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The Sustainable Development Goals (SDGs) were designed as inclusive and just and intend to leave no one behind. Therefore, the efforts must be rooted in human rights principles. While Goal 3 ensures healthy lives and promote wellbeing for al, Goal 10 commits to reduce inequality. Since health and equality are connected with all other goals, it is logical to address the health needs of the marginalised groups to make the efforts inclusive.
In India, at the governmental level, institutional arrangements have been well placed to coordinate the implementation of the SDGs. The National Institution for Transforming India (NITI) Aayog, formerly the Planning Commission of India, in collaboration with other Ministries and their selected departments, oversee coordination and implementation activities of the SDGs at national level.
NITI Ayog is a think tank of the government of India focused on development issues. It has mapped each SDG for individual Ministries and is ensuring coordination among states. As a baseline initiative, in 2016 it organised a consultation on SDGs with representatives from Ministries, bureaucrats, INGOs, policy research institutes (PRIs), and Civil Society Organisations(CSOs).
Despite efforts through institutional mechanisms, behavioural aspects of service providers- including negligence in service provision at community-level health centres- remain a critical issue. I participated in a discussion on the issues regarding local healthcare access, where 25 NGOs working in the health field at community-level pointed out a few major challenges they have observed. They emphasized that although there are health facilities, people are not able to access health care for many reasons, including non-functional health organisations and indifferent attitude from the service providers. The list of problems to access health services at village-level outlined below is based on the discussion with these 25 NGOs during a workshop on 15 July 2016 with IIDS and PACS India:
- Derogatory remarks made leading to social exclusion and discrimination
- Immunization services provided selectively
- Facilities of RSBY card denied by the hospital on the basis of documents
- Unable to use facilities of RSBY card
- ICDS centres not providing health services
- Hospitals refused to provide services
- Community suffered from an unknown epidemic
- Money demanded by personnel for public health services
- Problem of water-borne diseases
The Ministry of Statistics and Programme Implementation (MSPI) has worked on developing SDGs indicators for India. This MSPI has responsibility for creating the data base to monitor the progress of the implementation of the SDGs. The involvement of various Ministries with cross-cutting influence has strengthened institutional arrangements, and State governments formulate state plans based on the SDGs.
Monitoring and evaluating the SDGs is critical to understand the strategies and operation of programmes. The International Institute for Population Sciences and the National Institute of Health and Family Welfare engage in the monitoring and evaluation of policies and programmes through teaching research and action.
In my research I found that only a few PRIs provide direct policy input to policymakers through different communication channels. Policy institutes such as the National Institute of Health and Family Welfare and Population Research Centres are also involved in advocacy and in implementing health programs. PRIs such as the International Institute for Population Sciences, Central Bureau of Health Information, Anusandhan Trust, and Centre for Equity for Health and Allied Themes (CEHAT) are involved in development activities such as providing medical education, empowering local health service providers and beneficiaries, changing health seeking behaviours and networking along with main research and policy engagement activities.
For India, achieving the SDGs calls for building strong partnerships among different stakeholders, considering their expertise and proficiency for the implementation of all SDGs, particularly those focused on health. In India, ensuring ‘health for all’ is a constitutional obligation of the State. Different institutional arrangements are put in place to facilitate policy integration. However, there is a need of innovation in existing institutional arrangements to promote and monitor the implementation of health SDGs to ensure the achievement of periodic goals set by the government.