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Essay Competition

  1. 1. Strengthening Public Health: Translating Ideas into Action“Strengthening Public Health: Translating Ideas into Action” is the need of the hour. Its hightime, we the people of India realized the futility of adding volumes upon volumes of varioushealth programs – plan their strategies, decide objectives, set targets and goals; using incentivesas a bait to people for adopting /practicing that which is for their own benefit ! A lot has beensaid but with poor implementation and poorer show. So we need to reflect, rather meditate uponthe gaps that make all our good-intentioned, well planed, carefully maneuvered and highlyidealistic ideas and dreams to crumble down like a house of ‘pack of cards’ when it comes tooutcome and impact of these programs. In present scenario, the Health Programs suffers fromnumerous gaps like lack of dedicated efforts & accountability, feeling of ownership and absenceof standardized method for planning and monitoring. There is multiplicity of registers &reports. Voluminous data are collected, never to be used in planning. On meditating upon the thought, a realization dawned upon me that we have beenusing the twin instruments of fear and temptations to get the desired results- attain benefit for allhumanity in a complete sense, that is physical, mental, spiritual, economic; all that can possiblyaffect our life. Then what is the cause of “near-failure” like impossible situation we have landedourselves into! It is rooted deeply in our attitudes, our way of thinking; as wisely said, everythingbegins in mind-a wrong thought leads to wrong action and ultimately the wrong result. What thatwrong thought is? That, ‘I’ and ‘Mine’ have shrunk in size to ‘Myself’, it doesn’t any moreinclude my neighbours, friends, my state, my country etc. ‘I’ stands for my selfish desires; and tofullfill it I am ready to burry my conscience without ever realizing the fact that my happiness, myhealth, peace of mind all are dependent on happiness, health etc. of my neighbourhood, my city,my state, my country and the world as a whole; I am but a part of the ‘whole’ and henceinterconnected. I can’t just sit back and wait for miracle to happen and change the situation; Ihave to make the miracle happen, each one contributing our small bit ! No amount of communitymonitoring or any other external force can bring the desired impact. Finding faults with others &shifting the blame on somebody else can’t bring the solution, remember when we point onefinger at someone, the four fingers point at us! As rightly said “charity begins at home” , hence each one of us as individuals have tounderstand and accept the fact that ‘HEALTH FOR ALL’ is possible when all of us are willingto take upon ourselves the responsibility/accountability for ourselves and our fellow brothers.Health is not a government responsibility but individuals right and individuals fight, butfought together as our own battle, giving priority to the needs of all, enhancing thetransparency till the grassroot level. Then the battle is already won. That I think is the only wayof strengthening public health- translating ideas into Action ! Dr Sadhna Singh; Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun 1
  2. 2. Strengthening Public Health: Translating Ideas into ActionPublic health training and education have existed for over a century, yet there is little systematicevidence on whether current approaches prepare graduates to improve health by developing,evaluating and implementing effective and equity oriented public health programmes. There arethree reasons to document and debate this topic worldwide and disproportionately focus on low-and middle-income countries. The first is that the global health workforce is in a state of crisis. The World health report2006 describes this situation as a “major mismatch” between population needs and the availablepublic health workforce in terms of overall numbers, relevant training, practical competenciesand sufficient diversity to serve all individuals and communities. In many countries, publichealth programmes led by clinicians with little or no public health training are plagued by poormanagement and ineffective resource allocation. This cannot be overcome by simply building oncurrent policies: government oversight must ensure proper recruitment for public health jobs, andnew models are needed for pre-service and in-service training. The second is that there is increasing demand for well-trained public health professionalsthat can address the changing context of global health challenges, including complex andpersistent health problems, increasing health inequities, new and emerging diseases, necessity forgreater collaboration, and incorporation of social models and determinants of health. Thirdly, such debate allows networking among schools, public health agencies, policy-makers, student groups, professionals, United Nations agencies and other organizations. Thesegroups include the World Federation of Public Health Associations, regional associations ofpublic health schools, the People’s Health Movement, health ministries, other senior policy-makers and the newly created International Association of National Public Health Institutes.WHO estimates that about 400 schools of public health exist, not counting hundreds ofdepartments of public health, hygiene, epidemiology, community or social medicine, and otherunits with similar mandates. These programmes need evidence on selecting and retaining anoptimal mix of students and professionals, on matching