On Oct. 10, the government of India announced an ambitious new policy to provide universal mental health services. The policy, the country’s first on mental health, is admirable for its focus on the needs of the country’s poor, on lifting widespread stigma around mental health disorders and on preventing suicide. A bill to make the new policy law is awaiting approval by Parliament.

India has the highest number of suicides in the world. According to the World Health Organization, of 804,000 suicides recorded worldwide in 2012, 258,000 were in India. Indian youths between 15 and 29 years old kill themselves at a rate of 35.5 deaths per 100,000 — the highest in the world — and suicide has surpassed maternal mortality as the leading cause of death of young Indian women. A report from Human Rights Watch released in December exposed the horrific conditions in institutions where too many Indian women with mental and intellectual disabilities are confined, many against their will, and where some are subject to physical and sexual abuse and electric-shock therapy.

Unfortunately, the new policy may be almost impossible to translate into action. On Dec. 23, the government ordered cuts in the health budget of nearly 20 percent, from $5 billion to a little more than $4 billion. Given other serious health needs, the “fresh funds” promised by the government to pay for new mental health services and train qualified mental-health professionals are unlikely to materialize.

This is a pity. There is only one psychiatrist for every 343,000 Indians currently, too few to reduce the shameful suicide rate. Among other problems are depression, acute economic insecurity, anxiety among youths over educational success, and distress among young women caught in a bind between the opportunities of a changing India and pressure from traditionally minded families to marry.

Unless Prime Minister Narendra Modi reverses course, his impressive new policies will end up exactly like the development projects of the past administrations he excoriated during his campaign: high-minded pronouncements on paper with zero delivery in practice.

http://www.nytimes.com/2014/12/31/opinion/indias-mental-health-crisis.html?_r=0

The Union government plans to introduce a health cess to develop primary or basic healthcare infrastructure across the country.

This is mentioned in the National Health Policy 2015 draft put up on the ministry of health website on Wednesday for suggestions from public.

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The draft policy suggests the cess may be drawn from general taxation as well as “specific commodity taxes” such as those on tobacco and alcohol. Some industries that have a negative impact on natural habitats or result in displacement, too, may be asked to pay health cess.

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Public health experts, though, were unhappy with the draft policy saying it is vague on contentious issues such as the role of private healthcare providers and ways to fund healthcare for economically backward.

“The document sounds good, but it doesn’t emphasize commitment. For instance, it says the government will aim to reduce the common man’s out-of-pocket expenditure but doesn’t say by how much and by when,” said Dr Abhay Shukla of Jan Swasathya Abhiyan, a national coalition of NGOs in healthcare sector. “Considering that the Union government slashed the health budget last week, one wonders if this document is a mere decorative piece.”

National Health Policy Draft 2015 comes up almost 12 years after the last such plan, citing three main reasons—changing health needs, government’s inadequate healthcare expenditure and high out-of-pocket expenditure by people.

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While non-communicable diseases account for 39.1% of India’s ill-health burden, the draft points out that conditions such as cancer and heart problems are not covered too well in the public health system. Communicable diseases account for 24% of India’s disease burden. Most of them, almost 75%, too, are not part of any existing national programmes.

Noting that families are driven to bankruptcy by healthcare expenditure, the draft said around 6.9% of the household monthly per capita expenditure in rural areas and 5.5% in urban areas is spent on healthcare.

http://timesofindia.indiatimes.com/india/Centre-plans-a-cess-for-basic-healthcare/articleshow/45709245.cms

Some 503,142 toilets have been installed in households across India since October, when Prime Minister Narendra Modi first announced Clean India Mission, a sanitation campaign that aims to eliminate open defecation by 2019.

It’s an ambitious and necessary target. According to the World Health Organization, more than 620 million people—about half India’s population—relieve themselves in the open, a practice with serious negative impacts on public health, safety, and the economy.

India has a lot more to overcome than just a mass installation of toilets and latrines. In a recent survey of 3,200 rural households by Delhi-based Research Institute for Compassionate Economics, half of respondents who didn’t have a toilet believed that “defecating in the open is the same or better for health than using a latrine.” Most people who owned a government-constructed latrine still chose to use the outdoors. Some end up using their loo for storage or extra living space.

Modi’s administration announced Wednesday that sanitary inspectors will soon be going door-to-door to “check and verify the use of toilets,” using tablets or phones to publish results online in “real time,” according to a press release. “Earlier, the monitoring was done only about the construction of toilets, but now the actual use of toilets will be ascertained.”

That’s a lot of resources devoted to an approach with little in the way of precedent. Could it really work?

John Oldfield, CEO of WASH Advocates, a nonprofit that advocates for safe drinking water and sanitation, stresses there’s no silver bullet when it comes to solving a sanitation crisis. “Most importantly, I think one needs to take a more holistic look at this problem,” he says. “Change has to be demand-driven. People have to want to use toilets, not have them forced upon them.”

Oldfield suggests that inspections might be useful in that they might pressure or even “shame” citizens into using their toilets. “It could sort of be like neighbors spying on each other to see who’s defecating out in the open,” he says.

Others have warned that public outreach and educational campaigns should figure much more prominently in Clean India’s strategy. Only 8 percent of the $30 billion dedicated to the mission is marked for “information, education and communication.”

“I would spend at least half of the money on IEC,” Santosh Mehrotra, an economics professor at New Delhi’s Jawaharlal Nehru University, told the Wall Street Journal.

http://www.citylab.com/design/2015/01/indias-government-will-now-check-and-verify-the-use-of-toilets/384174/