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EDITORIAL COMMENTARY
Year : 2019  |  Volume : 65  |  Issue : 3  |  Page : 132-133

‘Shining a light on invisibles’: Specific learning disabilities and Universal Health Coverage


World Health Organization India, New Delhi, India

Date of Web Publication18-Jul-2019

Correspondence Address:
C Lahariya
World Health Organization India, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_95_19

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How to cite this article:
Lahariya C. ‘Shining a light on invisibles’: Specific learning disabilities and Universal Health Coverage. J Postgrad Med 2019;65:132-3

How to cite this URL:
Lahariya C. ‘Shining a light on invisibles’: Specific learning disabilities and Universal Health Coverage. J Postgrad Med [serial online] 2019 [cited 2019 Nov 13];65:132-3. Available from: http://www.jpgmonline.com/text.asp?2019/65/3/132/262996




The existing inequities in availability, accessibility, and affordability of health services, arguably, gave a boost to the idea and global discourse on Universal Health Coverage (UHC).[1] The need for addressing various types of inequities in health services has been widely recognized and accepted. India's National Health Policy (NHP) 2017 has its goal fully aligned to UHC with equity as one of the key principles.[2] The attention on UHC and Sustainable Development Goals (SDGs), along with National Health Mission (NHM) and now Ayushman Bharat Program (ABP) in India, provides converging opportunities to tackle inequities in health services use and improve health outcomes.[1],[3],[4] In India- at macro level- there are intents to re-design health systems to address the triple burden of communicable, non-communicable diseases as well as long existing challenges in maternal and child health.[3] Moreover, the emerging challenges such as injuries and mental health are getting the rightful attention.[3] Though the situation is better than ever, there are population groups such as those affected with Specific Learning Disabilities (SpLD), whose health needs merit higher policy and programmatic attention.

Available evidence indicates that the burden of SpLD in India ranges from 5-15% of school-going children.[5] The SpLDs have received insufficient attention of health policy makers due to a combination of factors i.e. the need for multi-sectoral interventions, limited clarity on roles and responsibilities, and lack of actionable data, amongst others.

This issue of the journal carries an important research article assessing economic burden of SpLD.[6] The cost analyses in health sector, though much desired and needed, are not commonly conducted in India.[7] Therefore, such evidence could prove valuable for advocacy, policy decision, investment on health and related social provision by the government. The paper has a few limitations, which authors have duly listed.[6] The limitation such as use of non-standardized methods and children studying in English medium private schools prevent the generalizability of the findings. Having said that, this research can be supplemented by additional scientifically robust research on different population which can build a body for evidence for Indian settings.

When making a case for increasing access to health services for all populations at affordable cost (the UHC goal), the evidence plays a vital role.[8] Much of the progress in areas of health services for persons with disabilities and for mental health in India, can be attributed to increased evidence-based advocacy by different stakeholders.

SpLDs need multi-sectoral and multi-dimensional interventions i.e., generating awareness, introducing language development as mandatory part of pre- and primary education; and professionals and personnel (psychologists and teachers), specifically trained in the field of SpLD. Clearly, there is need for increased coordination between different departments such as health, education and women and child development. A national policy for SpLD can facilitate this process and the work can be supported by research and evidence focused on interventions and dynamic assessment tools as well as cost studies.

Some of the work in this area is already in progress. The government of India had launched the Rashtriya Bal Swasthya Karyakram (RBSK) focused on provision of health services for disabilities including SpLDs for all children up to 18 years of age.[9] However, as to with other government initiatives and health program, the coverage under this program is only to a small proportion of target population. Many potential beneficiaries are not aware about the program and the remaining are deterred by distance from health facilities, quality of services and the out-of-pocket expenditure (OOPE) associated with use of services. The ABP in India has components for stronger primary healthcare through health and wellness centers (HWCs), and provides secondary and tertiary level health services through Pradhan Mantri Jan Arogya Yojana (PMJAY).[3] It will be important at this stage that the health needs of children with SpLDs are fully covered by two initiatives under ABP. Alongside, the complementary interventions are needed under 'Sarv Shikha Abhiyan' which includes training the teachers and to have a resource room for children with SpLD. HWC and Angan Wadi Centres (AWCs) would have important role in this process.

