India at 75: A dream of Health
By- Dr. Shivangi Shankar
India and her people are diverse as it gets. Similarly, the issues that plague her are many and varied. We’ve undoubtedly made some progress yet healthcare remains a thorn in the foot of our vast and growing nation. Health remains an area of concern even after 75 years of independence. Interestingly, despite the commitment to ensure availability of healthcare to the people of India, health is not a constitutionally guaranteed right. Even where healthcare is available, the quality and accessibility of it are a matter of luck.
The Bhore Committee, the document that led to formation of the health system was a comprehensive document delineating how the many areas of health would be catered. It understood the impoverished state of the country at the time and divorced the availability of healthcare from the ability to pay. Within this, the main way of healthcare provisioning was through the social physician. This would be a medical doctor who would be trained in Western medicine but also serve in the remotest areas solely out of a sense of duty. So far, so good but as the very next assessment by the Mudaliar Committee showed, this was neither functional at the time nor sustainable in the long term.
That we haven’t been able to fulfil the social physician dream is not an indictment of the healthcare professional- it is an acceptance of their humanity.
Even the best training cannot make one person capable of doing a job that requires multiple people (nor should it).
Over time, the private sector has stepped in to plug the perceived lacunae in the public healthcare services system. The popular narrative is that public sector is inept and must be replaced. This is in direct contravention to the original idea of treating health as an inalienable right irrespective of the ability to pay. Sure, the public sector needs a rehaul but to replace it with a system that leaves people vulnerable to exploitation is hogwash.
How do we change India’s HealthCare for the better then? Here are a few avenues:
- More Healthcare Workers, More types of HCWs, better pay and working conditions for all:
While advocating for doctors we need to remember that we are always going to be part of a team and that we need to make sure all HCWs receive appropriate training. Alongside it is important to ensure fair wages for all. Currently, we live in a world where ASHA workers are hailed by the WHO but penalised in their home country for asking for rights.
- Affirmative Action
The mention of affirmative action often draws the ire of medics across the board. However, it has been observed all over the world that inclusion improves the quality of care and increased and varied representation improves knowledge. Several concerns of marginalised are brought to the fore only when people from said communities become a part of the system. We also need to look at more ways of ensuring inclusion for the most affected(eg: through horizontal reservation within categories/deprivation points)
- Sensitisation and Accessiblity
As a natural progression of the first 2 points, we need to look at the state of healthcare systems and their accessibility for people. Are women confident of receiving unbiased, non-judgemental care? Are HCWs trained to cater to the health needs of sexual and gender minorities? Are different caste groups receiving equitable and dignified care? Are healthcare setups accessible to people with different types disability?
- Funding and Out of Pocket Expenditure
Insurance models seem like a tempting and easy solution to healthcare provisioning in a country like India. It is also convenient for shifting to a more profit driven medical setup. However, if we look at healthcare as a public good, i.e., something all need to be provisioned as a right, then it must be provided by the state. It is also important for the state to increase healthcare spending instead of relying on aid. The aid often comes with riders, takes way India’s autonomy and shifts the power to aid providers. This while the public spending on healthcare remains abysmal (Compare with the Bhore and Sokhey Committee recommendations of spending 15% of the budget on healthcare)
- Accountability and Research
We need to create functional and transparent feedback mechanisms to ensure that the lacunae in healthcare get addressed. An emphasis on research, coupled with more training and funding would further aid in improving the ways in which healthcare can effectively cater to the needs of the people.
- Engagement with other disciplines and systems
It is no secret that that there are parts of India still struggling with employment, food security, contraception, road inaccessibility, scarcity of drinking water, etc. Other factors like gender disparity, caste-based discrimination, and stigma associated with sexuality worsen health in several ways. These make health difficult to attain and maintain and there needs to be collaboration with healthcare systems in these areas to ensure primary prevention.
- Healthcare for the People
In our rather paternalistic system, there is very little space for the voice of the health seeker. Due to this, healthcare becomes a hostile and unsafe space for people affecting patient cooperation and destroying trust in the health system. Afterall, the healthcare system is for the people, so it makes sense to ensure it actually does serve them. Strengthening the primary healthcare setups as well as exploring how the existing traditional systems can tie in would provide a path for reaching farther into hitherto underserved areas of India. Traditional systems are widely accepted by people and within their frameworks, we need to search for ways for integration. Giving a profit motive to traditional systems and forcing them into modern medical practice is not integration. It is erasure and it is business. Healthcare systems need to ensure that people get a choice. This choice must be informed and transparent.
The healthcare system needs to be tailored to the people instead of people to the healthcare system. The solution to India’s healthcare woes, too, must be inclusive of the diversity of India’s people. HCWs cannot do this in a silo. It is not our burden alone, we must remember that it takes a village.
Tell us what you think can heal India’s Healthcare.