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Sustainable Development of Health in India: An Inter-Ministerial Contribution
towards Health and Wellbeing for Optimum Quality of Life
A.M. Elizabeth*, J.P. Shivdasani*, Vandana Bhattacharya*,Parimal Parya*, Kiran Rangari* , Subhash
Chand*, Bacchu Singh**, Ramesh Gandotra**, Lakhan Lal Meena**, Y.K. Singhal**, Rita Rani**,
Manisha**, Ghanshyam Karol**, Vaishali Jaiswal**, Rekha Meena**, Sherin Raj T.P.**, S.P. Singh**,
Sangita Mishra**, Bhawna Katuria**, Raj Narayan** and Harshad Thakur ***
* Research Officers, **Assistant Research Officers, ***Director, NIHFW, Munirka, New Delhi- 110067.
Reviewers
Prof. AM Khan, Former Professor, NIH FW, New Delhi.
Prof. Sanjay Gupta, Professor, Department of C ommunity Health Administration, NIHFW, Munirka, New Delhi- 110067.
Abst ract
The significant achievement within public health in India during the past few decades is visualized by a d ecrease in
demographic indicators for health like IMR, MMR, TFR and doubling of life expectancy
health care system across the states visages a kind of disagreement of an emerging disconnect between the complexity and
iniquitous nature of problems as well as the competence to address it meaningfully. The health outcomes still remain depleted
when the country is compared with others with similar economic stage of development. Our past efforts to improve the health
status showed that optimum health cannot be achieved without the development of other sectors like economy, education and
information, social and environment. Hence, there should be an intense collaboration with other departments for achieving the
quality of life; and it is desirable that each sector should consider health dimension in their public policy and programme
strategies with utmost priority of is paper is to explore the level of i nter-
ministerial contribution and collaboration within and between for health; based on the content analysis of various recent
annual reports and publications of each ministry. The intent is for a deeper understanding of inter-sectoral and multi-sectoral
collaboration and contribution at all stages for health; identifying the strength, weakness and disparity which need to be
tackled for improving and suggesting strategies for the sustainable development of health in India. The study found that
majority of the ministries has incorporated health dimension in their policy and programme. But for the country to attain
sustainable development for health, requires strong actions with well-defined strategies for m utual cooperation and
collaboration between all the ministries and departments at all stages from resources allocation to programme implementation
for the desired outcome with the set time period.
Key words: Sustainable development, Health, Quality of life, Centrally-sponsored schemes, N HM, AYUSH.
Introduction
Sustainable Development Goals (SDGs). The adorable phrase
Sabka Saath Sabka Vikas Effort, Inclusive
the
health status showed that optimum health cannot be achieved without the development of other sectors like
economy, education and information, social and environment. Hence, there should be an intense
collaboration with other departments for achieving the quality of life; and it is desirable that each sector
should consider health dimension in their public policy and programme strategies with utmost priority of
ssustainable
development strategies for achieving the optimum quality of health will be the best model for replication by
other countries with similar socio-economy, demography and environmental status. Research on the
intersectoral and multisectoral cooperation for health showed that collaboration was enabled by authorising
directives and support from the top. The experiences and lessons from the past struggles to find a way
Health and Population:
Perspectives and Issues, 44 (1):- 19-32/2021
20
forward on how to achieve collaborative action within the local health systems to address an unmet need for
health transformation.
The United Nation Development Sustainable Development Goals 2030 include 17 goals with 169 targets.
Out of these SDGs, the goal SDG-3 focuses on health comprising 13 targets with 4 listed as means of
implementation targets and a total of 26 indicators. Each target has one or two proposed indicators and
these health Goals have the largest number of proposed indicators among the all the SDGs. Further,
the SDG-3 lays emphasis on ensuring healthy lives and promoting well-being for all at all ages and to
make it attainable by linkage with other 8 SDGs i.e. SDGs 1- End poverty in all its forms everywhere; SDG-
2- End hunger, achieve food security and improved nutrition and promote sustainable agriculture; SDG -5-
Achieve gender equality and empower all women and girls; SDG-6- Ensure availability and sustainable
management of water and sanitation for all; SDG-7- Ensure access to affordable, reliable, sustainable and
modern energy for all; SDG-8- Promote sustained, inclusive and sustainable Economic growth, full and
productive employment and decent work for all; SDG-11- Make cities and human settlements inclusive,
safe, resilient and sustainable;SDG-13- Take urgent action to combat climate change and its impacts.
Thus, attainment of optimum health of the population is not the isolated responsibility of the ministry of
health rather it requires collective action by other ministries considering health dimension in the policy and
programmes.
The objective of the paper is to explore the level of inter-ministerial contribution and collaboration within and
between for health; based on the content analysis o f various recent annual reports and publications of each
ministry for a deeper understanding of inter-sectoral and multisectoral collaboration and contribution at all
stages for health. It also attempts to identify the strength, weakness and disparity which need to be tackled
between the concerned ministries for improving and suggesting strategies for the sustainable development
of health in country.