Another important development has been the inclusion of SpLDs in the Rights of Persons With Disability (RPWD-2016) Act.[10] However, more is needed for India including a medium to long term vision, a multi-sectoral action plan, various cadre of trained human resources and sufficient financial allocation for these initiatives. Considering the NHP 2017 has proposed to increase Government spending on health from existing 1.15% to 2.5% of gross domestic product (GDP) by 2025, the additional resources can very well be used for strengthening provision of services for conditions uncovered or insufficiently covered, and addressing inequities.[2] The Children with Specific Learning Disabilities (Identification and Support in Education) Bill was till last sitting of 16th Lok Sabha in Feb 2019 pending approval.[11] The draft bill had proposed to identify and support the children with SpLD in education and highlighted the need for special facilities in educational institutions, setting up detection and remediation centers and guidelines for certification of children with SpLDs. Considering that The Mental Health Care Act (MHCA) of 2017 has largely succeeded in placing services for mental health conditions on the forefront,[12] Relevance of the proposed draft bill cannot be over-emphasized.

Improving health outcomes and reducing inequities are desired from health systems in all countries and there is definitive role of evidence and implementation research in this process. Considering that there is a time lag between availability of evidence and policy interventions, in India and in most low and middle-income countries (LMICs), the researchers need to indeed think well ahead of time. In the journey towards UHC, attention on equity and services for special and marginalized population should never be lost. This is possible through broader stakeholder collaboration, government leadership and evidence provided by academic community.

Disclaimer

Author is a staff member of the World Health Organization (WHO). The views expressed in this article are personal, and do not necessarily represent the decisions, policy, or views of WHO.



 
 :: References Top

1.
Rodney AM, Hill PS. Achieving equity within universal health coverage: A narrative review of progress and resources for measuring success. Int J Equity Health 2014;13:72.  Back to cited text no. 1
    
2.
Govt of India. National Health Policy of India 2017. Nirman Bhawan, New Delhi: MoHFW; 2017. p. 4-29.  Back to cited text no. 2
    
3.
Lahariya C. 'Ayushman Bharat' program and universal health coverage in India. Indian Pediatr 2018;55:495-506.  Back to cited text no. 3
    
4.
Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, et al. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ 2017;95:537-9.  Back to cited text no. 4
    
5.
Karande S, Bhosrekar K, Kulkarni M, Thakker A. Health-related quality of life of children with newly diagnosed specific learning disability. J Trop Pediatr 2009;55:160-9.  Back to cited text no. 5
    
6.
Karande S, D'souza S, Gogtay N, Shiledar M, Sholapurwala R. Economic burden of specific learning disability: A prevalence-based cost of illness study of its direct, indirect, and intangible costs. J Postgrad Med 2019;65:152-9.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Lahariya C. Taking the road less traveled: Economic analyses for advancing universal health coverage. J Postgrad Med 2018;64:134-5.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Lahariya C, Menabde N. Evidence to implementation continuum for universal health coverage. Lancet Infect Dis 2015;3:250-1.  Back to cited text no. 8
    
9.
Govt of India. Rashtriya Bal Swasthya Karyakram. Nirman Bhawan, New Delhi Ministry of Health and Family Welfare; 2012. Available from: https://rbsk.gov.in. [Last accessed on 2019 Feb 12; 15:30 hrs IST].  Back to cited text no. 9
    
10.
Govt. of India. Rights of Persons with Disability Act 2016. New Delhi: Ministry of Social Justice and Empowerment; 2016. Available from: http://disabilityaffairs.gov.in/upload/uploadfiles/files/RPWD%20ACT%202016.pdf. [Last accessed on 2019 Feb12; 15:30 hrs IST].  Back to cited text no. 10
    
11.
The Govt. of India. The Children with Specific Learning Disabilities (Identification and Support in Education) Bill; 2016. Available from: http://164.100.47.4/billstexts/rsbilltexts/AsIntroduced/children-24317-E.pdf. [Last accessed on 2019 Feb 12; 15:30 hrs IST].  Back to cited text no. 11
    
12.
Lahariya C. Strengthen mental health services for universal health coverage in India. J Postgrad Med 2018;64:7-9.  Back to cited text no. 12
[PUBMED]  [Full text]  




 

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