Healthcare scenario in India
- Rishi Rajat Adhikary
- Feb 22, 2009
- 7 min read
“Medicine was conceived in sympathy and born out of necessity” is an oft quoted saying. Today, this necessity has brought us to the world where health and healthcare are of considerable importance. However the concept of “health for all” still remains a distant reality in many of the developing countries. India is a country where a paradox exists in the form of a health system which caters to a large majority of the population but deprives a major section. It would be quite interesting to explore the bright and the not so bright parts of the healthcare scenario in India.
STATISTICS AND THE PRESENT STATUS:
India is a country with a population of nearly 1.2 billion. It has a gross national income per capita international $ 3,800 out of which the expenditure on health per capita (2005) is international $100. Life expectancy at birth for males is 62years while that for women is 64 years. Total expenditure on health (2005) is 5.0% of the GDP. The probability of dying under five (per 1 000 live births) is 76.[1] Under the mandate of National Common Minimum Programme (NCMP) of UPA Government, health care is one of the seven thrust areas of NCMP, wherein it is proposed to increase the expenditure in health sector from current 0.9 % of GDP to 2-3% of GDP over the next five years, with main focus on Primary Health Care. The National Rural Health Mission (NRHM) has been conceptualized and the same is being operationalised from April, 2005 throughout the country, with special focus on 18 states which includes 8 Empowered Action Group States (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttaranchal, Orissa and Rajasthan), 8 North East States (Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura) Himachal Pradesh and Jammu & Kashmir.
Health care for the rural masses:
Rudolph Virchow once said, “Medicine is a social science.”[2] The majority of the Indian population lies in the villages. A large number of medical colleges and private hospitals have sprung up in large cities, all without any proper referral system to cover the rural population. However, there are still silver linings in this dark cloud:
RURAL SURGERY:
The concept of ‘rural surgery’ has been developed in India to make modern surgical care accessible to the have-nots. Nearly 600 post graduate trained surgeons are churned out of its medical colleges every year. Many of them go out to the Middle East or other developed countries and are totally lost to the nation. Some of the rest get absorbed in the teaching institutions of the country, super specializing. Others go out and practice in the impoverished district hospitals or voluntary, hospitals or set up private practices, in small towns, and in semi urban and rural areas. It is this third category of surgeons that reach out to the needs of majority of the population of the country. They work under extreme constraint of resource. They combine their western medical and surgical knowledge together with locally available human and material resources and provide appropriate health care to the people. A questionnaire was circulated among the members of the Association, 151 of who responded (142 practicing in rural areas)[3]. Half were in government hospitals and half in private practice. The survey showed that:
45% worked without a specialist anesthetist
63% had no blood bank facilities.
68% worked without a qualified radiologist.
68% worked without a qualified pathologist, and
32% had none of the above facilities
The whole purpose is to provide optimum surgical care to impoverished communities around the world within limited resources.
INDIVIDUAL EFFORTS:
In the context of the health care, it would be of much importance to mention about those stalwarts who have contributed immensely for empowering the local population in matters of health. One of these sincere efforts is the one by Dr. Abhay and Dr. Rani Bang, a doctor couple, now in their mid-fifties, has been quietly working for over 20 years for the people of Gadchiroli, an area two hundred kilometers to the south of city of Nagpur. Over the years, because of the selfless work and devotion to the cause, the Bangs have been remarkably successful in improving the health situation in Gadchiroli. The Bangs set up a Research and Community Service NGO called SEARCH (Society for Education, Action and Research in Community Health) in Gadchiroli. SEARCH took upon itself the task of identifying what ailed the local, predominantly tribal (Gond) community. Their experiences on the field taught them an important lesson that any attempt to solve local community problems should take into consideration what the local community deems as a problem and not what the government or research organization judge as worth pursuing. His work is the best example possible of combining the appropriate educational background with a sense of altruism – an altruism that serves people and steers social change. Gandhi once said, “I will give you a talisman. Whenever you are in doubt or when the self becomes too much with you, apply the following test: Recall the face of the poorest and the weakest man whom you may have seen and ask yourself if the step you contemplate is going to be of any use to him. Will he gain anything by it? Will it restore him to a control over his own life and destiny? In other words, will it lead to swaraj for the hungry and spiritually starving millions? Then you will find your doubts and yourself melting away”. For Dr. Bang, the innocent face of the newborn cradled in the arms of its mother is and will continue to be his talisman.
Thus, there have been great contributions in the form of trained rural surgeons or through the individual efforts in the villages of India. However, even today (As on March, 2007) about 5.6% of the PHCs are without a doctor, about 40% without a Lab technician and about 17% are without a Pharmacist. All these issues do need the consideration of the authorities.