Findings
Target, Ministries and Schemes for SDGs of Health
In line with the global attempt to achieve the sustainable development goals, India is set to achieve the 13
targets of various health indicators by linking the Ministry of Health and Family welfare with 19 other
Ministries/Departments through centrally-sponsored schemes/central sector schemes. Target-1:Reduce the
global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Target-2: End preventable
deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality
to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
by 2030. The ministries involved for target1 and 2 are Health and Family Welfare, AYUSH, WCD, and Tribal
Affairs. The Centrally-Sponsored scheme/Central Sector Schemes (CSS) approved are National Health
Mission (NRHM/NHM) RCH Flexible Pool including Health System Strengthening, Routine Immunisation
programme, Pulse Polio Immunisation Programme, National Iodine Deficiency Disorders Control Programme,
National Urban Health Mission Flexible Pool, Human Resources for Health and Medical Education, National
AYUSH Mission, Umbrella ICDS, Pradhan Mantri Matru Vandana Yojana (PMMVY), Mission Indradhanush.
Target-3 focuses on ending the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases,
combat hepatitis, water-borne diseases and other communicable diseases by 2030. The ministries involved
in this are Health and Family Welfare, AYUSH, Drinking Water and Sanitation, Ho using and Urban Affairs,
RD, Petroleum and Natural Gas, Food Processing Industries, Tribal Affairs. 12 Centrally -Sponsored
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Schemes/Central Sector Schemes (CSS) are approved i.e. NHM- Flexible Pool for Communicable
Diseases, National AIDS Control Programme, National AYUSH Mission, Swachh Bharat Mission (SBM)-
Rural, National Rural Drinking Water programme, Atal Mission for Rejuvenation and Urban Transformation
(AMRUT), Shyama Prasad Mukherjee RURBAN Mission, Pradhan Mantri Ujjwala Yojana, Pradhan Mantri
Kisan SAMPADA Yojana, Special Central Assistance to Tribal Sub Scheme, Umbrella Programme for
Development of Scheduled Tribes.
Target-4 aims at reducing premature mortality from non-communicable diseases through prevention and
treatment to one-third by promoting mental health and wellbeing by 2030. To achieve the targets,six
Centrally-Sponsored Schemes/Central Sector Schemes (CSS) are approved. These are NHM- Flexible
Pool for Non-Communicable Diseases, Injury and Trauma, NHM-Human Resources for Health and Medical
Education, NHM-Strengthening of State Drug Regulatory System, National AYUSH Mission, Special
Central Assistance to Tribal Sub Scheme, Umbrella Programme for Development of Scheduled Tribes.
Further, all these schemes are to be implemented by Health & FW, AYUSH, WCD and Tribal Affairs.
Target-5 focuses on strengthening the prevention and treatment of substance abuse, including narcotic
drug abuse and harmful use of alcohol. The ministries involved are Social Justice and Empowerment,
AYUSH, Home Affairs and Health and FW. Three Centrally-Sponsored Schemes/Central Sector Schemes
(CSS) have been approved. These are Scheme for Prevention of Alcoholism and Substance (Drugs)
Abuse, National AYUSH Mission, Police Infrastructure (Narcotics Control Bureau, etc.)
Target-6 aims to halve the number of global deaths and injuries from road traffic accidents by 2030. The
ministries identified and involved are Road Transport and Highways, Health and FW and AYUSH. To
achieve the targets, three Centrally-Sponsored Schemes/Central Sector Schemes (CSS) are approved like
Road Safety Schemes for publicity and awareness generation, NHARSS-National Highways Accident
Relief Service Project, Institute of Driving Training and Research, etc. linking with the National Health
Mission and National AYUSH Mission.
Target-7 focusseson ensuring universal access to sexual and reproductive healthcare services, including
family planning, information and education, and the integration of reproductive health into national
strategies and programmes by 2030. The ministries involved are Health and FW, Ayush, WCD. The
Centrally-Sponsored Schemes/Central Sector Schemes (CSS) approved are National Health Mission (RCH
Flexible Pool), National AYUSH Mission and Umbrella ICDS.
Target-8 aims at achieving universal health coverage including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential medicines and
vaccines. All these will be taken care through the Centrally-Sponsored Schemes/Central Sector Schemes
(CSS) like National Health Protection Scheme (Ayushman Bharat), National Health Mission (RCH Flexible
Pool, Flexible Pool for communicable diseases and Flexible Pool for non-communicable
diseases), National AIDS Control Programme, medical treatment of CGHS pensioners (PORB), NHM-
Human Resources for Health and Medical Education, National AYUSH Mission, Umbrella ICDS, Umbrella
Programme for Development of STs and Minorities, Umbrella Programme for Development of Minorities
including Development of Minorities- Multi Sectoral Development Programme for Minorities (MSDP), Jan
Aushadhi Scheme. The ministries identified are Health & FW, AYUSH, WCD, Tribal Affairs, Minority Affairs,
Chemicals and Fertilizers
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Target-9 focusses on substantially reducing the number of deaths and illnesses from hazardous chemicals,
air, water and soil pollution and contamination by 2030. The ministries identified are MoEF&CC, Housing
and Urban Affairs, Water Resources, River Development and Ganga Rejuvenation, Shipping, Health and
FW, AYUSH. The Centrally-Sponsored Schemes/Central Sector Schemes (CSS) listed to manage are
Environment Protection, Management and Sustainable Development (Pollution Abatement), Decision
Support conservation skills and System for Environmental Policy, Planning and Outcome Evaluation, Urban
Transport including Metro Projects, UT Planning Scheme and Capacity Building, National River
Conservation Programme, Research and Development and Implementation of National Water Mission,
Development of Major and Minor Ports.