training to health systems challenges, onmeeting the demand for specialized competencies and on ways to involve alumni in enrichinglearning approaches. Yet most research on public health training and education tends to focusnarrowly on educational measurements or new curricula. There is almost no evaluation of thedegree to which educational practices match real-world conditions. Possible avenues forinnovation include more strategic use of fellowships, foreign training experiences, student-ledresearch or institutional partnerships. Public health content also can enrich course work inbusiness, public policy, urban planning, foreign policy and international relations. Schools aredeveloping innovative models, public–private partnerships, wider ranges of students, networks offaculty and other programmes with greater relevance to public health priorities.Some suggestions to improve public health are-- schools’ leadership role in influencing strategies and policies;- intersectoral collaboration and networking with stakeholders;- diversity of students and professionals, their retention through graduation;- Community-based, problem-oriented teaching approaches addressing health challenges;- learning how to commission research, build evidence and use results;- steering student-led research towards global and national priorities;- in-service or executive training of public sector officials;- core competencies for public health practice;- adding public health learning to other schools’ curricula. Dr Kajal Srivastava, S N Medical College, Agra 2
  3. 3. Strengthening Public Health: Translating Ideas into ActionPublic Health is Exciting; dynamic, multidisciplinary team approach where people work toprotect health of the community and population.Taking into account, the level of development in India today, the theme of the Conference istimely indeed. I am sure India can become a developed nation by the year 2020 as envisioned byHis Excellency Dr. A. P. J. Abdul Kalam, past President of India. Certainly, India has thepotential, especially, in the areas of know-how and human resources to move forward to thatlevel of development by 2020. Only health security for the entire population has to be theoverriding concern in the process of national development. Good health for all citizens has to beensured throughout such a process. Public health forms “the root” of the communityHere we outline a conceptual framework for strengthening the foundation for public healthpractice and improving the understanding and use of ideas as a public health tool. The Future ofPublic Health, which defines the core functions of public health as assessment of populationhealth, policy development, and assurance that high-quality public health services are availablePublic Health forms the grass root of the community so strengthing ideas and actually convertingthose into action forms the mainstay for the betterment of the community which directly effectsthe entire nation, strengthing some of the essential public health services can bring a drasticchange in the system these are : (1) Monitor health status to identify and solve community healthproblems; (2) diagnose and investigate health problems and hazards in the community; (3)inform, educate, and empower people about health issues; (4) mobilize community partnershipsand action to solve health problems; (5) develop policies and plans that support individual andcommunity health efforts; (6) enforce laws and regulations that protect health and ensure safety;(7) link people to needed personal health services and ensure the provision of health care whenotherwise unavailable; (8) ensure a competent workforce—public health and personal care; (9)evaluate effectiveness, accessibility, and quality of personal and population-based healthservices; and (10) research for new insights and innovative like Health information systems.Targeting onto the essential public health services and actually turning those into action cancause the major up-liftment and a more core bonding of the various sectors in health and thesehealth servicesPrimary prevention in health is one of the cost-effective strategies to reduce poverty in anycommunity in developing countries. Since long, our health care services have been concentratedin areas of secondary care. The secondary care places emphasis on treating the sick, especially inthe medical institutions. Our health systems have, therefore, been over oriented toward curativeand rehabilitative services; at the cost of promoting and preventive care.In the end i will conclude that The nation’s attention should be focused on the vital need for astrong public health infrastructure to protect community health and this could only be achievedwhen ideas come to life and in full action. Dr Sumit Jethani; Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun 3
