The Planning Commission has called for comprehensive strategy to include participation of public, individual and community levels, increased expenditure by the Centre and States, inclusive approach encompassing Indian systems of medicines and public-private partnership mechanisms to ensure better health during the 11th Plan.

The Panel is for a comprehensive approach which encompasses individual health care, public health, sanitation, clean drinking water, access to food and knowledge about hygiene and feeding practice for better healthcare, according to its approach paper for the next Plan period.

``Energizing health systems involves additional government expenditure. The existing level of government expenditure on health in India is just under 1 per cent, which is unacceptably low, and effort should be made to increase the total expenditure at the Centre and the states to 2-3 per cent of GDP. This must be accompanied by innovative financing mechanisms like incentives to boost performance. The quality of publicly supplied healthcare depends on how healthcare providers are paid,'' it said.

The 11th Plan should experiment with different systems of private-public partnership, of which many examples already exist in some states. Studies across the country have shown that expenditure on healthcare is a primary cause of indebtedness. Due to inadequate and nonperforming public health infrastructure, the poor are forced to approach private practitioners who charge exorbitant fees. It is thus vital to ensure access to functioning public sector healthcare facilities.

"With concerted action including enabling pregnant women to have institutional deliveries and receive nutritional supplements; connecting PHCs and CHCs by all weather roads so that they can be reached quickly in emergencies; (accessibility to hospital should be measured in terms of travel time, not just distance from nearest PHC); providing home-based neo natal care including emergency life saving measures etc, we can be on track to reach the millennium development goals and for combating diseases by the end of the 11th Plan,'' the paper said.

To improve the primary health care system, the 11th Plan will first lay emphasis on integrated district health plans and second, on block specific health plans. The 11th Plan will recognise the feminine face of HIV and accord it the highest priority. The 11th Plan will continue to advocate fertility regulation through voluntary and informed consent. It will also address the special healthcare needs of the elderly, especially those who are economically and socially vulnerable.

"We also need to look at alternative approaches such as comprehensive risk pooling packages through the public system and through accredited private providers. This is possibly an area where multiple experiments need to be encouraged so that we can come to firmer conclusions about what model will work best,'' the Commission said.