Target-10 aims at strengthening the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries, as appropriate. The Centrally-Sponsored Schemes/Central
Sector Schemes (CSS) is the National Tobacco Control Programme. The ministries identified are Health
and FW, AYUSH.
Target-11 focusses on supporting the research and development of vaccines and medicines for the
communicable and non-communicable diseases that primarily affect developing countries, providing access
to affordable essential medicines and vaccines, in accordance with the Doha Declaration . The TRIPS
Agreement and Public Health affirms the right of developing countries to use the provisions in the
Agreement on Trade-Related aspects of Intellectual Property Rights and flexibilities to protect public health,
and providing access to medicines for all. The ministries identified are Health and FW, AYUSH, Science
and Technology, Chemicals and Fertilizers and Commerce. The Centrally-Sponsored Schemes/Central
Sector Schemes (CSS) listed are National Health Mission, setting up of a network of laboratories for
managing epidemics and national calamities, development of infrastructure for promotion of health
research, National AYUSH Mission and allied schemes related to pharmaceuticals innovation, Technology
Development and Deployment, Biotechnology Research and Development, National Institutes of
Pharmaceutical Education and Research (NIPERs).
Target-12 aims at substantially increasing the health financing and the recruitment, development, training
and retention of the health workforce in developing countries, especially in the least developed countries
and small island developing States. The Centrally-Sponsored Schemes/Central Sector Schemes (CSS)
identified areNHM, Human Resources for Health and Medical Education, Human Resource and Capacity
Development,Umbrella ICDS. The ministries involved are Health and FW, WCD and AYUSH.
Target-13 focusses on strengthening the capacity of all the countries, particularly developing countries, for
early warning, risk reduction and management of national and global health risks. The ministries involved
are Health and FW and AYUSH.
Thus, in tune with the SDGs for health, it was realized and considered that achievement of optimum health
is the responsibility of all the sub-department of
health her initiatives of all the
Ministries right from the conceptual stages. This was also stated by the Union Minister of Health and Family
Welfare (2019) over the MoU signing ceremony between National AIDS Control Organisation (NACO)
under the Ministry of Health and Family Welfare and Department of Social Justice and Empowerment
(DoSJE) under the Ministry of Social Justice and Empowerment (MoSJE).
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Role of Various Ministries for Health
Ministry of Social Justice and Empowerment (MoSJ&E): The MOU with MoSJ&E entrusts in
developing specific strategies and action plan for HIV and AIDS prevention, mechanism for drug addiction
treatment and extending social protection schemes to the vulnerable population. It emphasizes developing
human resources and capacity building for strengthening the service delivery mechanism for HIV and AIDS
prevention, drug addiction treatment and reference services by the National AIDS Control programme and
department of Social Justice and Empowerment.
Through this MoU, the services of various institutes under the DoSJE such as the National Centre for Drug
Abuse Prevention (NCDAP), National Institute of Social Defence (NISD), Integration Rehabilitation Centres
for Addicts (IRCAs) will be leveraged for execution of activities laid out in the MoU. As per the MoU, the
MoSJ&E also observes Swachta Pakhwara in which a free health and eye medical checkup camp and
distribution of reading glasses for the benefit of Bagri Lohar DNT Community was done. Further, the
NSKFDC organized Health Camps for the manual scavengers and sanitation workers and their family
members, conducted Recognition of Prior Learning (RPL) training programmes and provided One Time
Cash Assistance (OTCA) to the identified Manual Scavengers. It also observes Composite Awareness
Programme including free medical health checkup camps. During the programme, the schemes of MoSJ&E
as well as Apex Corporations were publicized and scheme pamphlets were distributed. These camps were
organized on a pan India basis. Further, under the Dr. Ambedkar Medical Aid Scheme, cent per cent
financial aid is provided to the poor SC and ST patients, whose annual family income is less than three lakh
rupees and who are required to undergo surgery of kidney, heart, liver, cancer, brain or any other life-
threatening diseases which require surgery including organ transplant and spinal surgery. The estimated
cost of the treatment is released directly (crossed cheque/DD)to the concerned hospital, with a maximum
ceiling limit set in each case. The MoSJ&E is also involved in promoting preventive health care, sanitation
and education by organizing activities like: (i) Intervention in Aspiration District of Mewat (state Haryana):
by sanctioning a CSR Project towards improving the access to Health Care Services through Mobile Van
for vulnerable children, youth and community from the backward district; (ii) Provision of Sanitary Napkin
Vending Machine and Incinerator Machines in educational institutions in Madhya Pradesh and West; (iii)
Counselling programme for maintaining menstrual hygiene; (iv) Promoting Health Care and Sanitation to
persons affected by floods in Kerala; (v) Provision of Toilets in a school in Haryana; and (vi) Free Medical
and Eye Check-up Camps and School-focussed camps providing treatment of dental filling, anaemia and
distance spectacles to school children.