  4. 4. Strengthening Public Health: Translating Ideas into ActionMankind has long accepted a self-posed challenge. No development has happened to us withoutan incumbent health risk – all medicines have side effects (some have proven abuse potential); somany radiological processes have associated hazards! Notwithstanding the disparities andimpropriety in health between and within ‘worlds’, our quest for ‘health for all’ ambitiouslyconcerts with our requirements. Today, we are directed towards betterment of public health byattempting to organize the efforts made by the society itself 1.India’s desire to ensure its citizens a perfection in health is evident from the number ofcommittees (from Bhore’s Report 1946, till date), policies (e.g., NHP 1983, 2002; NPP 2000,etc), plans (the Five Year Plans, etc) and programmes that have been worked out. The setting upof the Planning Commission in March, 19502 was a very purposive approach towards anorganized and balanced nation building. Ever since, we have increasingly prioritized health as athrust area for action in our Five Year Plans (from the 1st in 1951 till the 11th in 2007). Havingstarted with the welfare-state approach (post 1947)3, we have strengthened ourselves on theprinciples of Primary Health Care (Alma Ata, 1978). We respond well to vertical campaign-likeapproaches (e.g., the near eradication of poliomyelitis)4. However, strategies like decentralizedplanning, convergence of service delivery at village levels, meeting the unmet needs for familywelfare services, diversification of health care providers, mainstreaming AYUSH, focusing oncrunch areas like MCH care and adolescents, and collaborating with NGOs have redefined ourhealth service delivery. Gradually moving towards a demand-driven system, we have furtherstreamlined ourselves under NRHM and NUHM.Although claims exist regarding the rhetoric-reality divide, the Government of India stronglyaffirms our consistent movement towards the attainment of the Millennium Development Goals.5The repletion of innovations in the form of insightful ideas has compensated for our ‘resourcescarcity’(trained man-power, finances, logistics and of course, time!). In 1952, India was the firstcountry in the world to launch a national programme emphasizing family planning. We haveconstantly surprised the Globe by managing health crises with confidence and élan, given thecontextual challenges (large population, illiteracy, malnutrition, prevalent beliefs, etc) andimprobabilities. Socio-cultural proselytization is never easy but we have made the girl child tosurvive; and colostrum to be fed, at least in a certain portion of the society!Public health in today’s India is much stronger than ever before. Absolute perfection in healthcare may still appear elusive for us but we are aware of implementation strategies that should goa long way in translating our ‘ideas’ into ‘reality’. A nation as vibrant as ours is unstoppable!References 1. Acheson Report, 1988 2. 3. Nundy M. ; Primary Health Care in India: Review of Policy, Plan and Committee Reports; http:// 4. 5. Jacob K.S. ; Millennium Development Goals & India; The Hindu; Oct 20th, 2010. Dr Archisman, IMS BHU 4
  5. 5. Strengthening Public Health: Translating Ideas into Action The history of public health is the story of the search for effective means of preventingdisease in the population. Throughout centuries, public health evolved with trial and error, andwith expanding scientific medical knowledge, often stimulated by ideas innovated when struckby war and natural disasters. The transformation of ideas into action dated back to the time of Homer. Greek andRoman cities appointed doctors to provide free care for the poor and the slaves. Medieval guildsprovided free medical services to their members. Following Bismarck’s 1881 introduction ofnational health insurance for workers and their families, most countries in the industrializedworld introduced national health plans. So, the concept of health for general public is not newbut a refined modification presented in a comprehensible way called “Health for All”. But the utopian dream of international and national health agencies to achieve “Health forAll” faces serious obstacles of inequities, lack of resources, distortions with overdevelopment ofsome services at the expense of others, and competing priorities. It might seem appealing at thefirst glance but realistically it is difficult – if not impossible – to accomplish. Limited resourcesand overspending on high technology facilities in the capital cities leaves little for primary carefor the rural and urban poor. Here again comes the importance of taking practically feasible stepswhich will see the conversion of theory into reality. Another issue is policy making and implementation. Beaglehole and Bonita’s bookPublic Health at the Crossroads (2004) defines public health as “Collective action for sustainedpopulation-wide health improvement”. Selection of which direction to take in organizing healthservices is usually based on a mix of factors, including the political view of the government,public opinion, and rational assessment of needs as defined through epidemiologic data, cost–benefit analysis, and recommendations by experts. A proper coordination in a balanced way thusbecomes very much crucial for construction of public health on a solid base. Simultaneously focus should be on the redistribution of resources. The success that isbeing made in community development will count for nothing unless national priorities switchfrom nuclear weapons to maternal and child health. “This may sound like wishful thinking buthow else will we create hope from the despair of untold child death, wanton neglect of girls andwomen, and a rich elite feasting on the misery of millions in poverty?” (Bhutta Z, Nundy S,Abbasi K. Is there hope for South Asia? BMJ 2004;328:777-8) Last but not the least, adoption of international initiatives deserves special consideration.“The international system fails to meet the scientific and technological needs of the worldspoorest”. (Sachs J. Helping the worlds poorest. Economist 1999 Aug 14:17-20). Littlesensitivity to the local needs has led to the eventual failure of many programs, with a fewexceptions. We hope that we will embark on success in public health in near future by removing theobstacles and paving the way for translating plausible ideas into meaningful action. Dr. Manas Pratim Roy, Junior Resident, CSMMU UP, Lucknow 5
