From Public To The Republic
“Till Death Do Us Part”
The Chief Minister of Uttarakhand, Pushkar Singh Dhami, introduced a new law called the Uniform Civil Code (UCC) in the state’s assembly. This law has rules for marriage, divorce, land, and property, for everyone who lives in Uttarakhand, no matter what religion they follow, except for Scheduled Tribes.
While the pros and cons of the current UCC Bill will be debated over a long time it is important to understand the implications of voluntary versus mandatory systems. The choice between mandatory and voluntary participation often reflects the values and priorities of a society, as well as the specific political and cultural context. In democratic societies, there is often a balance sought between ensuring public order and compliance with the law, and respecting individual freedoms and rights. Striking this balance requires careful consideration of both approaches to assess potential consequences and trade-offs.
The Indian School of Public Policy (ISPP) is an institution that aims to develop a new class of policy leaders for India. As a recent graduate of their LokNeeti Programme, where the practicum served as a benchmark for our collective learning and helped us apply our theoretical understanding of what policy in practice meant. Prof. Parth Shah guided us through a critical evaluation of various policy implementations which involves assessing the effectiveness, efficiency, equity and sustainability of how a policy is put into practice. We looked at the current Public Health System in India - The Ministry of Health and Family Welfare and NHA have speculated an informative campaign to align with the current 100 Microsites — Project for ABDM Adoption — Complete Digitization — Complete Utilization: Onboarding Private sector health facilities onto the ABDM Ecosystem.
Are we facing a Public Health System failure?
Our research led us to define three major hurdles in the implementation of the policy: Unawareness among people and a tendency to take medical advice lightly. Vested interests of pharmacists, taking advantage of consumer’s unawareness. Lack of strict punishment, fines or cancellation of licenses
India is often described as a land of diverse cultures, languages, religions, landscapes, and traditions.
Indeed, India’s vast diversity presents unique challenges and opportunities when it comes to policy-making and implementation. Given India’s federal structure, effective policy implementation often requires coordination between the central government and state governments. Harmonizing policies across different states while accommodating local needs and priorities can be a complex task.
Mandatory participation can sometimes be viewed as coercive or restrictive, particularly if citizens feel that their voices are not adequately heard in the legislative process.
Theory Of Change and Effective Decision-Making: Understanding human behaviour helps individuals and organizations make better decisions. By knowing what motivates people and how they are likely to respond to different incentives, decision-makers can design strategies and policies that are more likely to achieve desired outcomes.
Keeping the above in mind our team comprising of Rama Rao Damerla, a Researcher in Cancer Genomics and Arunima Singh a keen observer of human behaviour, delved into the challenges faced by THE REGULATION OF THE SALE OF SCHEDULE-H DRUGS BILL 2020, through proposing bill preservation — ON ABDM PORTAL, a UCS approach (Unified Central Sytems approach).
The Schedule H1 notification of the Government of India on Aug 30, 2013, as an amendment to the Drugs and Cosmetics Rules of 1945, has come into force from Mar 1, 2014. This schedule imposes certain conditions in the dispensing of listed medicines, which are somewhat midway between Schedule H (that stipulates retail dispensing only against a valid prescription) and Schedule X (that stipulates prescription in duplicate, separate license requirements and meticulous storage and dispensing records). This schedule has been anticipated for some time but now that it is in force, needs wide publicity and a critical look, from all physicians and healthcare providers in general and the community of pharmacologists and pharmacists in particular.
A unified portal
The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap among different stakeholders of the Healthcare ecosystem through digital highways.
Will the UCS approach work in dampening rampant OTC sales of antibiotics? The answer to this probably lies at The Indian School of Public Policy (ISPP), where we are speculating on an awareness campaign that must be tackled at the grassroots level through multiple interventions. There is a lack of a centralized form of data that covers people/general public’s behaviours, specifically, people’s views and attitudes on self-medication. A multi-faceted and multi-skilled team of experts is required to design a non-biased approach to any policy-based solution. Different cultures and different geographical regions in India have different issues which hamper policy-making at a broader level.