Further, in line with the National Policy on Older Persons asproposed under the Finance Act (2015), Senior
Citizens Welfare Fund for the promotion of the welfare of senior citizens including schemes for promoting
financial security, healthcare and nutrition of senior citizens, welfare of elderly widows, schemes relating to
Old Age Homes, Short Stay Homes and Day Care of senior citizens, etc. are being developed. A National
Action Plan for Drug Demand Reduction (NAPDDR) for 2018-2025 is being prepared also. Under the IT
Initiatives, during the year 2018-19, a Web Portal for Pradhan Mantri Adarsh Gram Yojana MIS (PMAGY -
MIS) was developed for the integrated development of SC-majority villages. It aims at improving 50
monitorable indicators in 10 domains such as water and sanitation; education; health and family welfare,
etc. Introduced Pre-Matric Scholarship to the Children of those engaged in occupations involving cleaning
and prone to health hazards.
Ministry of Minority Affairs: This Ministry is looking after the health component of the minorities. Under
the National Health Mission, the Ministry of Minority Affiars in coordination with the Department of Health
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and Family Welfare, created more than 83,445 health facilities. Each health facility caters to a lakh
population in 235 minority-concentration districts. It developed a comprehensive programme of Skill
Development amongst the Muslims through an inter-ministerial group including Health and Family Welfare.
It recommended State Governments and UTs to consider posting of Muslim health personnel for providing
services in Muslim-concentrated areas. The Ministry of Health and Family Welfare delegated to issue
appropriate guidelines and Department of Personnel & Training (DoPT) will be the nodal department for
monitoring. Further, it stressed on the dissemination of information on Health and Family Welfare schemes
in Urdu and regional languages in districts, blocks and towns having a substantial minority population. A
basket of choices in contraception will also be made available along with ensuring easy access to such
services by the MoHFW. As per the Haj Committee Act (2002), a separate Division in the Ministry headed
by the Joint Secretary (Haj) has been set up to look after the Haj affairs. The Ministry manages the Haj
work in coordination with the Ministry of External Affairs, Ministry of Civil Aviation, Ministry of Health, Haj
Committee of India (HCoI) and the Consulate General of India (CGI), Jeddah, Kingdom of Saudi Arabia.
This ministry introduced the Jiyo Parsi scheme for addressing the population decline of Parsis in India and
released funds to Parzor Foundation for medical assistance, advocacy and addressing the health issues of
the community. It initiated the Nai Roshnischeme for leadership development amongst the minority women.
Through a six-day (five-day for residential) sensitization programme followed by handholding for a period of
one year. The ministry has developed specific training modules covering issues on Leadership of Women
through participation in decision making, Educational Programmes for women, Health and Hygiene, Legal
rights of women, Financial Literacy, Digital Literacy, Swachch Bharat, Life Skills, and Advocacy for Social
and Behavioural change. Further, it introduced the Pradhan Mantri Jan Vikas Karyakram (PMJVK) for
carrying out projects like construction and up-gradation of Primary Health Centres (PHCs), Health Sub -
Centres, drinking water supply projects, and other social development work, etc.
Ministry of Women and Child Development (MWCD): The nodal responsibility of thisministry is to
advance the rights and concerns of the women and children who together constitute 67.7 per cent of the
country's population (Census 2011). The prime intention of this ministry is to address the gaps in State
action for women and children, promoting inter-ministerial and inter-sectoral convergence to create gender
equitable and child-centric legislation, policies and programmes. This ministry has linkages with the health
department either directly or indirectly with different health schemes like Anganwadi Services Scheme,
Pradhan Mantri Matru Vandana Yojana, National Creche Scheme, POSHAN Abhiyaan, Scheme
for Adolescent Girls, Child Protection Scheme , Mahila E-Haat, Family Counselling Centre Scheme, Grant-
in-Aid for Research, Publication and Monitoring, Gender Budgeting Scheme, Nutrition Education and
Training though Community Food & Nutrition Extension Units(CFNEUS). The National Institute of Public
Cooperation and Child Development (NIPCCD) under the Beti Bachao Beti Padhaoscheme (BBBP),
provides information and training for better inter-sectoral and inter-institutional convergence at
district/block/grass-root level. It orients the trainers about planning process of preparation of district action
plan and advocacy campaign for social and behavioural change. The Food and Nutrition Board (FNB) is
engaged in inter-sectoral coordination and follow up action on the National Nutrition Policy, National Plan of
Action on Nutrition and policy matters related to nutrition.
