1. International Health Regulations

Ensuring the implementation of International Health Regulations (IHRs) and compliance with similar global commitments such as trade and health, both for ensuring safety in all exported products that can affect health, and for mitigating possible negative effects of trade on the health of the population.

All relevant norms should be aligned with the corresponding IHR and international commitments related to key determinants of health. This will ensure that providing food safety, improving water and sanitation, preventing and preparing for as well as responding to disease outbreaks (including emerging and re-emerging diseases) and other public health threats (caused by multiple hazards of natural, accidental or intentional origin such as chemical, radio-nuclear, biological and other risks) with direct implications for IHR is higher in the policy agenda of the country and is discharged through inter-sectoral actions.

Health statistics should also be adapted to IHR requirements. In particular, mechanisms will be built to register and analyse the BoD (e.g. diarrhoeal diseases, TB and HIV) bearing in mind there are worries about completeness of information. The opportunity will be taken to improve death certification and related statistics; the Sample Registration System will need to be refined, since independent evaluation suggests that the system only captures about 85% of deaths.

Knowledge on international trade and health issues, including trade negotiation processes and mechanisms related to health should be promoted through multi-stakeholder collaboration and ownership while fostering South-South and Triangular Cooperation. Capacity needs to be built and networks strengthened to ensure full credibility in the international health scene while providing constructive inputs to international fora, making India’s expertise available to the rest of the world. 

2. Pharmaceuticals

Strengthening the pharmaceutical sector including drug regulatory capacity and trade and health for it to play a special role in India’s future is a key objective in the Country Cooperation Strategy (CCS) (particularly in the context of enhanced access to generic drugs, vaccines and medical products). Increased access to drugs (including patent issues and Agreement on Trade-Related aspects of Intellectual Property Rights (TRIPS); continued advocacy for reducing prices as well as improvements in procurement and supply chain management) should be fostered, especially for quality essential products for managing NCDs, TB, HIV/AIDS, malaria and neglected tropical diseases (NTDs), among others.

The number of “stock-outs” of medicines in public centres will also need to be reduced. Promising market niches (e.g. generics for NCDs) should be explored with a view to both identifying business opportunities and serving the needs of low income countries and emerging world markets. WHO will support the development of platforms and networks for horizontal collaboration, and transfer of technology between the international community, industry federations and relevant players, and generation of knowledge on international trade and health. This will help in building enhanced capacities for trade negotiations in cognizance of intellectual property rights issues and international covenants which have bearing on public health. Due consideration should be given to their implications for Indian industry and access to affordable quality pharmaceuticals locally and globally.

Drug regulatory work by the relevant authorities including the Indian Pharmacopoeia Commission and other stakeholders should be strengthened in line with the emphasis on “trade and health” and access to medicines. The number of trained Institutional Ethics Committees as per standard operating procedures or guidelines should be increased to improve standards of clinical trials and research. Research and development (for example, the creation of drug testing laboratories) should be expanded and all trade legislation should strictly adhere to the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property(GSPOA).

Quality assurance and safety policies and, in general, good manufacturing practices (GMP) should be reaffirmed by consolidating the technical expertise developed in recent years while supporting the National PharmacovigilanceProgramme and integrating reports of adverse drug reactions (ADRs) under national programmes on HIV/AIDS, tuberculosis, malaria and vaccines. Rational drug use initiatives and sector inspections (e.g. distribution, prescription, and delivery over the counter) should be scaled up in order to protect customers and contain antimicrobial resistance. 

3. Stewardship

Improving the stewardship of the entire Indian health system by supporting the Government of India’s efforts is necessary for ensuring India’s leadership role in global health. Space for fertile collaboration between stakeholders needs to be found in a win-win relationship.

While planning capacity at the central level is robust, as already indicated, specific work is probably warranted to increase the policy-making and planning capacity of some states. Emphasis will be placed on implementation and the operational translation of ideas into action. Inter-state exchange of experience with the aim of setting up effective Health Strategy and Planning, Health System Innovation Units or the like will be fostered on a voluntary basis.

Another important step in better articulating the respective roles of the Union and of states, and of the public and private segments is the 2010 “Clinical Establishments Act” and subsequent legislation which empowers authorities to require mandatory enlisting and supervision of public and private sector institutions, supported by an effective health-care quality inspectorate. Creation, management and dissemination of an electronic inventory of enlisted clinical establishments; development of standard treatment guidelines and protocols; and normative instruments for the effective implementation of the Act would be facilitated.

Improved health information/intelligence for decision-making supported by better epidemiological surveillance and policy analysis also plays a role here. WHO will support the use of internationally gained experience in measuring health systems performance, as part of a broader effort to strengthen evidence-to-policy links.

Facilitating the inclusion of national centres of expertise into a global compendium of national expertise, conducting research on emerging infections and strengthening research capacity especially in clinical trials, health economics, health financing, infectious disease modelling and other critical challenge areas is also important, as is disseminating best practices (“What works at the scale of this country?”).

Increasing the involvement of the private sector in information systems will be an option, as already seen in other countries. In fact, private business activity in India often reaches world-class levels and now the government has a crucial role in ensuring the contribution of corporations to protect the broader social good. Clearer indications are needed about where investments in infrastructure are indispensable, where acute care and chronic disease programmes against both CDs and NCDs are most needed, where human capital in the health field should learn from successful business practices, and so on. Signals abound that the vibrant private sector is willing to contribute to improving population health, be it through donations, partnerships, targeted private funding from business leaders and philanthropists or similar arrangements as attested by Pulse polio and several P-P-P (Public-Private-Partnership) projects.