The Role of Public Health Policy, Programmes and Health Financing. Realizing the Right to Health: Societal Efforts, Responses and Responsibilities. The Role of Public Health Policy, Programmes and Health Financing. Dr. Thelma Narayan Community Health Cell, Bangalore.

Public Health Policy Explicit & Implicit Policies- National Level Shrivastava Report 1975, 6th Plan, ICSSR & ICMR report on Health for ALL. National Health Policy – 1982- based on Primary Health Care principles, reflected in 5 year plans. National Population Policy 2000 National Health Policy 2002-promotes medical tourism, privatisation, commercialisation. National Pharmaceutical Policy 2002

State Health Policies Karnataka and Orissa Adopted by Karnataka State Cabinet in 2004 Constitutionally Health is a State subject Karnataka Task Force on Health & FW Orissa Health strategy

Important Policy Influences power & strategic positioning Political Party Manifestos & willingness to be influenced Corporate Interests Pharmaceutical and Industrial Lobbies PHM/JSA JAAK/MNI, Networks, Movements, Civil Society, Media Professional bodies & lobbies Ministries and Directorates of Health Patient Groups & Consumer Groups

Placebo Policies Those with no intention of being implemented. Keeps people happy and hopeful. Masks the situation Allows for capture of policy space by elite Occurs with a passive population, disempowered.

Policy Gaps Lack of a strong enough countervailing power to articulate, demand and ensure policy & practice with a social justice, equity and rights based approach. Thus was born the Peoples Health Movement globally and the Jan Swasthya Abhiyan, India in Dec 2000.

Policy Process giving direction, sustaining, building Revitalizing the social goal of Health for All at all levels- Global, National, Local Reviving the Spirit of Alma Ata Policy Briefs for political parties Critical Engagement with government Creating Inclusive Networks & State units community awareness and involvement, working with social movements -women’s movement, dalit movements, Right to Food Campaign etc.

National Rural Health Mission 2005-2012 Strengthening Health Systems Integration Communitisation (Community action for Health) village health and sanitation committees, ASHAs, village health plans, village health days, PRI role; community monitoring. Financing: budgets;untied funds; demand side financing Better Management- Programme management units, Indian Public Health Standards

Implementation: The Black Box Framework of Implementation approved by Cabinet; Budget earmarked, state and district health societies, District Health Plan, State PIP, Reviews-concurrent, CRM,JRM. National Health System Resource Centre, SHRC, RRC Health and health related service staff Motivation, morale Capacity, Quality of Care Integrity, Accountability, Transparency Governance Using a public health/community health approach Strengthening comprehensive primary health care.

Eleventh Five Year Plan- 2008 Health Sector Allocation : Rs. 1,36,147 crores of which Rs. 89,478 crores for flagship NRHM. Approved by National Development Council , Dec 9th 2007. Three times increase for NRHM component. State Budgets to increase by 10% annually

Peoples Rural Health Watch State Health Assembly - 3 March 21st 2007, Bangalore JSA working from the ground up -8 states. State reports Annual reports Community monitoring in NRHM

Impacts The measure of our efforts on health indicators –(NFHS, DLHS,SRS, NGOs) on Mortality, Morbidity, Disability, (Quality of Life) Improvement in Health Services at district and taluk level with better governance Ongoing policy change reg. emerging PH issues – tobacco, alcohol, environment Strengthened civil society involvement

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