Regulate private diagnostic labs, create awareness

On the last day of 2014, the Indian government released a new draft National Health Policy (NHP). This is the third NHP in the history of independent India. The first was formulated in 1983, 36 years after independence, and the second was in 2002. The huge time lapses between these policies could be seen as evidence of a ‘non-seriousness’ of the Indian state towards healthy India. The NHP 2015, however, is a welcome step and could be considered holistic in its approach in many ways.

One of the most important provisions of the new policy is to argue for “Heath as a Fundamental Right.” The policy has made an attempt to address both rural and urban health, and it has identified key areas where an action is required. In addition to highlighting the growing chronic and non-chronic diseases among the Indian population, the NHP 2015 also pays attention to social and environmental determinants to health. The draft policy notes that “there is much that individuals and families can do to prevent disease and promote good health at their own individual levels. But if the social and economic environment in which they exist – where they work, live and play, where they bring up their families, interact with the community and experience life – is not conducive to good health, the impact of individual behaviours may be severely limited.”

The NHP has set up seven priorities: (a) Reduction of water and vector borne diseases including solid wastes through the Swachh Bharat Abhiyan; (b) Balanced and healthy diets; (c) Addressing tobacco, alcohol and substance abuse; (d) Yatri suraksha; (e) Nirbhaya nari (g) Reduced stress and improved safety in the work place; and (h) Reducing indoor and outdoor air pollution for coordinated action to improve environment for health. The NHP advocates for “A social movement for health” which is the Swasth Nagrik Abhiyan. The 57-page document highlights the current dismal state of health in the country and attempts to address most of the issues. However, it can be argued that this ‘comprehensive document’ lacks both a timeline and a firm commitment to achieve the desired goals, and there are also a few important elements missing which require urgent attention.

Missing elements: Modern medicine is highly dependent on diagnostic laboratories in making decisions; most of these laboratories in India are private in nature. To date, accreditation of private laboratories is voluntary, and, as a result, large numbers of diagnostic laboratories are unregulated and remain unaccredited. The draft NHP does not change this. It states that “in private sector voluntary accreditation with certificates like that of NABH (National Accreditation Board for Hospitals and Healthcare Providers) and NABL (National Accreditation Board for Testing and Calibration Laboratories) would predominate.” However, it further specifies that “if the private facility is part of a partnership, then quality certification either through the NABH/NABL or through the same system as used for public health facilities would be mandatory.”

This ambiguity in the policy suggests that the Indian government is supportive of a flourishing private sector without any effective regulation. The reason might be that the Indian government is not very committed to spending public money in the health sector. Public spending on health care is only 1.04 per cent of GDP as noted in the draft.

Public health spending
Though the government has acknowledged that public health spending should be raised to 2.5 per cent of the GDP, there is no clear roadmap or firm commitment to achieving this target. It is also worth highlighting here that the Centre, as per reports, has already slashed the health budget by nearly 20 per cent in 2014-15. Moreover, the NHP is comparatively more interested in the greater role of the private sector in secondary and tertiary care services, which raises a legitimate question of ‘affordability of healthcare’ for millions.

The NHP advocates the strengthening of the ethics and review committees against the backdrop of many unethical clinical trials but does not provide any framework to do so. It was often accused that many ethics committees are not well-trained, and there is a disconnection between the Central Drugs Standard Control Organisation and the functioning of ethics committees. India, therefore, needs a robust and committed framework to strengthen ethics and reviews committees.

The draft policy also highlights the growing problem of anti-microbial resistance in the country and advocates for the restricted use of antibiotics. This is a salutary step. However, what is missing from the policy is a plan to develop a public awareness programme. India had already formulated an anti-microbial policy by 2011 after the discovery of the NDM-1 gene that makes bacteria resistant to a broad range of antibiotics. With a government notification, effective from March 1, 2014, many third and fourth generation antibiotics have been placed under the restricted category.

In sum total, for healthy India a serious effort is necessary to regulate private medical diagnostic laboratories and a public awareness programme to combat antibiotics resistant including a robust framework for strengthening ethics committees. And above all, India should not shy away from spending more public money for healthcare.

(The writer, a scholar of science and
technology studies, is based in the US)