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Make healthcare a right

November 6, 2009

Lack of accountability and motivation has destroyed our public primary health-care system, and apex institutions are rapidly losing their excellence. Yet, complete privatisation cannot be the answer.

YESTERDAY,5,000 children — all below five years old — died in India. Not only yesterday, but day after day, about 5,000 children die. When some 3,000 people died in New York on 9/11, eight years ago, the world changed. When about 175 people were killed in Mumbai in November 2007, the nation was energised into action; a 100-day plan of action was announced, one chief minister and the Union home minister were, in effect, fired. Both these tragic terrorist events rightly generated anger, revulsion and action. Popular activism replaced apathy, governments moved quickly and decisively, and all agencies were mobilised. Why, then, does the horrifying daily mass-death of thousands of children not shock us into similar action? What causes this benumbing of sensitivity?

Certainly, it is not the inevitability of these deaths: the government itself admits that 60% of these are preventable. The infant mortality rate in India is about 10 times that in UK; it is also far higher than a whole host of other developing countries (four times that of Sri Lanka, for example). Clearly, a vast majority of these deaths are preventable even with our present level of income. Other key health indicators, particularly maternal mortality and nutrition, are equally distressing. Amongst children below five in India, 46% are under-nourished, 36% stunted and 22% wasted. Imagine the impact on each affected family, the depth of the unnecessary human tragedy, beyond the cold statistics.

The magnitude of the health crisis has not got the recognition it deserves. While economic parameters are monitored on a monthly — if not weekly — basis and a sensex sneeze causes contagious colds in the business world and amongst many in the government, few in power seem to have the same concern about our health metrics. Civil society organisations too have not been able to mobilise widespread public awareness or activism. Where is the action plan on healthcare? Will we fix responsibility for being years — and millions of avoidable deaths — away from the target of “health for all”? More importantly, will we take corrective steps?

Some progress has doubtless been made: infant mortality rates have been reduced, child-care and mid-day meal schemes have been expanded and life expectancy is up. However, government health facilities continue to be inefficient, under-staffed and over-loaded, generally dirty and decaying. As a result, an increasing proportion of dissatisfied people is looking for alternatives, and go to private facilities even though they cannot afford the cost. Due to the cost of treatment and loss of wages because of illness, for many this means taking a loan and then falling into a debt trap. Clearly, for the poor, sickness is not just a matter of physical ill-being but also has a deep and long-lasting economic impact. One bout of serious illness in the family can easily push it into the BPL or destitution zone.

Unfortunately, our model of healthcare seems to be evolving towards a private, high-cost, US-style one rather than the UK/European model. The US system has largely been a private-insurance based one and as costs of healthcare have escalated, so have the insurance premia. Despite one of the highest overall expenditures on health, the outcomes are generally acknowledged to be inferior to those in Europe. The US itself is now amidst major reforms — this is one of President Obama’s top priorities — and is moving towards the European model.

IN INDIA, lack of accountability and motivation has destroyed the public primary healthcare system at the grassroots, and apex public institutions — like AIIMS, Delhi — are rapidly losing their excellence due to a combination of systemic factors and political interference. Yet, complete privatisation — by plan or default — cannot be the answer in our situation. It is time we re-visited our healthcare system and stopped the drift towards abdication by the government of its responsibility in this area.

While the private sector is capitalising on unmet need and dissatisfied patients through conventional healthcare facilities, there is also a huge opportunity for technological solutions. New health devices — or cheaper and more portable versions of existing ones — combined with information and communication technology (ICT), can provide affordable, high quality healthcare even in rural and remote locations. Low-cost X-ray machines, inexpensive and portable ECG equipment, simple and easy-to-use blood-testing devices: these and many others are already a reality.

There is great scope for the development of new devices, and companies in the medical electronics, IT software and telecommunications sectors can build substantial business around remote healthcare: a unique opportunity to do well and do good. Such equipment, in conjunction with analysis and communication capabilities provided by ICT, can take specialist-level medical diagnosis and advice to patients who are thousands of kilometres away. With only a technician or para-medic in a village, patients there can access top medical specialists located in top-notch city-based institutions. The feasibility of this has now been well established, and it is moving to operational use.

The government needs to leverage these new possibilities and integrate them into a comprehensive healthcare system, rather than stepping back and leaving things only to market forces. Even at the low costs that should become possible with new devices and remote services, the poor will not be able to afford commercial healthcare for many years yet. It is imperative that, in conjunction with the use of new technologies, the potential to take health to all is actually realised.

The best way to make this happen, to improve the sad and shameful infant mortality and health indices, is to pass a Right to Health Act. Such an enforceable right may do as much good — or more — as NREGS, and will be a fitting complement to other existing rights with regard to education and information; hopefully, to food and shelter soon. It can be used to trigger serious action to stem the daily catastrophe which we presently choose to ignore.

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