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India won’t meet National Health Policy 2017 targets: Ex-health secretary

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New Delhi, April 15: Health has never been a national priority and it is one reason why we have the highest number of women dying during childbirth and under-five mortality rates, former Union Health Secretary K. Sujatha Rao wrote in her recently-published book “Do We Care? Indias Health System”.

Drawing on two decades of work in public health, Rao favours increasing the health budget, greater use of technology and providing leadership and good governance for better healthcare. In an email interview with IndiaSpend, Rao said that with the level of under-funding for health and crowding in of ambitious targets, India will not meet the National Health Policy 2017 targets. Excerpts:

Q: Public health spending is 1.16 per cent of GDP while the World Health Organisation (WHO) recommends spending five per cent of GDP. National Health Policy 2017 talks about increasing the spending to 2.5 per cent by 2025 but we haven’t met the 2010 target of two per cent of GDP. Why does India’s public health funding remain low?

A: Public health spend is low for three reasons: First, lack of political will and the absence of political philosophy that places an individual’s health, well-being and education as being central to the development process. Our mindset is still wired to fly-overs and fast trains. Second, the absence of accompanying reforms in the direction of decentralisation, flexibility and greater accountability to enable quicker absorption of funds and utilisation. Thirdly, on the macro-level, we are not collecting enough taxes and have competing demands and liabilities that have constricted space for increasing resources for health.

Q: Most of the health targets mentioned in National Health Policy 2017 are the same as in 2002, which were supposed to be met in 2010. Most targets have been repackaged with new deadlines. What went wrong, and how do we ensure that we meet the 2017 targets?

A: We will not meet these targets either… not with the level of funding proposed and the crowding in of too many ambitious targets, indicating an absence of prioritisation. I see no shift in strategy that could accelerate the process for achieving the targets within the time-frame suggested. Our public health systems are too weak to fulfil the many demands being placed on it.

Q: How important is it to regulate the private consultation system that caters to 75 per cent of the country’s health needs, as a 2016 Brookings India report showed?

A: Since the 1980s, with the gradual emergence of the economic crisis, India had no option but to allow the entry of the commercialised private sector. The structural adjustment following the IMF loan in 1993 accelerated the process due to severe budget cuts.

Health, unlike other sectors, is fraught with market failures such as the asymmetry of information. These characteristics put limitations on the ability of markets to arbitrate equitably necessitating state intervention. Regulations are critical to protect patient interests and ensure that patient vulnerability is not exploited by the provider… or, as we now see, by the hospital managements.

Q: Talking about the cut in health budgets in the 12th Plan (2015-17), you have said: “…reduced public spending on health and pushing of public-private partnership (PPP) is a dangerous cocktail”. Yet, the National Health Policy 2017 talks about partnerships with the private sector to “address specific gaps in public services”. Should India focus on strengthening the public sector than on PPPs?

A: PPPs work when the risk is shared. They fail when it is a one-sided game with all benefits taken by one partner and all risks borne by one. PPPs in the health sector seem to be more like the latter case.

Secondly, purchasing of health services is based on a contract that is a legal document. So, when you have restricted budgets and contractual obligations, spending priorities get dictated by the legal commitments and not what is in the immediate interest of the people.

Thirdly, the “gap” is more a huge hole. Private sector is the dominant provider. So, if there has to be a real PPP based on a level playing field, the public sector has to be strengthened.

Q: You have mentioned the lack of public discourse and involvement on health in demanding accountability from policy makers. What are the factors responsible for it, and how do we change it?

A: Lack of understanding or perhaps a belief that illness is our fault. Besides, in a very poor country still struggling for basics, health is not a priority — access to water, food and basic incomes to survive are.

By Swagata Yadavar (IANS/Indiaspend) 

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Health

Can drinking too much water harm you?

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Toronto, May 23: Do you drink too much water? Beware, overhydration — excess fluid accumulation — can lead to dangerously low sodium levels or in the blood or result in brain swelling, researchers say.

Hyponatremia, a life-threatening condition of brain swelling, is more common in elderly patients and can cause cognitive problems and seizures.

“(Hyponatremia) occurs in common pathological conditions, including brain injury, sepsis, cardiac failure and in the use of drugs, such as MDMA (ecstasy),” said Charles Bourque from the McGill University in Canada.

While it was yet uncertain how hyponatremia develops, the study found that a defect in the hydration sensing mechanism of the brain could be the culprit.

