Book review

Fashioning the healthcare superstructure

By
Randeep Wadehra

Challenges of healthcare in India by Dr. R. Kumar
Deep & Deep, N. Delhi. Pages: xxx+314. Price: Rs. 980/-

Although the economy is slowing down owing to global recession India’s healthcare superstructure is undergoing a makeover, although right now it does not present a pretty picture. Kumar points out that India records the largest number of oral cancer patients and diabetics in the world. With 5.1 million HIV/AIDS cases (likely to increase threefold by 2015) it is second only to South Africa. With a world population share of 16.5% it contributes 20% of the diseases. It fares no better when compared to Sri Lanka and even Bangladesh. Against Sri Lanka’s infant mortality rate of only 8 per thousand India’s is 68! The under-5 mortality rate in India is 87 per thousand compared to Bangladesh’s 69. The WHO attributes 60% of all deaths in India to chronic diseases.

On the infrastructure front too the country’s record does not elicit cheer. For example, it has 1.5 beds per thousand patients as compared to 4.3 beds in China. There are only 59 doctors per 100,000 of the population in India compared to 200 doctors in developed countries.

To add to the dismal scenario it has been pointed out that:

• 80% of general practitioners that practice allopathic care are not properly trained. A survey reports that only 37% of those performing as doctors have MBBS or higher professional degrees! The quality of nurses’ training is poor too.

• 73% of these practitioners use cost as their first point of reference when prescribing medicine.

• 75% are aware of the existence of Public Health Centres in their area but do not have information on who are the health workers there.

• Only 29% of health workers know how to make Oral Rehydration solution to treat diarrhea but almost all of them handle that condition regularly, thus adding to the morbidity rate.

Add to these the dismal performance of governments – both in the states and the centre in the field of general governance (the latest example is the outbreak of the killer hepatitis being attributed by media reports to callous official negligence towards the use of recycled syringes, among other things) as well as in such specialized areas as building of infrastructure, developing & managing human resources etc – and the healthcare situation in India begins to appear quite daunting. The National Health Policy 2002 takes cognizance of the fact that ground realities have undergone great changes since the last policy was formed in 1983. The NHP 1983’s attempts to systemize the healthcare network had met with limited success. Primary health centres and skilled health workers as well as volunteers – inadequate both qualitatively and quantitatively – have not been able to satisfactorily cover vulnerable sections of the population. Rural areas have been the worst affected. As Kumar notes, access to, and benefits from, the public health system have been very uneven between the better endowed and the have-nots – inordinately skewed in favour of the former. The NHP 2002 has come up with a comprehensive roadmap to a healthier India by ensuring better access to healthcare for the poor.

But, if this roadmap is to lead us anywhere, there is a need for massive resource mobilization. We need large numbers of skilled doctors, nurses and paramedics. Hospitals, clinics and primary health centres should be placed within reach of all. In order to make medical services affordable various options including selective subsidies and health insurance need to be considered. The author has examined the role – both present and future – of the private sector too, which, he envisages, would become increasingly prominent with the passage of time. But there is a need for putting higher cost of private healthcare in perspective. Would there be spin-offs to the advantage of the disadvantaged? The book mentions universal health insurance, but who will foot the bill, and how? Can the income from medical tourism be gainfully reinvested in public health services? Most important, is there a national will to make quality healthcare available to all at affordable costs? In the chapter on futuristic approach Kumar appears to be upbeat with r

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