This discussion theme is in continuance to our first discussion titled ‘Health System in India: Bridging the Gap between Potential and Performance’. To review what others have commented on this subject earlier in the first discussion, visit our Blog.

How can we maximize health returns through strengthening Public Health?

1. Issues

1.1. There is insufficient focus on primary prevention and public health within the health system.

1.2. There is less than universal cover of cost effective strategies for improving basic health outcomes.

1.3. Ineffective public health regulation and management limits the implementation of public health activities.

2. Suggestions

2.1. The enactment and enforcement of a Public Health Act must be prioritized.

2.2. A Public Health cadre may be developed to be centrally or state recruited and professionally trained. This cadre would cater specifically to public health management and improve the overall efficiency of public health delivery systems.

2.3. Responsibility and capacity may be assigned to Public Health officers/Public health cadre for the implementation of regulations such as PCPNDT Act (Pre-Conception and Pre-Natal Diagnostic Techniques), Food Standard Safety Act, Drugs and Cosmetics Act.

2.4. Public health regulations must be enacted and implemented that effectively address public health priorities, illustratively, prevention of exposure to risk factors for non- communicable disease (NCDs), enactment and enforcement of civic and building by-laws to reduce mosquito breeding sites.

2.5. Strengthening of existing campaigns for health education and behaviour change communication must be carried out. These may include a focus on preventive strategies against NCDs, illustratively, salt reduction in processed food/daily intake of salt in food prepared at home, screening for cancer, counselling for quitting tobacco, health education on diet and physical activity, intensive glycaemic control, promotion of physical activity in schools; occupational health promotion such as encouraging safety measures at the workplace; prevention of communicable diseases such as public awareness on reduction of mosquito breeding sites; mass media campaigns on mental health issues may be launched to reduce stigma and encourage family members to be supportive and sensitive.

2.6. The strengths of alternate systems of medicine, i.e. AYUSH (Ayurveda Yoga and Naturopathy, Unani Siddha and Homeopathy) for health promotion and prevention, rehabilitative care, especially in the case of non-communicable diseases and care of the elderly may be utilized.

2.7. Screening of workers may be introduced to promote occupational health.

2.8. Teaching self-care to patients and care-givers of chronic diseases may be undertaken to improve long term outcomes for patients.

2.9. The ease and certainty of access to early diagnosis of tuberculosis (TB) and Directly Observed Treatment Short-course (DOTS) therapy including Programmatic Management of Drug Resistant TB (PMDT) should be ensured.

2.10. The midwifery model of care for women during pregnancy, labour and post-partum may be developed. This promotes safety and low-cost care in the absence of gynaecology services and increases skilled attendance at birth1 (offering women the option to adopt midwife- led care during delivery decreases the risk of preterm births and loss of the fetus before 24 weeks gestation).

2.11. Simple strategies for prevention of pre-term births and low birth weight such as a pre-conception care package, ante-natal care, provider education for promoting appropriate induction and caesarean, care of the premature baby and management of pre-term labour may be emphasized.

2.12. Maternal death review should be strengthened to improve reporting systems, increase coverage, include data from the private sector and the data may be made public.

2.13. Emphasis on spacing methods in addition to limiting methods of contraception increases the uptake of family welfare services.