Ministry of Home Affairs (MHA): The MHA in collaboration with Ministry of Environment and Forest
involved in diversification of the forest land for creating dispensary/hospital. The Government has approved
a centrally-sponsored scheme for road connectivity project for left wing extremist affected areas. The
Department of Telecommunication is setting up mobile towers in these areas. Under the Border Area
Development Programme, it provides funds to the states develop infrastructure for health. It has launched
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the M-Aarogya App of Medical and Health Department; and IT Policy for Information and Technology
Department. It has introduced Annaprashan under POSHAN Maah and Annaprashan Kit was provided to
the Post-Natal Care (PNC) women and 6-month-old babies. In the UT of Dadra & Nagar Haveli, it
has introduced Swabhimaan which aims at improving the nutritional status of pregnant women,
lactati ng mothers and out of school adolescent girls in the age group of 11 14 years who find it difficult to
attend the Anganwadi Centres for obtaining supplementary nutrition. Under the Aarogyam Sarvadha, 15
acre of land in Sayli area has been acquired for setting up of a Medical College with a capacity of 150-
medical seats. Under the Empowerment of Women Scheme, the rural women/girls are trained in the
matters like family health, child care, nutrition, domestic and environmental sanitation, small saving, etc. at
the Home Science College, Chandigarh. Further, free lab diagnostic and free radiological services to the
patients through empanelled radiological centres are made available if they are referred by the Delhi
Government Health Centres. The scheme of free treatment/surgery/diagnostic for general public, which
cannot be provided at Delhi Government hospitals, are being provided through identified private hospitals
for which payment is released through Delhi Arogya Kosh. Further, financial assistance is provided through
Delhi Arogya Kosh for free treatment of Medico-legal victims of road accident, acid attack and thermal burn
injury in identified private hospitals/nursing homes. To reduce the response time in congested areas and
J.J clusters, it has initiated a pilot project for induction of First Responder Vehicles (FRVs).
The MHA has launched the Ayushman Bharat the UT of Daman & Diu and celebrated the
Ayushman Bharat the Gram Swaraj Abhiayan. Ayushman Bharathelps the poor people in
getting treatment in various hospitals by providing a health insurance up to rupees 5.00 lakh per family. The
public health services are being provided through the network in the UT of Dadra and Nagar Haveli.Free of
cost curative, preventive, rehabilitative and supportive health care services are provided across the islands
through a well-developed Government health infrastructure. Under the MOU with Puducherry Cancer Trust
Hospital, radiotherapy and chemotherapy medical treatment are made available to cancer patients. During
the National Breast-Feeding Week, emphasis was laid on donating breast milk. Periodical audit of still birth
and caesarean has been initiated on a monthly basis.
Further, the UT of Lakshadweep (UTL) has been declared Open Defecation Free (ODF). Cloth bags have
been distributed to all the households in the islands to replace the use of plastic bags for behavioural
change. It has ensured accessibility to toilets in all households in Lakshadweep. All the public places like
the Mosques, Madarsas and Temples are provided toilet facilities under the CSR funds of Shipping
Corporation of India; and Mumbai and Cochin Shipyard, Kochi. The UTL administration transports non-
biodegradable resource materials for recycling to the Swachh Recovery Center, Kochi. The UTL conducted
Swachhata Hi Seva- (SHS-2018); and Lakshadweep Swachh Surveksan
Grameen-2018 (LSSG- 2018) was observed. One of the main components of the SHS-2018 was the mass
Shramadan Programme in which entire UTL was cleaned by involving people from all walks of life.
The UTL administration has signed an MoU with the National Health Agency, GoI, to implement the
Ayushman Bharat(Health Insurance Scheme) as part of the National Health Insurance Mission. The UTL
administration has extended the existing health Insurance Scheme to incorporate Antyodaya Anna Yojana
(AAY)/Priority House Hold (PHH) beneficiaries. A 20-bedded Deen Dayal Upadhyaya AYUSH Hospital has
been established in the capital island Kavaratti. Rashtriya Vayoshri Yojana
administration conducted a camp for distribution of Assisted Living Devices to senior citizens of BPL
category. Under the Health and Sanitation programme, Chandigarh has been conferred with Kayakalp
Award by the Union Health Minister for implementing the Kayakalp module. SKOCH Order of Merit Award
(top 50 Swasth Bharat Projects in India) has been introduced for the innovations and best practices in 2018
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in Night Vigil, Mobile Food, Testing Lab, Pradhan Mantri Surakshit Matritv Abhiyan (PMSMA), etc. Further,
under the e-Governance initiative in NHM, e-Hospital Module has been implemented in four City Hospitals.
- A NIGHT VIGIL: a first of its kind initiative in the country to improve immunization
has been implemented. In this, the teams shall be sent to the areas to vaccinate the children of
homeless/nomads/rag pickers/beggars, etc.) during the National Immunization Day. For strengthening
medical facilities for the personnel of CAPFs; it is visualized to have a Unit hospital at each CAPF with
indoor facilities with the required number of health care personnel and equipment.
