Edition 22 | June 21, 2023 | |
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Dear Friends,
We are delighted to present to you the next edition of the monthly newsletter by the Lancet Citizens' Commission on Reimagining India’s Health System. This edition discusses the evolution of traditional community health workers and their impact and outcomes. It further includes an analysis of the effects of the COVID-19 pandemic on global mental health, an understanding of the political motivation as a critical driver for universal health coverage, and more.
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Evolution of community health workers: the fourth stage
Comprehensive primary care is a key component of any good health system. Designers need to incorporate the Starfield requirements of (i) a defined population, (ii) comprehensive range, (iii) continuity of services, and (iv) easy accessibility, as well as address several related issues. They also need to keep in mind that the classical British GP model, because of the severe challenges of physician availability, is all but infeasible for most developing countries. There is, therefore, an urgent need for them to find a new approach which offers comparable, possibly even superior, outcomes. The next evolutionary stage of the traditional Community health worker (CHW) model may well offer them one such approach, write Nachiket Mor, Bindu Ananth, Viraj Ambalam, Aquinas Edassery, Ajay Meher, Pearl Tiwari, Vinayak Sonawane, Anagha Mahajani, Krisha Mathur, Amishi Parekh and Raghu Dharmaraju.
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Political motivation as a key driver for universal health coverage
Variation in public investments to health, health outcomes, and progress toward universal health coverage across countries is vast and neither economic status nor the knowledge on solutions have borne out to be binding constraints to health improvements. The drivers for universal health coverage go beyond the macro-economic context of a nation, and as pointed out by scholars, are deeply linked with the extent of political prioritization of healthcare, write Sandhya Venkateswaran, Shruti Slaria, Sampriti Mukherjee.
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Cooperative healthcare model: A comment on its scope in India
Achieving universal health coverage (UHC) through tax-financing or social health insurance is often challenging for lower-middle-income countries (LLMICs) with large informal sectors and limited tax bases. In such cases, the potential of alternative financing mechanisms needs to be explored to provide citizens with affordable healthcare while awaiting structural changes, write Nachiket Mor, Hasna Ashraf, Anjali Nambiar.
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Include sexual and reproductive health services in climate change policies
Women also reported that Climate Change was a reason which has influenced their ‘fertility intention’. While some women said they had postponed having children due to the fear of losing them in disasters, others said they would like to have more children as they would not like to be childless if their child died due to the climate emergency, writes Poonam Muttreja.
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Reimagining the journey to recovery: The COVID-19 pandemic and global mental health
We have learned much about this novel virus and miraculous new ways of preventing its worst outcomes. The pandemic has also reminded us that social connectedness and solidarity are essential, with disruptions of our social behaviors having manifold implications for individual and societal well-being. We have also been reminded of the need for clear and transparent communication of science and the necessity of universal health coverage, stewarded by the state, with a strong population health and equity focus. And, of course, the pandemic has highlighted the critical importance of mental health to overall well-being. For those of us who have often complained of the low priority afforded to mental health, surely this is a truly historic moment that we must not let slip from our grasp, write Vikram Patel, Daisy Fancourt, Toshi A. Furukawa, Lola Kola.
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Vikram Patel Named New Chair of Global Health and Social Medicine
Vikram Patel, the Pershing Square Professor of Global Health in the Blavatnik Institute at Harvard Medical School and a well-known expert in global mental health, will be the next chair of the HMS Department of Global Health and Social Medicine, effective Sept. 1, 2023. Patel will succeed Paul Farmer, who led the department until his death in February 2022.
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Commission Member in Spotlight | |
"The district study has certainly taught us there is no uniform answer. UHC pathways will have to take different forms across states and perhaps this is the challenge: devising nuanced approaches suited to India’s different contexts. That said, building strong primary health care [including community engagement], ensuring financing enables high-quality continuity of care and supporting accountability at different levels are common threads that deserve greater priority as we build a more equitable health system, along with critical human resource challenges that have been discussed at length," says Sapna Desai, Associate, Population Council | |  |
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