My Health depends upon your Health - Time for Bhore Committee 2.0

COVID 19 pandemic has done a great service to India. It has brought forth the vulnerabilities of the Indian Health System, in the fore-front, particularly for the policy maker, to think and act upon. When there was a frantic exercise done in every state of India, high level meetings being held to develop a strategy for taking on the challenge of COVID 19 pandemic, the entire calculation was done on availability of doctors, nurses, masks, PPE kits, ICU beds, Ventilators and testing labs. The health infrastructure was to be developed for a possible nation wide pandemic, affecting millions of people. The policy makers realized that the infrastructure was not adequate at all. The only way we could combat a pandemic was through preventive means. It would take time to put together whatever resources we had. The nation needed some time to prepare, and some time to see whether the preventive measures would be successful in containing the disease in some clusters. 

A disease is not just a physiological phenomenon. It is a socio-cultural-economic phenomenon too. More importantly, the health of an individual doesn't depend on him alone. It depends on the environment that he is living in. It also depends upon the other people he is with, in the community. COVID 19 has put a very important fact, that people cannot be healthy alone, to keep someone healthy, most of the people in the community, have to be healthy too. One's health also depends upon others; and thus healthy citizens are not found in a home, a nation has to be a healthy nation. Health cannot be planned at micro level, it has to be planned at a macro level. The overall benefits of health that a nation enjoys are translated into economic benefits eventually. 

Health is the most important pillar of sustainable development. Sickness tampers with human life, health is life itself. If you wish to sustain life, you wish to sustain health. Modern living has made human being healthier, but has also made him fragile, because the seasons of sickness are global now, they do not remain restricted to a geographical area anymore. Thus, health is a global goal now. The scientific community of the world has come together to fight Corona Virus. People have realized globally, that everyone in the world has to defeat corona virus, and everyone has to be healthy at the same time. 

If you look closely, that is the case with the non-communicable diseases too. The society as a whole has to fight them. It is not a person's fight alone. Lifestyle is deemed responsible for certain diseases and thus the interventions have to be planned at the societal level to fight the disease. That's where we have to rethink on our Health Care Models. It is important to have hospitals and health workers, but do you also need to plan at the national, the state and the district level, for the health of the population? Do you need qualified individuals who would assist in developing these plans? What kind of data would be required to construct these plans? Do we need to integrate the health data of every individual at the national level to be able to develop a comprehensive plan? What other variables does health interact with? Can we attain something like a national health or global health? 

Indian Health System came into being as a result of Bhore Committee Report in 1946. The committee recommended the integration of curative and preventive measures at all administrative levels. Up till the formation of National Rural Health Mission (NRHM), which was launched in 2005, to improvise primary health care in villages, the integration of preventive and curative care at the administrative level could not be done. There have been many efforts made to develop public health in India, but they remained segregated. The Mukherjee Committee in 1966 prescribed a system of targets and incentives and identified ANMs( Auxiliary Nursing Midwifery) and other village-level workers as agents for popularizing  health programs in the community. Accredited Social Health Activist (ASHA) is a community health worker, appointed since 2005, under NRHM. Ayushman Bharat operational guidelines gave a  key addition to the primary health team at the SHC-HWC, the Mid-level Health Provider (MLHP) who would be a Community Health Officer (CHO). 

There is a unique opportunity at present in India. The digital footprint that the nation has been able to create, can give Indian Healthcare System a unique shape. Digital technologies will help the nation leapfrog to advance health systems. It is time for making organised efforts to redesign the healthcare systems in the country by developing comprehensive health systems, that take care of socio-economic components of health too. The rationale given for introducing the new cadre of community health officer at HWCs is to:

1)Augment the capacity of the Health and Wellness Centres to offer expanded range of services closer to community, thus improving access and coverage with a commensurate reduction in OOPE.

2)Improve clinical management, care coordination and ensure continuity of care through regular

follow up, dispensing of medicines, early identification of complications, and undertaking basic

diagnostic tests.

3) Improve public health activities related to preventive and promotive health and the measurement

of health outcomes for the population served by the HWC (Health and Wellness Centre).

But this is not enough. In order to develop executable national plans for people's health we need to extend this cadre at block, district, state and national level. This cadre has to be integrated with the curative care infrastructure too. Doctors and community health officers have to work hand-in-hand to attain national healthcare goals. 

It is time to have a national consultation on the vulnerabilities of the Indian Healthcare system, and design a robust public health system. In principle, the community health officer posted at Health and wellness centre would be the nodal workforce to prepare a report on health status of the population served by HWC. This would be made possible by creating a digital health eco -system 'National Health Stack', where digital personal health records captured at the PHC level, will be stored in a national database, under a unique identity number (UIN). National Digital Health Blueprint (NDHB), 'which is more than an architectural document', as it provides an implementation plan of 'National Digital Health Eco-system' has been released on 15th of July, 2019, by Ministry of Health and Family Welfare, Government of India. 

The cadre at the block district and state level is also to be designed. The curricula for such public health officers is to be designed and be aligned with his role and responsibility under a broad planning structure. COVID 19 year will be a good time to initiate the process. Goals and objectives decided at the national level have to be converted into executable plans according to the need of the community, with the help of this workforce. Countries like Cuba and Sweden have achieved a lot, by having a robust public health workforce. It has been reinforced during COVID 19 times also. Nation's health needs attention. 

Time for Bhore Committee 2.0?