Critical Appraisal of India's National Stroke Rehabilitation Programme J Ind Fed NR

Page | 18

Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1

INTRODUCTION

Health Systems in India:

India is a federal union with 28 states and eight

union territories.

Health is a state subject in India

where the state government takes up the

responsibilities to provide good quality health care

and public good to the people in each state.

Organized provision health services in India have

been envisioned since 1946 by the

recommendations from the Bhore committee.

Health Systems for Rehabilitaon – Crical Appraisal of the Naonal

Programme for Stroke in India.

Sureshkumar Kamalakannan

, Abhishek Srivastava

, Manigandan Chockalingam

, Dorcas Gandhi

, Rajinder K

Dhamija

John Solomon

, Preee Shey Akkunje

,Sonal Chitnis

, Hitav Someshwar

, Nirmal Surya

1. Northumbria University, Newcastle Upon Tyne, U.K. & Pragyaan Sustainable Health outcomes Foundaon, Hyderabad, Telangana,

India. 2. Kokilaben Dhirubhai Ambani Hospital & Medical Research Instute, Mumbai, India. 3. Naonal University of Ireland Galway,

Galway, Ireland. 4. Chrisan Medical College and Hospital, Ludhiana, Punjab, India. 5. Instute of Human Behaviour and Allied Sciences,

New Delhi, India. 6. Manipal Academy of Higher Educaon, Manipal, Karnataka, India. 7. Kasturba Medical College, MAHE, Mangalore,

Karnataka, India. 8. Bhara Vidyapeeth Deemed to be University, Pune, Maharashtra, India. 9. Topiwala Naonal Medical College & BYL

Nair Ch. Hospital, Mumbai, India. 10. Bombay Hospital and Medical Research Center, Mumbai, India.

Consorum for Rehabilitaon in Health Systems, The Indian Federaon of Neurorehabilitaon (IFNR), Mumbai, India.

ABSTRACT

The organized provision of health services in India has been envisioned since 1946 by the recommendations from

the Bhore committee. However, the policy and program strategies for the provision of good quality health care still

lack effectiveness. Access to rehabilitation services for persons with disabilities continues to be a significant public

health problem in India. This review intended to identify the barriers to integration and implementation of

rehabilitation services within the national program for stroke in India. The methods involved the critical review and

appraisal of the last five years of the published common review mission reports which report the performance of the

entire health system and national program of the country. All relevant policy and program documents related to the

national program for the prevention and control of cancer, diabetes, cardiovascular diseases, and stroke, were also

reviewed. The World Health Organization, Rehabilitation 2030 recommendations were also cross-compared to

summarize the findings from the critical review. The results revealed that rehabilitation was neglected within the

conceptualization and implementation of the NPCDCS program. Let alone for the Stroke program, there was not

any evidence-based description of the concept of disability management and rehabilitation within the NPCDCS

program. The health system in its current form appears to be a non-inclusive system for disability-inclusive

development. The priority is mainstreaming disability within the agenda for the health of the nation. If disability

could be mainstreamed within the health agenda of India and in LMICs, universal health coverage and disability-

inclusive development can certainly, be achieved.

KEYWORDS- Health Policy; Health Systems; Rehabilitation; Disability; Inclusive Development; Policy Analysis.

CORRESPONDING AUTHOR

Dr. Sureshkumar Kamalakannan

Associate Professor

Department of Social Work Education and

Community Wellbeing

Northumbria University

Newcastle Upon Tyne NE7 7TR

England, U.K.

Phone: +44 7366962444

Email: Sureshkumar.kamalakannan@northumbria.ac.uk

Received on- 4

May 2024

Published on

July 2024

Critical Appraisal of India's National Stroke Rehabilitation Programme J Ind Fed NR

Page | 19

Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1

However, the policy and program strategies for the

provision of good quality health care still lack

effectiveness.

This had in fact led to the emergence

of private health care systems in India which is

currently being utilized by a significant proportion

of the country’s citizens, especially those living in

urban areas.

4-5

India has a health care system where

the public and private sectors work simultaneously

and sometimes in partnership to meet the health

needs of the population.

The private health system

is primarily located in urban areas and provides

secondary and tertiary healthcare services.

The

government health system is three-tiered covering

primary, secondary, and tertiary level care and

health services for the entire state supported by the

national ministry of health and family welfare

(MoHFW) (Figure -1).

2,7

This system has improved

significantly in the past two decades in terms of its

approach to meet the increasing health needs of

people in the country.

Given the epidemiological

transition in the second-most populous country in

the world, there have been several strategic re-

organization of the health system with new national

programs for non-communicable diseases, mental

health, elderly care, as well as health insurance

policies converged under the new National Health

Mission (NHM).

2, 7-8

However, the tertiary prevention aspects such as

disability and rehabilitation have been neglected

and are hardly visible in any of this strategic

reorganization.

9-11

Access to rehabilitation services

for persons with disabilities is an important public

health problem in India.

7, 12

Comprehensive

rehabilitation services are available only in tertiary

care hospitals situated in urban areas and they are

predominantly run by physicians and

physiotherapists.

12 -16

Disability and rehabilitation

are viewed only from a charity model especially by

the government systems through the ministry of

social justice and empowerment and it is restricted

to the provision of monthly pension and livelihood

opportunities.

12-16

The health system in its current

form appears to be a non-inclusive system for

disability-inclusive development.

National Program for Stroke in India:

The National Programme for Prevention and

Control of Cancer, Diabetes, Cardiovascular

Diseases and Stroke (NPCDCS) is the only

program that was designed to cover Stroke or

cerebrovascular disease initiatives in the country.

The NPCDCS was launched in 2006 and was

piloted in 2008 in selected states and then rolled out

to all states a decade ago. The objective of this

program was to prevent and control non-

communicable diseases (NCDs) including stroke

through the establishment of NCD clinics at the

community level and opportunistic screening for

NCDs at the primary health centers (PHCs) and

Sub-health centers (SHCs) in the villages.

Screening, capacity building, community

awareness, treatment, and management of

complications were the core program activities

within the government health facilities and NCD

clinics in the community.

However, there is very

little understanding and effort on the impact of

these activities on the stroke survivors

experiencing disabilities and the consequences

leading to their poor quality of life. Although more

than a decade and a half since its inception, the

NPCDCS program has still not been effective

enough to reduce the growing burden of stroke and

stroke-related disabilities in India.

18-20

Recent

evidence on the magnitude of stroke in India very

clearly highlights the unchanging and rather

increasing incidence and prevalence of stroke.

This implies the importance of identifying the

barriers to effective implementation of the

NPCDCS program and developing scalable

solutions to address the disability burden imposed

by stroke and other NCDs in India.

Common Review Mission:

The Common Review Mission (CRM) is an

extensive national monitoring exercise of the

national health mission. This initiative has been in

place since 2007.

22-23

The primary objective of the

CRM is to enhance the focus of the NHM on a fully

functional health system at all levels in the country.

The CRM reviews all the national health programs,

policies, and strategies of the NHM from the

perspectives of the community to ensure people

with health needs can access good quality service,

free of cost in any place within the country.

22-23

The

CRM reviews have been even more rigorous since

within the expanded service delivery package of

the health systems.

Having been scaled up in all

2018 particularly because, most of the national

programs have been operationally strengthened