Healthy citizens are the greatest assets any country can have. Are Indians healthy? Short answer is ‘No’. I would not go into the usual citing of statistics that conclusively prove that India is ranked below some poor nations when it comes to healthcare. Everyone, including the government, knows that. Even the Economic Survey (the annual report card which precedes the Union Budget each year) is not happy. It says and I quote: “Inadequacies in the existing health infrastructure have led to gaps in coverage and outreach services in rural areas.” The confession comes just after. “India’s position on health parameters compared even to some of its neighbours continues to be unsatisfactory.” We all know who our neighbours are!

The word ‘healthcare’ is probably not a misnomer but it might be one in the Indian context. Care is not available even for important events like child birth. Child mortality rates are high. Health becomes less important when lives are lost. Critics like Dr Rajendran (a practising surgeon) say that the national strategy lacks explicit measures to achieve broadly known goals. He point out, “Particular problems include the failure to integrate health services with wider economic and social development. We are short of nutritional support and proper sanitation…and above all, the pitiable participation at the local level.”

But is integration a new problem? Some may blame the Constitution. While population stabilisation is in the Concurrent List, ‘Health’ is a State subject. As a result, Central and State governments jointly share expenditure. So, here we come to bureaucracy, where the Central government efforts are administered by the Ministry of Health and Family Welfare, thus looking after both administrative and technical services and managing medical education. The States, on the other hand, provide public services and health education.

“To cut a long story short Swati, in between all of this, healthcare spending as a share of total government expenditure has actually fallen,” complains social worker Sita Mathur, who is in the Women Healthcare division of an NGO. Interestingly, the huge expenditure that has happened has not brought desired results. What were the goals in the first place? So, private sector spending on healthcare has now been growing at a much faster rate. With the private sector, most of the times profit motives would rule. A government should be less inclined, one thinks.

There is growing divide between rural and urban India — salaries, standard of living, power of expression, law. But the biggest of all dividers would be healthcare. “Look at the frenzy with which new-fangled hospitals are being built. As money starts flowing into Tier I and II cities, healthcare providers are also migrating to those small towns. But these are supposedly to meet the demands of a growing middle class population that now can pay for the best in healthcare. This is really sad,” laments Dhritimaan, who has just arrived in Chennai to join his new job.

Actually, not a day goes by that a new healthcare venture — be it some established hospital chain or some JV between local and foreign entities — is not announced. A logical and sustainable map that addresses the healthcare requirements of the masses is conspicuously lacking. One thing we need is more technically qualified people. Way back in 1991, there were 47 doctors per one lakh people. Today, as per the Medical Council of India, the total number of registered allopathic doctors in the country is around seven lakh. Although there are around 63 allopathic doctors for one-lakh patients, are they accessible by all people?

“We need something more than National Rural Health Mission. It’s a beginning but we need more such initiatives,” says Suresh Krishnamoorthy, a regular reader. NHRM or The National Rural Health Mission was started in 2005 with the noble goals to provide accessible, affordable and accountable quality health services to the poorest households in the remotest rural regions. The idea was to have a fully functional, community owned, decentralised health delivery system.

“To its credit, NRHM has provided a platform for community health action at all levels. The merger of the Departments of Health and Family Welfare in all States have helped. Flexible financing has also helped in driving reforms that empower local communities to make their own decisions. As the Economic Survey puts it succinctly, “It is thus a serious effort at putting people’s health in people’s hands.” If it’s our health so the choice should be ours, if we can make them. Villages should have more hospitals because they need them more.

Who doles out data about number of rural and urban patients? What’s the success rate of a particular medicine? What is the ratio between the survival rates between surgeries performed at a village or a city? A good way to help this transition would be having a form of record keeping, preferably electronic.

“An Electronic Health Record system would help in knowing how and whether the goals have been achieved. Execution is key but so is knowing it. An air of transparency throughout the healthcare system is an urgent need of the hour,” Joseph Fernandes comments. Fernandes, who left his job as Resident Medical Officer in a government hospital years ago, has been instrumental in grooming and finding thousands jobs for Indian nurses.

“Except a few people in the administration, nobody knows what is happening to all the new drugs that are being bought. Why medical equipment suddenly stop working, and how they reappear in fine condition at local clinics? How is the taxpayer’s money being spent for him/her?”

Anitha Srinivasan, who works in an administrative position at a cancer institute, said something worth mentioning. “A lot of people talk about medical insurance being godsend. But do we have adequate historical data of what the costs for the treatment of a particular condition are? In its absence, insurers have a field day while setting their premiums.” There is time to recover from this mess. Oil reserves may end in 2030, but the healthcare system can be revamped quickly. Besides looking at insuring health of workers in the unorganised sector in the BPL category of Rs 30,000 each, ask private insurance companies to provide medical insurance coverage to the overall population. Healthcare may be affordable to a few but millions can afford insurance.

Naresh Sivaraman says, “With right medical information systems, an atmosphere of proof would be created. Think about a system that would show how a medicine has worked and helped cure people. Not just in trials. The Government should encourage healthcare data compilation.”

Yes. Its time to plan things. Extend health cover at a minimum cost to all. Healthcare should be the most important agenda of the government. Have active participation between private and public interests. Have a data system where each medicine is accounted, and if maintained over a period of time, can reveal important trends. “Healthcare is not pizza that can be delivered everywhere. It’s not a fast food. It needs careful application and performance monitoring at every step. Abuse of power and money is happening. Vicious circles between doctors, hospitals, and diagnostic centres should be clamped. Everybody knows it’s happening,” Rahul Vaidyanathan, a BPO employee says. His concerns are genuine.

Mere allocation of Rs 16,000 crore for the healthcare sector will not work. “In effect the Government has decided to spend Rs 144 per citizen for healthcare. And for the rural population it is somewhat better, they get an additional Rs 150 each,” reads a post in a blog named Healthcare Magic (http://healthcaremagic.com/blog/?p=20).

A draft policy that looks after the needs of all Indians is the need of the hour. For how long will we pride ourselves for being a medical tourism destination of choice, when our country’s healthcare is in such a bad shape?

Responses to Episode-177 on the issue: ‘What about the aam aurat’s Budget expectations?’ (Business Line, February 18, 2008).

Exponential earners are always the winners ever since the dawn of the IT laws. They are the speculators in all fields. For example, their contribution to cost escalation, especially in real estate, is phenomenal. The Government knows the winners; it is not that identification is a problem, but willingness to implement tax for the exponential earners.

Krishnamoorthy, Mangalore

How would you like the present healthcare system to change? Readers may send their feedback on the column, mentioning their names and addresses, to swatilistening@gmail.com.

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