  6. 6. Strengthening Public Health: Translating Ideas into Action "Health care is vital to all of us some of the time, but public health is vital to all of us all of the time." – C. Everett KoopGaining new ideas are important, however understanding how ideas change our perceptions,understanding and actions is even more important. We need to make sure we systematicallyintegrate new ideas into people’s lives, in a manner that changes community thinking andultimately people’s behaviour.The field of public health changes the social conditions and systems that affect everyone within agiven community. It is because of public health that we understand that unclean water can carrybacteria that cause disease, that second-hand smoke can be deadly, and that seat belts can savelives.From scientific discovery to policy change, there have been countless advances in public healththroughout human history. In 1999, the Centers for Disease Control and Prevention named theten greatest public health achievements of the 20th century, namely on vaccination, motorvehicle safety, safer workplaces, control of infectious diseases, decline in deaths from coronaryheart disease & stroke, safer & healthier foods, healthier mothers & babies, family planning,fluoridation of drinking water & recognition of tobacco use as a health hazard.To shift the emphasis from disease-based health services to risk and determinant-based healthsystems is really a formidable task. As a prerequisite, we need to have the right workforce toengineer health systems toward the desired direction. To move efficiently along this course ofprimary prevention, we need a public health and community-based health workforce. Theworkforce should be able to effectively develop and implement public health programs. Theprograms should deal primarily with health promotion, disease control, and prevention. Theworkforce should ensure reaching the unreached. It is important to emphasize the critical role ofcommunity-based health workers who work at the grassroot level, rendering services to the poor& underprivileged.There is an urgent need to reorient our strategy in the development of human resources for healthin this new direction. To be able to do this successfully, we need strong and sustained politicalcommitment and support. Besides, we need unwavering and long-term policy and strategy back-up at the national level. The Rural Health Mission and Public Health Foundation are a clearevidence of the Governments intention and commitment in this regard.An effective public health specialist should be aware of the importance of reviewing the creationprocess, as it moves from the idea concept to the action and the outcome. Once an idea has beenidentified the translation into action can only take place once the individuals responsible foraction are able to use their own experiences, skills and ability to figure out the best possiblemethod of creating the outcome. In conclusion the literature portrays that there are enormousideas and plans about strengthening public health. A strong will, an impregnable determinationand an open mindset is all what is necessary to translate those ideas into action. Dr Ashish Yadav, LLRM, Meerut 6
  7. 7. Strengthening Public Health: Translating Ideas into Action Public health is “the science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society”.Strengthening public health is a major challenge before all of us in the 21st century. Many health policiesand strategies have been formulated in the past with respect to public health but has not been able todeliver the required outputs which were desired of them.We should be honest enough to accept that there is a large gap between a volume of public healthknowledge generated through research and the application of research in community settings. The majorquestion before us is why do we need to strengthen our public health system? We all know whathappened with Health for All 2000 AD. The answer to this is that a robust and effective public healthsystem is essential if we need to deliver Government policies for improving health and wellbeing. Astrong public health will go a long way in solving most of the critical issues relating to health, as it willprovide necessary infrastructure to help change the social, economic and environmental factors whichlead to poor health. Also at the same time it will help address social exclusion, inequalities in health careand provides support to local authorities and reoriented NHS in ensuring that local partners focus onimproving health as well as service quality.There are certain areas that we need to work upon if we need to strengthen our public health or make ourideas feasible, practical and action oriented. Emphasis should be laid upon framing healthy public policy,create supportive environments for health planners and health professionals and at the same timestrengthen community action as it requires a coordinated effort from all to bring about a change andefforts directed towards enchancing personal skills and reorienting health services. There is a serious needto develop a national strategy to raise awareness and knowledge of specific public health issues and totake effective through national campaigns, public information materials etc. Emphasis should begiven to grass root level workers as they are key leaders and they should be duly empowered, listened toand given proper incentives. They should undergo training with HMIS so that the results are obtained at