Ministry of Road Transport and Highways: This ministry contributed towards health by focusing on road
traffic injuries which is the leading killer of people aged 5-29 years. The SDG 3.6 targets to decrease the
number of road deaths and injuries by half by 2020 achieved without drastic action. In India,
accidental injury is one of the leading causes of disability, mortality and morbidity; and road traffic crashes
are one of the major causes. The Committee on Road Safety was of the view that the programmes to
promote road safety should be developed and implemented using the public health approach, identifying
the problem and the risks, identifying the appropriate interventions based on cost effectiveness,
sustainability and culture specificity, and finally evaluating these interventions by the actual reduction in
injuries and deaths.
The ministry considers that road safety is a multi -sectoral and multi-dimensional issue which includes
health and hospital services for trauma cases (in post-crash scenario). Health departments are responsible
for medical care of accident victims; insurance companies provide insurance cover and
compensation. Ministry of Road Transport & Highways would provide 140 advanced life support
ambulances to 140 identified State Government hospitals to be upgraded under the Ministry of Health and
Quadrilateral, North-South and East-West Corridors of the National Highways.
Ministry of Water Resources, River Development and Ganga Rejuvenation: There is no direct link with
health activities in this ministry.
Ministry of Jal Shakti: The ministry launched a Jal Shakti Abhiyan
citizens of the country become aware of water conservation. The 'Jal Shakti Abhiyan' focuses on five
aspects i.e., water conservation and rainwater harvesting, renovation of traditional and other water bodies,
reuse of water and recharging of structures, watershed development, and intensive forestation. The
conservation efforts will be supplemented by initiatives like developing block and district water conservation
plans and 'krishi vigyan kendra melas' to promote efficient water use for irrigation and better crop choices.
In urban areas, plans with time-bound targets will be developed for waste water reuse for industrial and
agricultural purposes. Plans will be developed for at least one urban water body for groundwater recharge
in the block or the city. Scientists and IITs will also be mobilised at the national level to support the teams.
Ministry of AYUSH has developed various schemes like grant-in-aid for promotion of AYUSH intervention
in public health initiatives, scheme for assistance to organisations (government / non-government non-
profit) engaged in AYUSH education / drug development and research / clinical research, etc. For
enhancing the health security of the rural community, grant-in-aid to non-profit/non-governmental AYUSH
organisations/institutions are provided. Revitalization of local health traditions, midwifery practices, etc. are
encouraged through extra mural research (EMR) in ayurveda, yoga and naturopathy, unani, siddha and
homoeopathy. Acquisition, cataloging, digitization and publication of text books, promotion of information,
education, and communication (IEC) in AYUSH, and development of AYUSH clusters have been
27
envisaged. Further, various activities were initiated by the ministry under SDGs-03 to ensure healthy lives
and promote wellbeing for all by 2030. Some of the initiatives are like research projects on Reproductive
and Child Health (RCH), protocol on Anti-Natal Care, pilot project in Tamil Nadu for delivering AYUSH
services as part of the nutrition scheme for reduction in the infant and maternal mortality rates as well as
anaemia among girls have been implemented. Yoga has been introduced in schools and celebration
of International Yoga Day on 21 June every year to promote wellness and prevents psychosomatic
disorders. Further, the AYUSH practitioners have been empowered through its research councils and
National Institutes. A detailed strategy paper has been prepared on strengthening AYUSH on Nutrition and
Diet Schedule, development of AYUSH clusters for an effective and sustainable strategy for
competitiveness enhancement of MSMEs. Promotion of Information, Education, and Communication (IEC)
in AYUSH for awareness among the members of the community about the efficacy of the AYUSH Systems,
cost-effectiveness and the availability of herbs used for prevention and treatment of common ailments at
their door steps have been given priority.
Ministry of Tribal Affairs (MTAs) introduced the scheme for the Development of Particularly Vulnerable
Tribal Groups (PVTGS) for who have stagnant or diminishing population with low literacy level, still use pre-
agricultural technology, and economically backward. It aims at protecting and improving their social
indicators like livelihood, health, nutrition and education in order to lessen their vulnerability. For addressing
the health service delivery gap; it has introduced programmes beyond the NHM such as provision of safe
drinking water, land distribution, land development, social security, housing and habitat, connectivity (road
and telecommunication), electricity supply, solar power with provision of maintenance, irrigation, urban
development, culture, sports including traditional and tribal games and sports, other innovative activities for
the comprehensive socio-economic development of PVTGs.
For improving their health status, emphasis has been given on the creation of special health centers for
PVTGs beyond the National Health Mission (NHM) norms. Support to the existing institutions for
manpower, medicines, equipment, buildings, the need to undertake health surveys of PVTGs including
issuing health cards to them indicating their health status especially with respect to sickle -cell anaemia
(100% screening), keeping aside the untied funds for emergency and specific needs, training for
paramedics amongst the tribal people; promoting the use of treated mosquito nets to prevent malaria,
composite fish culture to control mosquito growth and also to supplement protein for nutrition. Cent per
cent health facility coverage of pregnant mothers and immunisation of children are taken care of in these
programmes. The schemes/projects will be monitored by the Ministry in a continuous basis through various
monitoring mechanisms like field visits by the State Government officials and Ministry officials by
considering specific outcomes with respect to literacy, drop out, immunization, nutrition, income levels,
employments, etc.
