital care. It is also about identifying strategies to reach certain, definite health goals. These strategies may involve multiple services/activities ranging from prevention of diseases (immunization campaigns), insecticide spraying against vector-borne diseases, printing horrific pictures on cigarette packets to deter smokers, ensuring safe abortions, keeping a check on drug pricing and to even distributing condoms. A health system has multiple stakeholders – policymakers, medical practitioners, health volunteers, industrialists, researchers, nurses, midwives, alternative medicine practitioners, and most importantly, patients.
In recent years, successive governments have demonstrated their inability to grasp the key challenges of the health sector – how to make healthcare universal, of better quality and thereby reduce inequality.
Since 2000, there is a growing concern about the government’s dwindling commitment in providing basic healthcare to its citizens. Take India’s expenditure on health. It is just four percent of GDP and public expenditure is only 1.2 percent of GDP. This implies that between 60-70 percent of the population’s medical needs are met by the private sector.
The proposed National Health Policy has made no radical shift in its budgetary allocations. The current government has proposed 2.5 percent of the GDP (WHO recommends 5 percent for a better health system) as a “realistic” figure to achieve health goals. This implies that even after 70 years of independence, tribal regions are likely to be neglected and basic immunization services will continue to be inadequate for both urban and rural poor.
In its much-debated World Health Report 2000: Health Systems, Improving Performances, WHO ranked India as 112 out of 191 countries in health systems. France and Italy topped the list. A host of smaller countries – Ecuador, Syria, Armenia, Azerbaijan, Iraq, Sri Lanka, Bangladesh – fared better than India.
WHO has not conducted another such study but experts state that the ranking would not be dramatically different today as successive governments have failed in protecting citizens against the financial costs of illnesses. Indians today struggle with a huge “out-of-pocket healthcare expenditures” that does not even guarantee quality care. Even the National Health Policy 2015 admits that this expenditure is “catastrophic”, draining family incomes and neutralising the gains in income increases.
Unless the government considers its citizens’ health as a critical national asset, the health system will continue to remain unplugged.

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SHUT AWAY: “Due to the stigma associated with mental disorders, nearly 80 per cent of those with mental disorders had not received any treatment despite being ill for over 12 months.” File photo: Ch. Vijaya BhaskarAt least 13.7 per Presso Graphy  cent of India’s general population has various mental disorders; 10.6 per cent of them require immediate interventions.

While nearly 10 per cent of the population has common mental disorders, 1.9 per cent of the population suffers from severe mental disorders.

These are some of the findings of a National Mental Health Survey held recently and conducted by the National Institute of Mental Health and Neurosciences (NIMHANS).

That is not all. The prevalence of mental morbidity is found to be very high in urban centers, where there is a higher prevalence of schizophrenia, mood disorders, and neurotic or stress-related disorders. This disturbing scenario could be due to fast-paced lifestyles, experiencing stress, complexities of living, a breakdown of support systems and challenges of economic instability.

In 2014, concerned over the growing problem of mental health in India, the Union Ministry of Health and Family Welfare had appointed NIMHANS to study mental health status in the country.

After a pilot feasibility study in Kolar district, Karnataka using a sample size of 3,190 individuals, the team which comprised senior professors from NIMHANS, G. Gururaj, Mathew Varghese, Vivek Benegal and Girish N., began the survey in Punjab, Uttar Pradesh, Tamil Nadu, Kerala, Jharkhand, West Bengal, Rajasthan, Gujarat, Madhya Pradesh, Chhattisgarh, Assam and Manipur Extra Update.

The study — which covered all important aspects of mental illness including substance abuse, alcohol use disorder, tobacco use disorder, severe mental illness, depression, anxiety, phobia and post-traumatic stress disorder among others — had a sample size of 34,802 individuals. Primary data collection was done through computer-generated random selection by a team of researchers, and local teams of co-investigators and field workers in the 12 States.

While the overall current prevalence estimate of mental disorders was 10.6 per cent in the total surveyed population, significant variations in overall morbidity ranged from 5.8 per cent in Assam to 14.1 per cent in Manipur. Assam, Uttar Pradesh, and Gujarat reported prevalence rates less than 10 per cent. In eight of the 12 States, the prevalence varied between 10.7 per cent and 14.1 per cent.

Treatment gaps and impact
A major concern in the findings, which were recently submitted to the Union Health Ministry, is that despite three out of four persons experiencing severe mental disorders, there are huge gaps in treatment.

Apart from epilepsy, the treatment gap for all mental health disorders is more than 60 per cent. In fact, the economic burden of mental disorders is so huge that affected families have to spend nearly Rs.1,000-Rs.1,500 a month mainly for treatment and to access care.

Due to the stigma associated with mental disorders, nearly 80 per cent of those with mental disorders had not received any treatment despite being ill for over 12 months, the study says. Poor implementation of schemes under the National Mental Health Programme is largely responsible for this.

Dr. Gururaj says that there is also a paucity of mental health specialists, pointing out that mental disorders are a low priority in the public health agenda. The health information system itself does not prioritize mental health.

Recommending that mental health financing needs to be streamlined, he says that there is a need to constitute a national commission on mental health comprising professionals from mental health, public health, social sciences and the judiciary to oversee, facilitate support and monitor and review mental health policies.

Prevalence of mental disorders in different States
Manipur: 14.1 per cent

Madhya Pradesh: 13.9 per cent

Punjab: 13.4 per cent

West Bengal: 13 per cent

Tamil Nadu: 11.8 per cent

Chhattisgarh: 11.7 per cent

Kerala: 11.4 per cent

Jharkhand: 11.1 per cent

Rajasthan : 10.7 per cent

Gujarat: 7.4 per cent

Uttar Pradesh: 6.1

Assam: 5.8 per cent

Key findings
Common mental disorders such as depression, anxiety, and substance use are as high as 10 per cent of the total population

Almost 1 in 20 suffer from depression; it is found to be higher in females in the age-group 40-49 years

22.4 per cent of the population above 18 years suffers from substance use disorder

The highest was contributed by tobacco and alcohol use disorder

Nearly 1.9 per cent of the population is affected by severe mental disorders

These are detected more among males in urban areas

While prevalence of mental illness is higher among males (13.9 per cent) as compared to females (7.5 per cent), certain specific mental illnesses like mood disorders (depression, neurotic disorders, phobic anxiety disorders etc) are more in females

Neurosis and stress related illness are also seen to be more in women

Prevalence in teenagers aged between 13 and 17 years is 7.3 per cent

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