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न्यूज क्लिपिंग्स् | Healing a nation by Patralekha Chatterjee

Healing a nation by Patralekha Chatterjee

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published Published on Dec 30, 2009   modified Modified on Dec 30, 2009


Copenhagen showed how fast and far India has traveled geo-politically. The same, alas, cannot be said about the health of the nation. On the international stage, India’s relentless focus on equity made us proud. The time has come to apply that principle at home.

India’s ailing health delivery system is viewed as a worthy but dull topic on a normal day in a typical newsroom in the country. Typically, such neglected issues become headline-grabbers if a crisis strikes. In 2009, that crisis was H1N1, popularly known as swine flu. It turned the harsh glare of public scrutiny on the many cracks and faultiness in our healthcare system — the lack of trained personnel, the lack of capacity in our laboratories and so on. By mid-December, swine flu had claimed more than 700 lives within India. In a country of a billion-plus and competing tragedies, however, this is viewed as only one among the many challenges confronting policy-makers and health workers. India has more than 2 million people living with HIV and AIDS, though recent official data points to declining new infections; there were 1.5 million laboratory-confirmed malaria cases in 2008; tuberculosis accounts for around 3,30,000 deaths every year and, in Uttar Pradesh alone, at least 560 people have died of Japanese Encephalitis in 2009.

As a new year and a new decade dawns, there are reasons to be depressed and reasons for hope. First, the depressing news. Quality healthcare remains inaccessible throughout the country despite the presence of a highly skilled and qualified medical workforce. Glaring disparities exist between regions, states, towns and villages and even within the same state. A few telling indicators cited by Prof. K. Srinath Reddy, president of the Public Health Foundation of India, at the Fourth Oxford India Business Forum in March this year are revealing — there are 0.2 hospital beds and 0.6 doctors per 1,000 people in rural India. For urban India, the corresponding figures are 3 and 3.4. India spends only 1.15 per cent of its GDP on health, one of the lowest expenditures in the world. Globally, our out-of-the-pocket spending on health remains one of the highest. All this is exacerbated by an acute shortage of health personnel — doctors, especially physicians, at district and sub-district levels, nurses, pharmacists, transfusion technologists, lab technicians, and paramedics. Unresolved and emerging public health concerns include persistent malnutrition, high levels of anemia in women and children, unsafe drinking water in several villages, poor maternal and child health, a pool of infectious diseases, alongside a surge in (chronic) non-communicable diseases.

Now, a few nuggets of good news: India is now the fifth-largest public funder of neglected disease research and development globally, with an investment of $3 billion in 2008, according to the recently-released G-Finder Survey by the George Institute for International Health, an Australian think tank. The driving force behind these investments are a handful of central government funding agencies: the Indian Council for Medical Research, the India Department of Biotechnology, the Department of Science and Technology and the Council of Scientific and Industrial Research.

The latest figures from Sample Registration System of the Registrar General of Census show some improvement in maternal and child health, though we are still far from achieving the National Rural Health Mission’s (NRHM) targets for 2012 of reducing the maternal mortality ratio to less than 100 per 1,00,000 live births, and infant mortality ratio to less than 30 per 1,000 live births.

In recent times, there has been a genuine effort in critical areas of the health sector. One important example is the focus on neonatal mortality which accounts for almost half of under-5 deaths in the country. While management of H1N1 situation was the highlight of the year, the government is also trying to give an innovative push to medical education, NRHM, Indian Systems of Medicine, the battle against HIV and AIDS, and medical research.

What needs to happen? Reduction of the glaring disparities in healthcare, tackling the human resource handicap and putting in place an effective regulatory system, are prime needs. Things are moving in some areas, but more medical colleges and doctors alone will not produce a healthier India. More attention needs to be given to continuous skill development of all cadres of health workers, standardised training as well as task shifting and task sharing. Secondly, ministries and departments need to talk to each other more often. Health outcomes are determined not only by what the health ministries do or not do. Other factors such as absence of good roads, electricity, telecommunication services, hugely impact health. India has a thriving pharmaceutical industry and generic majors. This advantage needs to be leveraged to give affordable medicines to all.

The last and most important word is accountability. Without this, all plans will remain just that. As I write, there is news that the Comptroller and Auditor General of India has slammed the NRHM for wasting crores of public money. In eight states, more than Rs 8 crores were spent procuring drugs which were not strictly necessary and in seven states, medical equipment worth over Rs 26 crores is lying unutilised, resulting in blockage of funds. We also know that seats in medical colleges are still being sold or even hawked to the highest bidder despite a Supreme Court order.

Continued tolerance of such a state of affairs is continuing the status quo. Time is running out. An influential emerging economy cannot afford to have millions of its people submerged in malnutrition, disease, a lack of basic sanitation or clean water.

Patralekha Chatterjee writes on development issues in India and emerging economies and can be reached at patralekha.chatterjee@gmail.com

 

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