The researchers said that brain’s hydration sensing neurons could not detect overhydration in the same way that they detect dehydration.

Overhydration activates Trpv4 — a calcium channel that can be found in glial cells, that act to surround hydration sensing neurons.

It is cellular gatekeeper implicated in maintaining the balance of water in the body.

“Our study shows that it is in fact glial cells that first detect the overhydrated state and then transfer this information to turn off the electrical activity of the [hydration sensing] neurons,” Bourque explained.

“Our specific data will be important for people studying hydromineral and fluid electrolyte homeostasis, and clinicians who treat patients faced with hyponatremia,” he noted.

The results, published in the journal Cell Reports, showed that overhydration is first identified by the Trpv4 channel which triggers the release of a type of amino acid known, taurine, which acts as a trip wire to inhibit hydration sensing neurons.

“Preclinical models of hyponatremia will be used to examine if the mechanism we report is affected in this condition with the long-term objective of designing new treatments or diagnostic tools,” Bourque added.

IANS

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An egg a day may keep heart diseases away

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Beijing, May 22: If you thought eating eggs is bad for your heart due to their high cholesterol content, think again. A large study has now shown that people who consume an egg every day could significantly reduce their risk of cardiovascular diseases.

“The present study finds that there is an association between moderate level of egg consumption (up to one egg/day) and a lower cardiac event rate,” the study authors said.

The researchers pointed out that eggs are a prominent source of dietary cholesterol, but they also contain high-quality protein, many vitamins and bioactive components such as phospholipids and carotenoids.

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide mostly due to ischaemic heart disease and stroke (including both haemorrhagic and ischaemic stroke).

For the study, published in the journal Heart, Chenxi Qin from Peking University Health Science Centre in Beijing, and colleagues set out to examine the associations between egg consumption and cardiovascular disease, ischaemic heart disease, major coronary events, haemorrhagic stroke and ischaemic stroke.

They used data from the China Kadoorie Biobank (CKB) study, an ongoing prospective study of around half a million (512,891) adults aged 30 to 79 from 10 different geographical areas in China.

The researchers focused on 416,213 participants who were free of prior cancer, cardiovascular disease (CVD) and diabetes.

Analysis of the results showed that compared with people not consuming eggs, daily egg consumption was associated with a lower risk of CVD overall.

In particular, daily egg consumers (up to one egg per day) had a 26 per cent lower risk of haemorrhagic stroke, a 28 per cent lower risk of haemorrhagic stroke death and an 18 per cent lower risk of CVD death.

In addition, there was a 12 per cent reduction in risk of ischaemic heart disease observed for people consuming eggs daily, when compared with the ‘never/rarely’ consumption category — about 2.03 eggs per week.

This was an observational study, so no firm conclusions can be drawn about cause and effect, but the authors said their study had a large sample size and took into account established and potential risk factors for CVD.

IANS

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Delhi govt planning free dialysis at pvt hospitals: Jain

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Dialysis

New Delhi, May 21 : The Delhi government is planning to make the dialysis procedure free at private hospitals and dialysis centres on a public-private-partnership basis, subject to conditions, Health Minister Satyendar Jain said today.

Jain said only those private hospitals and standalone centres which have more than 10 dialysis machines and are empanelled under the Delhi Government Employees Health Scheme or the Central Government Health Scheme would be eligible to become a partner in the project.

Delhi government through the Delhi Arogya Kosh will pay them Rs 1,274 per dialysis.

Delhi residents who have been living in the city for the past three years and having an annual income of less than Rs 3 lakh shall be eligible to avail the facility, Jain said.

The government is also installing dialysis machines at its own hospitals.

“We have installed 15 machines out of the 75 machines that we intend to install at various hospitals,” he said.

Jain said the idea behind providing the facility at private hospitals or dialysis centres is to cut the travel time for patients, who otherwise may have to go long distance to avail that facility at a government hospital.

“This would be like a reverse referral facility where patients would be referred to an empanelled hospital or centre nearby their home,” he said.

Jain said the government was in an “expansion mode” as far as health services were concerned.

“Five of our hospitals have already earned NABH entry-level accreditation – Pt Madan Mohan Malviya Hospital, Shri Dada Dev Matri Avum Shishu Chikitsalaya, Acharya Shree Bhikshu Hospital, Guru Gobind Singh Hospital and Dr Baba Saheb Ambedkar Hospital,” he said.

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