Sunday Reading

New Delhi, 26 March 2009

Elections For Aam Aadmi

BETTER HEALTH SYSTEM, MORE VOTES

By Dr. Manmohan Kapur

A vibrant democracy will emerge in India when people at all levels participate fully. This is likely only when life and health conditions allow the aam aadmi to use his right with time and space to think and vote. This will not occur if urban and rural life conditions of the common man are under constant threat.

Air, water and food are the elements of life and health. Their quality and cost/availability impact our body machine. Poverty and under-nutrition (UNN) are linked. So are UNN and the impaired immune response leading to infection requiring medical and surgical treatment.

There is scientific data that the bacterial viral, chemical contaminants and inadequate nutrition are the cause of disease disability and death. The provision of safe water, food and air for all is a binding mandate for the government. It is so stated in the Directive Principles of our Constitution that sees nutrients and public health measures as the means towards these objectives

The rise in population has increased the number of aam aadmi seeking cure of both communicable and non-communicable diseases. This is the burden that the Government must undertake to provide means of treatment and cure. So far, no increase in volume and efficiency in facilities are seen in the public sector, where 80 per cent of our population can afford and seek care.  

Statistics reveal a dismal scenario: Half of the new born are underweight with 5.6 million childhood deaths in the first year of life; maternal mortality is second highest in the world; one-third of the world’s tuberculosis cases occur in India; 900,000 die each year from causes related to contaminated water and air and the new set of lifestyle disorder (cardiovascular + diabetes) are on the increase in the affluent.   

Indian health scenario in the hands of the corporate is increasingly seen as a growing industry currently worth US$ 35 billion and increasing to $135 billion by 2017. These facilities meet the demands of upper class and the insured in urban locations. Today only14 per cent of the population has health cover the rest have to use their own meager resources.

India's wealth is its Human Capital of a billion, only the healthy part of this resource has lead the economy to a boom through its primal energy and motivation.. It would be good economics if more of the aam aadmi in good health could participate and earn through this effort.

Primary Health Centers (PHC) are the delivery outlets for rural health care they provide walk-in clinics and pharmacies. The infrastructure for curative care is in place only in about 22371 PHCs, 4400 District hospitals and 170 Medical colleges.    

In 1983 the national health policy promised health care to all by 2000. However, the public expenditure in health has not kept peace with the GDP. In fact in absolute terms it has fallen from 3.3 per cent of the first plan period to 1.9 per cent of the seventh plan period. In this same period private sector spending in health was 1.5 times as much as that of the government.

Low investments in health have led to poor uneven health systems and care across the country. Inadequacies in this infrastructure need to be met to provide adequate services for the common man. The Draft health policy has identified PHCs as the focus of attention. I write to highlight the urgent need to provide resource for the public sector PHC’s so that they are enabled to restore the requisite services to the people in both rural and urban India

A significant number of public sector hospitals also lack adequate manpower and supplies for cure/care services. This is also true for medical school teaching hospitals. Thus, both the rural and urban poor have to seek services of the urban private sector hospitals at high costs, for travel and hospital charges. This resource inputs will convert these public sector assets from low to high performing assets.

In the context of Government’s administrative functioning, the prevalent approach is top-down. There is no avenue for feedback correction. This has been true for health care administration. Clearly, there is a need for change to a modern two-way communication between the PHC and District hospital and medical school hospitals.

This will enhance PHC care function and backup supply. It would also upgrade data storage on disease prevalence and the options available. The urgent need is for an intelligent responsive system. It is entirely possible that this may require a NGO/private/public partnership.

An alternate strategy is required to meet the needs of the aam aadmi of today and in the future. All PHCs be staffed (doctors) and with a laptop for efficient data recording of disorders in a uniform format. This will introduce standardization of data input and the outcome data will ensure accountability of the staff in service. The 22,000-odd PHCs would thus rightly be a live data source on disease prevalence and morbidity. 

Importantly, the PHCs need to be in contact with district hospital for referral and funds available for subsidized travel to get there. In effect this will also install a hub and spark a relationship in this part of the health system

Other than the PHCs, the district hospital too needs to be fully staffed and equipment upgraded to meet the hub function for the area’s morbidity burden. One member staff of the clinical department should be assigned for consultation with his/her counterpart in the PHC. This will help not only upgrade clinical services at the PHC but will identify patients that require transfer to the district hospital.

PC workstations for data recording of patients and their progress should be available in wards, duty room and OPD (out patient department). This will ensure storage and retrieval for review for patient care and assessment by supervision. No data is lost since workstations are available at all locations. More importantly, this will generate authentic health data.

Besides, the workstations could be linked to library services for backup information support and learning when needed by staff. This staff service will circumvent the knowledge isolation of the PHC staff. Moreover, software can be evolved for treatment protocols for prevalent disorders. Both these backups will help better quality of care service as well as job satisfaction.

To improve general and specialty service for complicated cases, a strong viable referral system between district and teaching hospitals needs to be in place. In addition, the advent of new therapeutic options can be introduced at any times. All these new interventions may require inputs in excess of the two per cent allocated. These inputs are well deserved to improve the working conditions and quality of patient care. They must have first priority in the current revenue position 

In fact the improved public health care system will impact the quality of private sector health care system through the introduction of standard data recording and accountability. The aam aadmi and the "not so" aam aadmi will both gain

All these services can be further augmented by the “Rural Health Mission” and other initiatives. And if this happens, the aam aadmi will undeniably see visible evidence of the success of the economy and democracy. All these initiatives will convert the low- performing assets to high-performing service units and restore confidence in the people.

In the developed world, and US in particular, stimulus packages for the economy focus on health and education investments as a means of reviving public confidence and return of the retail investor. In India, 60 years have come and gone since Independence and each day it is becoming more difficult to convince the aam aadmi that the actions of governance are working for him, and his salvation is round the corner.--INFA

(Copyright, India News and Feature Alliance)