The Ministry is also responsible to draw up plans for the PVTGs involving reputed national level bodies,
including industry associations, the concerned State Governments and other a
Conservation-cum-Development (CCD) Plan is a cent per cent Central-Sector Scheme. Under the Special
Central Assistance (SCA) to tribal sub plan, 10-15 per cent of the money has been released to States/UT in
one/two installment(s) to further the health of the tribal populace. Few expected outcomes under the CCD
Plan are like enrolment rates in schools, reduction of dropout rates, increase in immunisation rates of
infants, increase in health coverage of pregnant mothers, etc.
Ministry of Housing and Urban Affairs is involved in the health activities directly or indirectly under the
Swachh Bharat Mission (Urban). Under this mission, it has identified two primary components- achieving
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cent per cent open-defecation free status and scientific processing of solid waste in all the statutory towns
in the country. The Swachh Survekshan has given rise to healthy competition between cities to become the
,
rankings. Ministry also
garbage free status and launched the ODF+ and ODF++ protocols, with a focus on sustaining ODF
outcomes and achieving holistic sanitation. While ODF+ protocol focuses on O&M of community/public
toilets by ensuring functionality and proper maintenance of CT/PTs for their continued usage, ODF++
focuses on addressing safe management of fecal sludge from toilets, and ensuring that no untreated
sludge is discharged into open drains, water bodies or in the open. MoHUA has a Central Public Health and
Environmental Engineering Organisation (CPHEEO). Water supply and sanitation including Solid Waste
Management being a State subject, the State Governments/Union Territories and Urban Local Bodies are
responsible for planning, designing, implementating, operating and maintaining these. The Ministry of
Housing and Urban Affairs is responsible for formulation of policies and programmes and assisting the
States for technical guidelines/financial support. Further, the ministry developed National Urban Sanitation
Policy for Urban Sanitation in India. According to the Annual Report 2018- 19, the MoHUA does not show
any inter-sectoral co-ordination with MoHFW and no committee formation is also reported.
Discussion
To bridge equality with development initiatives, each ministry has incorporated various health associated
programmes and schemes with allocated funds. According to the National Health Policy, each ministry has
to consider health in all policies. Thus, the assessment of recent activities of each ministry revealed that all
the ministries have tried to incorporate health dimension in their policies and programmes; and introduced
various schemes. But, more coordinated efforts between the ministries are required for optimum quality of
health and wellbeing within the stipulated time frame. Thus, for the country to attain sustainable
development for health, requires strong actions with well-defined strategies for mutual cooperation and
collaboration between all the ministries and departments at all stages of resources allocation and
programme implementation. Kim et. al. reported that convergence of sectoral programmes is important for
scaling up essential maternal and child health, and nutrition interventions. These interventions are
implemented by two government programmes designed to work together- Integrated Child Development
Services (ICDS) and National Rural Health Mission (NRHM). But, it was found that there is limited
understanding of the nature and extent of coordination in place, and needed at the various administrative
levels. How inter-sectoral convergence and the factors influencing convergence in policy in nutrition
programming are operationalized between ICDS and NRHM from the state to village levels in Odisha has
been examined. It was observed that there was a close collaboration at the state level in developing
guidelines, planning, and reviewing programmes, facilitated by a shared motivation and recognized
leadership for coordination. However, the health department was perceived to drive the agenda but
different priorities and little data sharing presented challenges. At the district level, it was seen that there
were joint planning and review meetings, trainings, and data sharing but poor participation in the i nter-
sectoral meetings and limited supervision. While the block level is the hub for planning and supervision,
cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and
poor communication. Strong collaboration among flaws was facilitated by close interpersonal
communication and mutual understanding of roles and responsibilities. The study suggested that congruent
or shared priorities and regularity of actions between sectors across all levels will likely to improve the
quality of coordination. Clear roles, leadership and accountability are also imperative. As convergence is a
means to achieve effective coverage and delivery of services for improved maternal and child health; and
nutrition, focus should be on delivering all the essential services to the mother-child dyads through
29
mechanisms that facilitate a continuum of care approach rather than sectorally -driven, service-specific
delivery processes.
Further, idealistic SD for health can be linked to Strategies and Global Action Plan adopted by the World
Health Assembly. It involves covering the national health concerns and also majority of the international
programmes. Any approach to national health development focussing on individual programme initiated by
different ministries in isolation will be counterproductive leading to fragmentation and competition that has
been observed previously. It fails to address many cross-cutting issues that do not fit into the programme
areas. The emphasis on Universal Health Coverage (UHC) making it central to the overall health goals
under the SDGs is crucial for the health sector to overcome all these challenges.
