Do health policies address the availability, accessibility, acceptability, and quality of human resources for health?: Analysis of three decades of National Health Policy of India

Background Human Resources for Health (HRH) are crucial to improve health services coverage and population health outcomes. The World Health Organisation (WHO) promotes four dimensions - availability, accessibility, acceptability, and quality (AAAQ) for HRH strengthening. Integrating AAAQ dimensions in policymaking is essential to reduce the critical shortage of HRH in India.Methods We created a multilevel framework to evaluate the incorporation of AAAQ dimensions along with strategies and actions that can improve them in HRH-related policies. HRH-related recommendations of all versions of the National Health Policy of India (NHPI) were classified according to targeted dimensions and cadres. We evaluated the extent to which NHPIs incorporated AAAQ dimensions over three decades. Furthermore, dimension-wise normalized indices were formulated to calculate HRH deficits for pre-NHPI years to assess situational deficiencies. Finally, we evaluated whether or not the HRH recommendations of NHPIs addressed the deficient cadres and dimensions for the corresponding year.Results We observed that HRH availability and quality were focused more in NHPI compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and health assistants. AAAQ indices showed deficits in all dimensions in almost all cadres over the years. The cadres focused by NHPI recommendations did not completely correspond to the deficient cadres.Conclusion The framework and indices based method can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening in countries. At the global level, the application of framework and indices will allow a comparison of strengths and weaknesses of HRH-related policies of various nations.

Opportunities and Challenges for effective implementations of Karnali Province Health Policy

The health sector is complex, involving many stakeholders, multiple goals, and different beneficiaries. Health policy is an instrument to decide, plan and action that are undertaken to achieve health care goals within a society to combat the health problems. It is crucial for understanding it influences on health systems and prioritizing the health needs of the population.1 In 2015, Nepal became a federal republic and replaced a unitary government with a federal government at the central level, seven provincial and 753 local governments having more authority and resources in planning and managing than before. In the spirit of Constitution of Nepal 2015 and with the vision to make the health services of the country universal and qualitative, Ministry of health and population of Nepal (2019) revised National health policy in 2019. National Health policy 2019 of Nepal has expanded its plan and strategies according to federal structure of the country to improve health sector.2 The revision of health policy paved the way forward towards health system reform in the country which is further supported by Local Government operation act 2017.3 With the new governance structure, accountability has also been divided among the three tiers and the local level is responsible for the program implementation responsibilities.4 5 The Ministry of Health and Population (MoHP) is responsible for managing the health system at the federal level, whereas at the provincial level leads by the Ministry of Social Development and local governments metro/sub-metropolitan, municipality and rural municipality are responsible for its management.6 This indicates that the health system must gear up to meet the escalating healthcare needs of every citizen and upgrading the system as per the structure of the country.

A review on the prevailing gaps in women’s sexual and reproductive health rights in Tanzania’s National Health Policy 2017

Women’s sexual and reproductive health rights (SRHR) are linked to numerous human rights; health, education, freedom from torture, protection from all forms of discrimination, and right of privacy. SRHR refers to a set of rights that every human being is entitled to, regardless of culture, race, religion, ethnicity, or disability. Women’s sexual and reproductive health rights have been taken for granted, especially in Tanzania’s health policies. However, Tanzania has several National Policies and Laws that affect women and men differently and in certain areas, they even contradict other existing laws. The prolonged poor SRHR shows the urgency of the reformation of the policies and laws. The analysis was carried out qualitatively through a reflection focused on the policy and other legal materials concerned. The study revealed that the policy does not cater enough for women’s SRHR. This study concludes that the policies are outdated and have a lot of loopholes. This has led the sexual and reproductive health system in Tanzania astray. The study concludes that the TNHP 2017 has to be reviewed and revised in order to meet the women’s SRHR and also to align it with some of the international policies and targets concerning sexual and reproductive health.

Declining trend of smoking and smokeless tobacco in India: A decomposition analysis

There has been a relative reduction of tobacco consumption between Global Adult Tobacco Survey-India (GATS-India) 2009–10 and GATS-India 2016–17. However, in terms of absolute numbers, India still has the highest number of tobacco consumers. Therefore, this paper aims to examine the socioeconomic correlates and delineate the factors contributing to a change in smoking and smokeless tobacco use from GATS (2009–10) to GATS (2016–17) in India. We used multivariable binary logistic regressions to examine the demographic and socioeconomic correlates of smoking and smokeless tobacco use for both the rounds of the survey. Further decomposition analysis has been applied to examine the specific contribution of factors in the decline of tobacco consumption over a period from 2009 to 2016. Results indicated that the propensity component was primarily responsible for major tobacco consumption decline (smoking- 41%, smokeless tobacco use- 81%). Most of the decrease in propensity to smoke has been explained by residential type and occupation of the respondent. Age of the respondent contribute significantly in reducing the prevalence of smokeless tobacco consumption during the seven-year period, regardless of change in the composition of population. To achieve the National Health Policy, 2017 aim of reducing tobacco use up to 15% by 2020 and up to 30% by 2025, targeted policies and interventions addressing the inequalities identified in this study, must be developed and implemented.

Bounded Justice and the Limits of Health Equity

Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity.

Promoção da saúde bucal e o idoso

Introduction: For the year 2050, the estimate is to have more than two billion people over the age of 60 worldwide. This projection of population aging highlights the importance of assessing the oral health of the elderly and, consequently, highlighting the role of public policies and the dental surgeon in health promotion in this context. Objective: The purpose of this paper is to approach the main oral changes that occur in the elderly and the importance given to this by public policies. Discussion: The literature emphasizes the national health policy of the elderly and the duty of the professional to promote the quality of life while preserving the autonomy and functional independence of the patient. Conclusion: Several public policies ensure the rights guaranteed to people aged 60 years or older regarding whole health care for the elderly. However, much needs to be done for them to benefit and have full access to this service. Therefore, it’s the dental surgeon’s responsibility to bring awareness to this reality and need.