VACCINATION:
India introduced the Expanded Program on Immunization (EPI) in 1978 with the objective of reducing morbidity and mortality from diphtheria, pertussis, tetanus, polio and childhood forms of tuberculosis. 1985 saw the introduction of measles vaccine and in the same year the Universal Immunization Program (UIP) was established, aimed at rapidly raising coverage, with a target of reaching nationwide coverage of 80% by 1990. During the 1990s, following the introduction of the Universal Childhood Immunization (UCI) goals, reported coverage levels for all antigens reached more than 90% of eligible children in India.
Since 1990 routine immunization coverage has declined, probably in all areas, but most markedly in some populous northern states, where no more than 50% of the eligible infants are estimated to receive all scheduled immunizations. In spite of declining coverage in routine immunization, the outcome of the supplementary immunization activities for polio has been impressive, with polio incidence declining from 24,000 reported cases in 1988 to 134 cases in 2004. From 1995 onwards, the routine UIP was supplemented by intensive pulse polio immunization (IPPI) campaigns aimed at national polio eradication. Childhood immunization is one of the most cost-effective health interventions. Government is committed to the reduction of morbidity and mortality due to vaccine preventable diseases (VPDs) and to the establishment of reliable surveillance for VPDs. The goal to eradicate poliomyelitis adopted under the UIP has retained its position of high priority under the newly launched RCH Program.[4]
INFECTIOUS DISEASES:
India is a country with high incidence of a number of infectious diseases. Prominent among them are tuberculosis, malaria, filariasis and many newer outbreaks of diseases like Chikungunya. There have been many success stories in this regard. The Revised National Tuberculosis Control Programme (RNTCP) had a nationwide coverage by March2006. Treatment success rate for tuberculosis has more than trebled, from 25% in 1998 to 86% in 2004. Death rate has been brought down seven-fold, from 29% to 4%. However still, Tuberculosis (TB) disease newly affects around 1.8 million Indians every year.[5] Hence there are still miles to go in the treatment of such fatal diseases.
MODERN MEDICAL TECHNOLOGY:
The Indian healthcare also has to its credit the ability to contribute to the development of the modern medical technology. The following are some of the famous examples:
STEM CELL RESEARCH IN INDIA:
In India, several agencies of the government and some industry research organizations are promoting stem cell research. The major programmes include: establishment of the Human Embryonic Stem Cells lines, use of the limbal stem cells to repair the corneal surface disorders, exploring the potential of the stem cells to treat many conditions like stroke, cardiac, spinal cord injuries etc. [6] Important institutions in this field include Reliance Life Sciences, Mumbai; National Centre for Cell Sciences, Pune; Christian Medical College, Vellore; LV Prasad Eye Institute, Hyderabad; National Institute of Mental and Health Sciences, Bangalore; All India Institute of Medical Sciences(AIIMS), New Delhi etc.
OTHER AREAS OF DEVELOPMENT:
AIIMS has been conducting cancer prostate robotic surgeries for the last two years but the chest surgery using a robot was a new feat for the institution early this year to thymectomise patients of Myasthenia Gravis.[7] There are about 15-20 cancer centres in the country but India needs many more such centres considering the burgeoning population and rising incidences of cancer. ICMR has about 100 projects on the epidemiology and pathogenesis of cancer. Dr Purvish Parikh, Medical Oncologist, Tata Memorial Hospital (TMH) says, "Reputed international journals have declared India as the most preferred destination with about 49 percent of global trials moving to India."[8]
CONCLUSION:
The land where great geniuses like Sushrata and Charaka have practiced is moving fast towards the development of a new and advanced healthcare system. But there are fellow Indians who continue to ail, suffer and die due to ailments which are potentially curable. Today we need a combination of dedicated health care providers, a rational and sensitive government and a well informed public for the development of a more efficient healthcare system. This will be of prime importance in creating a healthy, efficient and more productive Indian population.
Jai Hind
References:
[1] Website of the World Health Organization: http://www.who.int/countries/ind/en/
[2] Virchow R Quoted in Straus MB, ed. Familiar medical quotations. Boston: Little, Brown, 1968: 561
[3] Prabhu RD. A survey of surgeons practicing in peripheral areas in India: their problems and constraints. In: Banerjee JK. Concept and practice of rural surgery New Delhi: B.I. Churchill Livingston, New Delhi, 1993: 9-14.
[4] Field Guide: Surveillance of Acute Flaccid Paralysis Third Edition September 2005: Child Health Division
Department of Family Welfare, Ministry of Health & Family Welfare, New Delhi (Prepared with assistance from National Polio Surveillance Project - India)
[5] TB India 2006:RNTCP Status Report: Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi 110011
[6] Sharma A, Stem cell research in India: Emerging Scenario and Policy Concerns Asian Biotechnology and Development Review Vol.8 no.3,pp 43-53