arapid rate. There should be appropriate feedback system as well as health workforce should bestrengthened and work with positive frame of mind.There should be improved system of surveillance to tide over constantly occuring epidemics such asSwine flu,sars or recently Dengue fever Saga.Emphasis should be laid upon imposing behaviouralchanges such as avoidance of stress at workplace.Lifestyle changes and careful screening will bring aboutdrastic fall in levels of Hypertension and Diabetes and source of government information such as housingindicators, should be fully utilised by public health departments in monitoring public health. Thereshould be overaching public health research and development strategy. There should be ways ofsupporting the local approaches to implementation of local health programme and strengthen effectivejoint working between academic and public health service departments. It is high time that we should givean insight into this meticulous problem and come out with a solution sooner than later. To summarise,remembers me a saying of Louis Pasteur “To him who devotes his life to science, nothing can give more happiness than increasing thenumber of discoveries, but his cup of joy is full when the results of his studies immediately findpractical applications.” Dr Danish Imtiaz, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun 7
  8. 8. Strengthening Public Health: Translating Ideas into ActionPublic health can be strengthened by strengthening the existing system of health care delivery i.e.Primary health care delivery system, which is a three tier model of health care in India. The firststep towards this goal would be to maintain the number, infrastructure and the manpower of thehealth care facilities up to the standards (IPHS) and the second step would be a continuousmonitoring and evaluation of the health care facility and people working there.Even after so many years of recommendations of Bhore Committee and Alma Ata Declaration of“Health for All”, the current provision of health care by focussing on curative aspect in ourcountry defeats the very concept of comprehensive health care, which states it as preventive,promotive and then curative health care. So we need to change our focus from CURATIVE toPREVENTIVE AND PROMOTIVE and URBAN to RURAL+URBAN, if we really need toimprove the status of public health in our country. This change should be incorporated at thenational level by our eminent policy makers, which will percolate down to the most peripherallevel gradually. Besides, our leaders should make the provision of flexibility in the policy andprograms for the states to incorporate changes as per their needs and requirement keeping inview the social, cultural, economic, educational and infrastructural diversity.At the peripheral level we should make use of the existing systems to improve health caredelivery in a country as large as ours. Panchayati Raj Institutions, which are already functioningin our country, should be involved in planning, implementation, monitoring and evaluation ofvarious health programs being implemented in our country. Apart from this more Non-Governmental Organizations should be promoted to take active part in implementation,monitoring and evaluation. As we make the government by the people for the people in thelargest democracy, we should also imply the same principal as far as health care is concerned.We should try to increase the involvement of the community in all the process of health caredelivery, as is already being done with the help of ASHAs, AWWs, TBAs, etc. But this is not all,every program should have a peripheral community based worker like ASHA, so that our healthforce increases and also the ASHA is not overworked as is being done currently. These workersshould make a weekly or monthly report to submit to their superiors for monitoring andevaluation just like being done in case of polio these days.Public health scenario cannot be strengthened in isolation, instead it is the overall development(not only economic) of the nation which will boost the status of public health in our country.This statement can be justified by the example of Kerala, where the health indicators are the bestand which also has high literacy rate. So what we can do is that we can make the educationmandatory for every individual besides other interventions to open the path towards HEALTHYINDIA. DR. RITESH SHARMA, LLRM, Meerut 8
  9. 9. Strengthening Public Health: Translating Ideas into Action“Knowing is not enough, we must apply; willing is not enough, we must act.”(Johann Wolfgang von Goethe)Now is the time to make it happen where it matters, by turning scientific knowledge intoeffective action for people’s health.Science has led to dramatic improvements in health worldwide. Yet all is not well. Disparitiesand inequities in health remain major development challenges in the new millennium, andmalfunctioning health systems are at the heart of the problem. Half of the world’s deaths couldbe prevented with simple and cost-effective interventions. But not enough is known about how tomake these more widely available to the people who need them.Stronger emphasis should be placed on translating knowledge into action to improve publichealth by bridging the gap between what is known and what is actually being done.It is now a global imperative to find effective ways to strengthen health systems in order toimprove the lives of people, to meet the MDGs and to prepare for what is to come. Since thetime of Hippocrates humanity has struggled to grasp the fundamental principles of science