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People & Their Problems
New Delhi, 23 May 2008
Improve Patient
Care
UPGRADE GOVT
HOSPITALS
By Dr M.M. Kapur
Air, water and food are the elements of life and health.
Their quality and availability impact our body machine.
The bacterial viral and chemical contaminants 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 as is stated in the
Directive Principals of our Constitution. That sees nutrition and public
health measures as the means towards these objectives
The rise in population today has increased the number
of ‘aam aadmis’ seeking cure of
communicable and non-communicable diseases. This is the burden that the
Government has to undertake to facilitate the means of treatment and cure.
So far no increase in the facilities is seen in the public sector.
Shockingly, today only 14 per cent of the population has
health cover while the rest have to use their own meager resources. Poverty and
under-nutrition (UNN) are linked as are UNN and impaired immune response
leading to infection which requires medical and surgical treatment.
India's wealth is its Human Capital
of a billion strong. And only a part of this resource has led the economy to a
boom through its primal energy and motivation. It would be good economics if
more aam aadmis in good
health could participate in this effort.
Significantly, the infrastructure for curative care is
already in place. There are 22371 Primary Health Centres, 4400 District
hospitals and 170 medical colleges. However, low investments in health have led
to poor, uneven health systems and care across the country. The Draft health
policy has identified Primary Health Centres as the focus of attention. I write
to highlight the urgent need to resource the public sector hospitals to provide
succor to the aam aadmi in rural and
urban India
Sadly, a significant number of public sector hospital
lack adequate manpower and supplies for cure/care services. This is also true
for medical school teaching hospitals. Thus, the rural and urban poor have to
seek services of the urban private sector hospitals at great cost ( for
travel and hospital charges) This resource input will convert these public
sector assets from low to high performing assets
Clearly, an alternate strategy is required to meet the needs
of the aam aadmi today and in the
future. All Primary Heath Centres should be staffed with doctors who should be
provided with a laptop for efficient data recording of disorders in a uniform
manner. This will not only introduce standardisation of data input and
outcomes data but will also insure accountability
The Primary Health Centre needs to be in contact
with the District hospital for referral. Funds for subsidised travel to
district hospitals should be made available. This will also install a hub and
spoke relationship in this part of the health system. The District hospital
also need to be fully staffed and its equipment upgraded to meet the hub
function for the district morbidity burden.
Also, PC workstations for data recording of patients and
their progress should be made available. This will insure storage and retrieval
for review. The workstation should be linked to library services for backup
information support when needed. Software too can be evolved for treatment
protocols for prevalent disorders. A strong viable referral system between
District hospitals and the teaching hospital specialty services needs to be in
place
All these new interventions may require inputs in excess of
the 2 per cent allocated. These inputs are well deserved to improve the working
conditions and quality of patient care. They are possible in the current
revenue position. The improved public health care system will impact
the quality of the private sector health care system and the aam aadmi and the "not so" aam aadmi will both gain
The success of the economy expressed in metric measures of
Gross Domestic Produce (GDP) rate of growth and health statistics hide
more than they reveal. After 60 years of Independence
it is high time that we use Genuine Progress Indicators (GPI) for our policy
guidance towards sustainability. These indicators would look upon all projects
and their gross profits and balance them against the costs.
Namely, financial inputs, natural resources input,
environmental damage costs, pollution of air, water and food and the cost
of health damage to the population. The net profit is obtained after
subtraction of these costs
In sum, if all the costs of these elements are computed
honestly the projects may show low, nil or negative profits. Needless to say,
the sustainability of these projects requires ingenuity in cutting these
costs to improve the net profit. This will lead to long term benefit to
the aam aadmi and the country. ---
INFA
(Copyright, India News & Feature Alliance)
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