The book blurb says it aims at “demystifying the issues of healthcare – for the general reader – provoking rethinking, along with actionable solutions”.
Published by Penguin India in collaboration with the Samruddha Bharat Foundation and spanning a 243-page compilation of 13 essays, the chapters swing from policy to reminiscences and from constitutional and federal issues to molecular science to small case studies.
The opening essay on India’s Population Structure by demographer PM Kulkarni et al confirms India’s declining fertility – quite distinct from population growth – which the authors forecast will persist for at least three decades more. Two predictions about the growth of the elderly and increase in rural-urban movement, involving attendant challenges for health, should act as a warning for planners and policymakers.
The essay by cardiologist-cum-public health expert K. Srinath Reddy highlights key determinants that influence good (and bad) health. He makes a well-argued case for conducting health impact assessments, but his expectation that coalitions of civil society and people’s representatives can jointly monitor the espousal of health friendly policies, sounds feeble, given the enormity of vested interests at play.
Noted academic Imrana Qadeer harks back to the Nehru-Mahalanobis era and details health programmes from bygone times, which belie the book’s title about dreams for a Healthy India in post-Covid times.
Describing some innovations in health sciences, Vice-Chancellor Darshan Shankar et al have highlighted the harm from excessive consumption of uniform diets. They have emphasised why dependence on drug discovery does not address the complexities of disease progression and stressed the need for cross-cultural research. Recognising the limitations of different medical systems, the authors have pushed for a cadre of professionals, capable of conducting integrated practice. The most interesting part was data showing how effectively medicinal plants have treated and cured diseases – albeit in animals.
Feminist writer Syeda Hamid reminisces about her field visits undertaken in 2006, the most recent one being in 2020. Although these are first-hand accounts which are valuable, most have been written upon several times before her, by others. More recent case studies rooted in the present may well have been more relevant and engaging.
Academic Ritu Priya’s chapter on Re-visioning Development and her first-hand account of the 2017 Acute Encephalitis Syndrome, which snatched away hundreds of lives of defenceless children in a Gorakhpur Hospital, presents a telling story of how public health outbreaks go far beyond hospital management issues and are interlinked with poverty, malnutrition, and lack of access to timely primary and secondary level services. However, when she makes suggestions involving the complex arena of urban planning, her simplistic solutions will not resonate with practitioners and citizens, who face the brunt. On Local Health Traditions (LHTs) she laments how WHO’s own systems “do not accord LHT any space” while holding the bureaucracy responsible for drawing from global knowledge systems, while ignoring the informal traditions drawn from peoples’ own knowledge.
Sujatha Rao, a former Union Health Secretary, has discussed the reinvention – not the revival – of the community-based medical practitioner. She has also listed 10 prescriptions as a roadmap for filling enormous gaps that persist – certainly worthwhile material for health system planners.
A chapter by academics Rohina Joshi and Vivekanand Jha describes “a new healthcare paradigm,” with an emphasis on safe motherhood, childhood, the gender gap, acute and chronic care, and vaccine preventable diseases. Minus an assessment of the now 18-year trajectory of the National Health Mission (which by all accounts has greatly improved numerous health indicators they refer to) their adages about a rights-based approach, based on trust fail to give practical solutions.
Two Community Medicine doctors, Ramani Atkuri and Pavitra Mohan, have described encouraging examples of small hospitals in rural/ tribal areas and small towns run by NGOs. But data is missing in those descriptions. Additionally, the authors recommend extending limited autonomy to government hospitals to foster creativity and responsiveness.
Harvard Professor Vikram Patel, in an essay on transforming mental health, cites three case studies which, while he concedes are like demonstration projects, raise hope. While discussing the Mental Health Care Act 2017, he, however, eschews critiquing its implementation. Rather, he goes into the achievements of the Sangath programme with which he is associated. While his ideas give hope, they cannot be called a solution, given the absence of data, together with the stigmatisation that exists in Indian society.
Several authors and editors, including public health physician Abhay Shukla et al have upbraided the private health sector for profiteering and being extortionist. While this view is widely shared by the public, no essay refers to whether the criticism is aimed at corporate hospitals, which account for some 5 per cent of the hospital beds or single hospitals, nursing homes and practitioners that provide 95 per cent of the beds and services.
Criticism by itself is no solution.
On Governance, former Executive Director of NHSRC Sundararaman et al sound disapproving of over-centralising things under the National Health Agency set up under the Niti Aayog and likewise the focus on privatising healthcare. Their critique on the constitutional framework, the mechanisms for accountability and the Health Ministry’s organisational structure are extremely well understood within the system, but might enlighten a curious lay public. But the description of power play between IAS officers and those manning the Directorate General of Health Services is put across as a systemic problem. (He forgets that, as happens everywhere else, power flows from proximity to power i.e., the Minister.) Three unrelated suggestions the authors make are, perceptive, and worth considering.
The essay by the Deputy Chief Minister of Chhattisgarh, Mr Singh Deo is the only one in the book to have provided verifiable data – on a plethora of successful schemes under implementation in Chhattisgarh state. The chapter should open doors for health research organisations to evaluate the professed outcomes.
The most positive feature of the book is the width of the canvas covered and the gravitas of some writers. Its limitation lies in mostly falling short of giving the promised actionable solutions.
(Shailaja Chandra was a Secretary in the Health Ministry and Chief Secretary, Delhi. Her website is: over2shailaja.wordpress.com)
Check out the book on Amazon here