- that is progress in one area depends
upon the progress in many other areas. Translating this idea into a practical action is one of the challenges
of this new agenda. To address health issues, a purposeful action is required to influence governance in
many policy areas leading to achieve health sector goals. The health of the people is not only depend ant
on the health sector but also impacted by other issues such as transportation, housing, agriculture, safe
drinking water and sanitation, clean environment, housing, trade and foreign policies, information and
communication, etc. To address the multi-sectoral nature of the health determinants, the health sector
should strongly promote 'health in all policy'- an approach to public policy sector that it automatically takes
into account the health implications decisions, making synergies, and avoid harmful health impact. In order
to improve population and health equity, and address the social determinants of health; the target in other
ministries/sectors goals should be given special attention in designing and implementing policies. Further,
there is a need to monitor the individual targets to address the cross-cutting approaches to the health
challenges. Robust and reliable monitoring of progress and performance are important for all the major
health programmes with the set of indicator proposed for the set targets by each ministry for maximization
of health with pooled minimum resources.
Under the MDGs, India was able to make remarkable progress. Hundred million people have been lifted out
of poverty, under-five child mortality rate has been dropped by 61 per cent from 125 death per 1000 live
births in 1990 to 49 in 2013; maternal mortality ratio dropped by 70 per cent from 560 to 167 during 2011-
13. The country has been successful in combating HIV, tuberculosis and malaria. The HIV prevalence
among the pregnant women aged 15 24 years have declined, and malaria incidents have also come
down. Deaths due to TB have been nearly halved. The SD for health provides new opportunity to
strengthen the inter-sectoral governance for health based. Much of the attention on governance for health
has been focussed on global issues but the SDG declaration underline s the importance of governance for
health at the national and regional levels. The integrated nature of the SDGs agenda presents opportunities
for new approach to the earlier problem but also present challenges to address regional disparities covering
different ministries/sectors. Consecutively, to achieve the universal health coverage goal, the health system
needs to be strengthened and made adaptive to the emerging health priorities associated with
demographic and epidemiology transition, technologies development and meeting the changing public
expectations.
The country had initiated certain specific programmes for the achievement of the SDGs focusing on health
and some of them in a mission mode by different ministries. There has been a general improvement in the
provision of Healthcare infrastructure, human resource development but more was needed as could be
30
is still way below the world average. This raises questions about implementation strategies of these
programmes.
The MDGs agenda and the countr National Health Programmes have contributed to the expansion of
health system capacities but each state and union territory is at a different state of economic, social,
democratic, political and health system achievement. The GoI and the states should deliberate and
consider several essential but critical aspects like- how to integrate the SD for health agenda into the
existing policies, programmes and plans, what additional strategies would be required within and outside
the health sector for coordination, cooperation for collective impact , how could the needed additional
resources be mobilized for collaboration for health, how to implement and monitor progress of different
ministries on different targets made under collaboration, how to establish centre-state and inter-
ministrial/inter-sectoral coordination and cooperation mechanism for this process of transition and
managing the change for sustainability.
The country has to achieve the SDGs by 2030. It has to be tackled by coordinating and cooperating with
other sectors like education and women empowerment, availability of clean drinking water, sanitation and
hygiene, environmental protection, transportation and communication, etc. for collective impact. The SDGs
have to be achieved if the country is to ensure quality health for all. Therefore, the India government ha s
identified 19 ministries/departments which need to be collaborated and integrated leading to collective
impact for human welfare. Studies have shown that under the inter-sectoral coordination for health, the
major challenges identified included lack of clear directives and institutional support for collaboration,
obstacles to monitoring, interdepartmental administrative challenges, differing perspectives on strategy
among district and local leaders, community resistance and inaction, and intervention over-commitment. In
spite of strongly addressing difference between different ministries for inter-sectoral coordination,
Governments at the centre and state-level continue to implement more sectoral actions and inter-sectoral
coordination to address health issues and challenges but coordinated broader efforts for radical changes
need to be made to transform policy and programme into resulted-oriented achievable action.
Conclusion
The experience and achievements of MDGs highlighted that health cannot be achieved in isolation.
Considering the above scenario, there is a need to review and assess the current inter-ministerial
collaboration of governance to address health and its associated dimensions of development. This will also
suggest strategies to overcome the problems faced by various ministries for inter-sectoral/multi-sectoral
agreements. For making such inter-setoral/multi-sectoral collaboration meaningful and coherent; there is a
need to explore and comprehend the current status of inter-ministerial collaboration. For Sustainable
Development of Health and issues for future course of action; the multi-sectoral understanding of various
health-linked developmental initiatives needs to be relooked. The target in other sectors goals can be
considered to be health-related and should be given special attention in designing policies , planning and
implementing the strategies to achieve the health goals and monitor its progress. Assessing and
understanding all these dimensions will lead to scientific designing of more sectoral collaboration for health
addressing the local and regional disparities.
References
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2. http://jalshakti-dowr.gov.in/annual-report.
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3. http://mohua.gov.in/cms/annual-reports.php.
4. http://socialjustice.nic.in/writereaddata/UploadFile/Social_Justice_AR_2018-19_English.pdf.
5. http://www.minorityaffairs.gov.in/reports.
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Health and Population:
Perspectives and Issues, 44 (1):-19-32 /2021
