Health Outcomes and Policy in India

After reviewing health outcomes and policy in India, this chapter concludes that there are at least six sets of issues to be addressed with regard to improving the quantity and quality of health services, and ipso facto improving health outcomes, in India. First, the amount of resources earmarked for health needs to increase. Second, health resources need to be used in a fair and just manner and, in particular, complaints relating to egregious health outcomes need to be addressed. Predominant in this set of issues is oversight and regulation of private sector health provision. The third set of issues relates to the allocation of health resources and, in particular, to the imbalance in the allocation of health resources between towns and villages. A fourth issue is the accessibility of rural areas since it is the most remote areas that have the lowest density of health workers. Another issue is the more efficient use of health workers in order to make them more productive. Finally, Indian health policy is stronger on rhetoric and aspiration than it is on action and implementation. The successful implementation of policy requires the explicit recognition that objectives are often competing (primary versus tertiary care) and the acknowledgement that, with budgetary constraints, one cannot have more of one without having less of the other. The first role of policy is to then choose the optimal mix of objectives with respect to these trade-offs. Secondly, policies come up against vested interests which agitate (often with the support of opposition politicians) and litigate against proposed changes. Lastly, policies in India are made against a background of poor governance with the predatory presence of corruption looming over every policy initiative. In implementing, rather than simply articulating, policy it is important to address these governance issue

Ethical and Economic Perspectives on Global Health Interventions

Interventions that improve childhood health directly improve the quality of life and, in addition, have multiplier effects, producing sustained population and economic gains in poor countries. We suggest how contemporary global institutions shaping the development, pricing and distribution of vaccines and drugs may be modified to deliver large improvements in health. To support a justice argument for such modification, we show how the current global economic order may contribute to perpetuating poverty and poor health in less-developed countries

La necesidad de hacer reformas del sector de la salud orientadas hacia la equidad

Se necesita una nueva ola de reformas del sector de la salud orientadas hacia la equidad que estén emprendidas con más pasión y empeño aun que las reformas efectuadas en los años noventa para aumentar la eficiencia. El objetivo de este trabajo es estimular más reflexión acerca de cómo conseguir este tipo de reformas mediante el planteamiento de tres argumentos: • En primer lugar, hay un gran cuerpo de documentación que crece aceleradamente según el cual las intervenciones sanitarias que suelen constituir los componentes principales de los programas de salud para personas pobres benefician más a las personas más prósperas que a las más necesitadas. De ahí que se necesiten reformas más profundas de lo que se suele pensar si los sistemas de salud han de dar una ayuda eficaz a los pobres. • En segundo lugar, el actual movimiento que busca eliminar la deuda de los países pobres está creando un clima general mucho más propicio a contemplar estos cambios profundos que el que había hace algún tiempo. • En tercer lugar, hay una necesidad urgente de contar con una sólida base de ejemplos de intervenciones mejor encaminadas hacia las personas pobres, si el potencial que ofrece el actual clima ha de aprovecharse