In the New Decade, will Good Health become a rarity?
Another year has gone by and India continues to rank among the poorest achievers of good health. Our bad health record does not get much attention even in the press, which continues to uphold its narrow focus on technology, the markets and the never dull political narrative we have become accustomed to. Any meaningful conversation around education and healthcare continue to be ignored or just shelved because ‘it won’t sell’.
Over the next few days, one is bound to see a flurry of analysts and healthcare organisations present their predictions for India healthcare; often futuristic, unmeasurable, representing the view of the corner office, which is perpetually rose-tinted.
So what explains India’s healthcare debacle? We spend little, so the results are bound to be little. We have heard that argument often. While there is truth in seeing India’s healthcare failure from that perspective, the low allocation of public resources, and poor resource commitment is an important factor too. But what’s more disparaging is the corruption in healthcare.
Corruption in healthcare is beginning to receive attention, although mostly superficial and confined to moral outrage and lament.
A friend of mine mentioned a situation that got the blood in my spine freeze. Her sister had accidentally poured scalding water on herself and was being rushed to a private hospital. The private hospital suggested she be moved to a hospital with a specialised burns unit. Very few hospitals in India have this specialisation. My friend managed to pull a few political strings and get an emergency admission at one of the city’s government hospital with a specialised burns unit. As her sister was being rushed in, my friend witnessed, another patient who had suffered 80% burns, being shown the door to accommodate her sister, courtesy the few political strings that were pulled! Her blood froze too. She refused to usurp the rights of the other patient. The other patient was a poor daily wage worker, who knew no politician, let alone knew how to pull strings on any kind.
There are few of us, with the consciousness and presence of mind to care for the other. Many would not have bothered to even think for a second. Many would have even gloated over their political clout. Sad. Such is the value of human life.
This brings me to the most worrying aspect of healthcare linked corruption – the deteriorating standards of personal conduct and ethical behaviour among practicing doctors, and other healthcare professionals. A stark example of this is the appalling child sex ratios in the country. This would not have been possible without the active connivance of doctors and other health professionals.
To complicate matters further, the corruption in the pharmaceutical industry, shows no sign of a change. It is rampant across clinical trials, pricing, and manufacturing of spurious drugs and continues to grow with each passing day.
How does one work towards a solution to a wicked problem such as this? Information asymmetry is heightened with the hospital-based healthcare system which privileges the position of the doctor above everyone else.
But every dark cloud does have a silver lining. There are several examples of outstanding work, where dedicated professionals have not fallen prey to the ecosystem they work in. The Jan Swasthya Sahyog and Jan Arogya Abhiyan are shining beacons of hope.
One of the most important lessons emerging from a study of the above is that public health must remain a public responsibility and neither the lack of financial resources, the inability to manage systems, the unwillingness to govern responsibly nor an unfamiliarity with technology should became an argument or an excuse for outsourcing healthcare to private enterprise.
“Healthcare is largely in the hands of the private sector, not out of ideology but because the government has long done a lousy job of providing it.’”
— The Economist
And this leads us to a final link, in my mind the most vital, which is the need for a comprehensive rethink of the medical curriculum and syllabus. Research is almost dead in most colleges and universities. Many private medical colleges do not have the patient load to sustain systemic teaching. There is a high concentration on just the lucrative specialisations like radiology, obstetrics, and orthopedics, ignoring the much-needed disciplines like psychiatry, family medicine, palliative care, and geriatric care. Shortages in these specialisations lead to exploitation and corruption. Would you be surprised if I were to say that the only colleges in India that have both a credible and high standard of teaching and research are just three – AIIMS-Delhi, JIPMER-Pondicherry, and PGI-Chandigarh.
Do you think that through conversation and introspection we can learn to bring about change?
I wish you ‘health’ in 2020 and beyond, for its fast becoming rare.
