Political Diary

New Delhi, 17 November 2012

Public Health in ICU

GOVT: MAUT KE SAUDGAR, KYA?

By Poonam I Kaushish

Health is wealth, is an old adage. Alas! In India public health is in the ICU while the Government bandies cut throat monetary imperatives and growth figures to assert ‘all is well’! Raising a moot point: Is the aam aadmi’s well-being merely about statistics?  Or is the Government becoming a maut ka saudagar? With the Government averring, Aacha who mar gaya kya?

Trust maverick and blunt Union Rural Development Minister Jairam Ramesh to spill the beans:  “We all know that our health system has collapsed due to his Government's failure to extend a social safety net for the poor whereby 70 per cent of health spending was out of people's pockets leading to rural indebtedness.

Worse, he made no bones about the fact that we have horribly lacked on investment on health, sanitation, nutrition. Reeling out hard World Health Organization figures, said he, “spending in 2010 was four per cent of gross domestic product ---- less than many African countries or Afghanistan and a fraction of developed nations, which spend around 10 per cent. Notwithstanding Prime Minister Manmohan Singh’s promise earlier this month that health spending would triple in the Twelfth Five-Year Plan adopted by his Government.

“Nearly 65% of India’s 1.2 billion people the country lacked basic sanitation”, he added for good measure. His solution to avert an impending sanitary crisis? Build toilets instead of temples. Undeniably, he had a point. Arguably, consistent public under-investment in health, barely 1% of GDP , is a major reason why health care is so unaffordable for so many people.

Think. According to the 2011 census, 59.1% of urban homes don’t have a toilet, which increases to 80% in rural households. Further, field studies indicate that even the use of the existing toilets in both rural and urban areas is very low as the aam aadmi prefers open defecation.

Jharkhand tops the list with as high as 77% of homes having no toilet facilities, while the figure is 76.6% for Orissa and 75.8% in Bihar. All three are among India’s poorest states with huge populations that live on less than Rs 50/- a day

This is not all.  Two-thirds of Indian homes have no drinking water facility from a treated tap source, and four-fifths are devoid of closed drainage connectivity for discharge of wastewater. Over 36% households have to walk more than half a km to get water for their families and cattle in rural areas. And 55% of them are forced to bathe in the open.

The situation is pathetic in drought-prone areas which face perennial water shortage, UP’s Bundelkhand region, Rajasthan, Bihar, Jharkhand and Orissa In urban areas the figure is marginally lower.

Add to this the widespread practice of manual scavenging. Over 1% of all households in both the urban as well as rural areas continue to rely even today on this practice. In over 13 lakh toilets, the waste is flushed into open drains and cleaned by humans. Around 25 crore households (12 lakh in rural and 13 lakh in urban areas) depend on manual scavengers to remove night soil from the toilets

Shockingly, there is only one doctor for 28 villages with over 20,000 people. When he is away on call all is left to God. Over 230 million of the rural poor are mal-nourished accounting for 50% child deaths and another 43% are underweight, according to a UNICEF report. Also, nearly 136,000 maternal deaths out of 30 million pregnancies occur annually and 9 out of 10 pregnant women aged between 15 and 49 years suffer from mal-nutrition and anemia which causes 20% of infant mortality.

Also, while the country is still struggling to bring infectious diseases under control, the incidence of non-communicable diseases is also on the rise. Heart diseases, diabetes, and cancer are expected to show a combined average decadal growth of 47% in future. This will add to the demand for diagnostic, therapeutic and research facilities in tertiary care specialties. 

In 2011, India had 62.4 million people with type 2 diabetes, compared with 50.8 million the previous year, according to the International Diabetes Federation (IDF) and the Madras Diabetes Research Foundation. By 2030, the IDF predicts, India will have 100 million people with diabetes.

Most scandalously, a study done by the Global Antibiotic Resistance Partnership-India Working Group and the Centre for Disease Dynamics, Economics and Policy found the infections rate of Indian hospitals wards and intensive care units is five times more than in the rest of the world. Of which some diseases are not only difficult but also impossible to treat leading to death.

Where do we go from here? It all depends on our netagan. Perhaps it is time for the Government to realize that economic reform without reforms in the social sectors can become a bane in itself. In fact, the Planning Commission last year set up a High Level Expert Group (HLEG) on Universal Health Coverage (UHC) which recommended that health-care should be available to all citizens with a smart card and be cashless at the point of service, a combination of preventive, promotive, curative and rehabilitative care through a package of primary, secondary and tertiary services.

Calling for a step up in public investment in health to reach 2.5% of GDP by the end of the 12 Five Year Plan, the HLEG argued that a strengthened public sector must be the bedrock of reforms. But how to deal with the fact that public facilities themselves ignore public health, often lack adequate staff and equipment, and treat patients with scant respect?

What next? Clearly, India needs more investment which must be backed by the creation of a public health cadre, the recognition of a three year medical qualification in order to increase the availability of qualified professionals, and more staff at the lowest level. And a strong set of management reforms to improve quality and performance of public facilities must be urgently implemented.

WE need to integrate primary health centres with district hospitals to allow for continuity of care. Child care and women’s care services should be strengthened by enhancing the availability of trained professionals at primary care clinics and district hospitals. Nodal Government hospitals should be identifies and equipped with strong emergency services for timely critical care along-with the number of medical and paramedical colleges be increased in rural and poor areas.

It is now imperative for India to rethink its strategies and approaches to safeguard public health infrastructure, constitute a public health policy, establish fresh priorities, improve service delivery in public hospitals, rail and road management and establish close links between research, policy and service; with people at the centre of social development.

The Government can no longer bury its head in the sand. Ministerial conferences and Central directives to States will not do. Our netagan need  to respect human life. Time is far gone to aver, Kohi baat nahi, ek aur mar gaya! -----INFA

(Copyright, India News and Feature Alliance)