Influence and Persuasion: Understanding human behaviour allows individuals and organizations to influence and persuade others more effectively. By knowing what drives people’s actions and decision-making processes, individuals can tailor their messages and appeals to resonate with their target audience.
Proposing a voluntary eco-system to store data and to ensure that a holistic communication system is built between all stakeholders, which would address issues affecting the distribution and safe consumption of Schedule H Drugs. The well-being of society at large can be addressed within the first 5 years of system implementation as all medical records would be streamlined and a comprehensive portal with personalised health care support can be designed. The expected outcome of the eco-system is a unified medical service system bridging the gap between public and private medical suppliers, practitioners and corporations, curbing illegal hoarding and selling of schedule H drugs and contributing to accessibility and improved immunity and general well-being.
A Balanced Approach:
- Looking into people’s attitudes that elicit behaviours like self-medication despite being aware of mandates and laws, we found present bias in conjunction with Temporal Discounting Bias at the forefront, with quick gratification taking precedence over considering long-term effects.
- Peer pressure or social influence (Social norms) plays a significant role in influencing people’s behaviours, even if detrimental.
- Furthermore, optimism bias leads people to believe they will not have to face consequences themselves, resulting in them again choosing the quicker path.
- We found that methodologies that work to build people’s trust in authority result in voluntary compliance which tends to work better than enforced compliance.
Implementing, and evaluating social interventions by systematically mapping out the logic of how change is expected to happen. It encourages a holistic and evidence-based approach to driving meaningful and sustainable impact.
Community antibiotic stewardship is the new watchword.
A focus on non-prescription antimicrobial sales is essential to curtail antibiotic resistance. A three-pronged intervention strategy will reap rewards: health education to the general public and the pharmacists about the personal and societal perils of antibiotic resistance, the factors that cause it and lastly, ranking and recognizing pharmacies publicly based on their sale of prescription medication only. Strategies that lean too heavily solely on professional education or punitive damages are unlikely to result in large-scale or long-lasting improvement.
We conclude that it is the need of the hour for the government to consider pharmacies as a significant factor in antibiotic resistance and plan for specific educational measures to raise awareness of the causes of antibiotic resistance. It would also be prudent to restrict the sale of higher antibiotics, similar to Schedule X medications. Primary care physicians will need to stand in the gap created to fill the healthcare needs of our population.
Transitioning from a public to a republic system involves a shift in the structure and principles of governance. Navigating these complexities requires policymakers to adopt an inclusive and participatory approach, taking into account the perspectives and experiences of all stakeholders. It also underscores the importance of flexibility and adaptability in policy design to accommodate India’s dynamic and diverse landscape.
Collaborating with industry peers, cybersecurity experts, and government agencies to share threat intelligence and best practices for combating cyber threats in the healthcare sector is also critical to ensure success. Security of unified medical health systems and mitigating the risk of data breaches is essential to continuously monitor and adapt security measures to address evolving threats in the healthcare landscape.
“Till Death Do Us Part” takes on a new significance when viewed through the lens of the public health system. Overall, the transition from a public to a republic system represents a fundamental change in the way a country is governed, with a greater emphasis on democratic principles, representation and accountability to the people. It is often a complex and multifaceted process that can shape the trajectory of a nation for years to come. In Service of the Republic” Vijay Kelkar and Ajay Shah delve into the issues of government intervention and policy failures in India. The authors argue that societies that value individual freedom and free markets are more prosperous. Let us ensure that debates do not result in debacles, but instead lead us towards holistic solutions for a better tomorrow.
Disclaimer: All creatives are speculative | All rights reserved — ISPP ‘24
UTKARSHA M. | Design Thinker | Creator — A desire to understand the world and to improve it always remains at the core. As I speculate and design, my liberty of self-expression is in direct correlation to my existence and knowledge. https://www.utkarshaofficial.com/