and,perhaps more importantly, their implications for human health.Health systems in the developing world face major problems related to shortages, maldistributionand waste of financial, human, knowledge and other resources, and coverage shortfalls.Programmes can be national or international in scale but what is critical to success in terms ofimproving health is how they function at the local level. Priority setting should occur mainly atsub-national or regional levels rather than at the global level. Communities are powerfulinfluencers of acceptance and change in much of the developing world. Implementing aprogramme without the acceptance and explicit support of community leaders is probablydoomed to fail.To shift the emphasis from disease-based health services to risk and determinant-based healthsystems is really a formidable task. However, for our future efforts in health development forgood health for all, this is a challenge indeed. We need to have the right workforce to develophealth systems toward the desired direction. To ensure balanced development in health care andservices, we need to pay special attention to the public health workforce. The workforce shouldalso include community-based health workers. For strengthening public health, we need strongand sustained political commitment and support. As a requisite for this change, we needunwavering and long-term policy and strategy back-up at the national level. With the currentgovernment health policy, Preventive and Social Medicine can make an important contributionto the achievement of Indias Vision 2020.At the end I would like to conclude with the thought of Tim Evans, “Health systems shouldnurture a stronger culture of learning and problem-solving to tackle the major health challengesof our times. This could be achieved through a greater understanding of how the diverseelements within a health system interact with each other, and by finding innovative ways to solvecomplex problems.” & do agree with him that this is the right approach to strengthen the healthof our nation. Dr Deep Shikha, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun 9
  10. 10. Strengthening Public Health: Translating Ideas into ActionIndia has a rich public health heritage, which has led to public health actions during the first twodecades after Independence Known as the Golden age of public health.The concept of public health has seen several radical transformations as follows: I. Early 19th century - Environmental phase II. Mid 19th century -Individualistic phaseIII. Mid 20th century -Therapeutic phaseIV. And Curently, concept of public health touches following parameters: • Rapid and unplanned urbanization • Ecological imbalance • Side effects of globalization • New diseases and epidemics • Lifestyle modification for non-communicable diseases • Equity in the accessibility to the healthcareThe current concept mainly deals with the preventive and promotive initiatives of health.Why the media feels that public health has changed?Let us look at the media reports about the public health system According to Times of India, dated 5.7.10 - “India has just one O.T. per 1 lakh population and of the surgical facility available most lack the basic safety equipments” The Times of India, dated 23.11.07 states that- that there are ample vacancies in the PHCs as well as shortage of specialists and even if they are posted, they remain absent from duties. Some newspapers are highlighting the misuse of JSY by the doctors by not entertaining them in the odd hours and going for caesarian section without any such indication. Now let us look at some other critical comments of the expert authors: HEALTH FOR THE MILLIONS vol 30, page 67-68, by Tejal Barai Jaitly “At the village level, • There is no sharing of information or co-ordination among the service providers. • ANMs working according to their convenience and people referred by the ANMs are not given priority in district hospitals • AWWs provide irregular supplies, distribution of 3 days is done in 1 day and their rates are not revised • Distant location of PHCs, lack of staff, poor supply of medicines, and no examination room etc...” According to HEALTH FOR MILLIONS vol-32, page -7 “Janani Suraksha Yojna could be a successful programe under public private partnership was discontinued by the state 10
  11. 11. due to lack of trust in the ability of the non-profit sector. The report was not revealed when asked by the UNICEF in the interest of few politicians.” Human development report admits the increasing gap between rich and poor as a result of certain policies. Besides, the above comments, there are problems responsible for system failure e.g. • If pulse polio immunization is being done, then the routine immunization is forgotten • Wastage of drugs - irrational use and inaccessibility to important drugsWhat are the solutions? (There are many others but limitation of space here)Most important is the strengthening of human resource especially doctors. • Medical graduates should be oriented for traditional medicine - yoga and Ayurveda. Streamline AYUSH with the integration of ayurvedic treatments. • Incentives should be given to doctors like high allowance, accommodation etc. • Strengthening the capacity of paramedical workers and their motivation. • Higher involvement of local self government like Gram Panchayat. • Proper accountability of money.In the end, the policy makers require an equitable, appropriate and sustainable healthsystem, as health is the fundamental right of every human being. Dr Rashmi Katyal, Subharti Medical College, Meerut 11