Health manifesto: Why isn’t prevention better than cure?

Sunday, 2 February 2014 - 2:16pm IST | Place: Ahmadabad | Agency: DNA

If food subsidy had not been targeted at 65% people, but, say only 40 -50% people, we would have found enough resources for overcoming anemia among poor women forever, or nutrition-linked blindness among all vulnerable children. One does not need too much of imagination to understand why preventive healthcare is more democratic, affordable and inclusive than curative care (not that we can neglect the latter for the poor).

Over time, our performance in providing healthcare has been worse than most countries in south Asia and many other parts of the world. With all the recent initiatives, studies have shown that private expenditure on health is four times more than public expenditure at around 1.2% of GDP.  If Sri Lanka can reduce infant mortality to 13 infants below one year per thousand, why should India have it at 52, higher than Nepal, Bangladesh and Maldives? What kind of model of development are we planning for future and why should that be not at the heart of political debate. India does not even collect data on chronic diseases at community level in regular health surveys, providing preventive diagnostic and clinical support to a vast majority of poor is not even on the cards.

Every worker at the employment guarantee worksite could get mandatory health check-up and Central and state governments must then report to the nation about steps taken to remedy the inadequacies of these workers. These workers are not even provided soap (which can be made by them only) to ensure better hygiene and a water filter to prevent water-borne diseases. Government has enough funds to subsidise non-poor people through food and LPG gas cylinders, but it cannot meet basic health and educational need of the poorest people.

Twenty million people travel by train every day; and as I have argued many times they can thus be reached with preventive healthcare messages in interesting, educating and interactive manner. We can also source ideas from people for dealing with many social, technological and cultural problems. By the time passengers reach long to medium distance destinations, we can process these ideas through voluntary help of students and professionals in public and private sector and give prizes in real time. And then a precise operational plan can be made to implement viable ideas after pilot testing. But there seems to be no political will among any party to give priority to such ideas of engaging with masses for near term resolution of persistent problems of health, hygiene and related education.  Similarly, I will keep repeating the idea of using 1.6 lakh post offices to reach 6.5 lakh villages every month with focused messages coded in powerful metaphorical or symbolic and cultural forms.  We have reached NMEP (for eradicating malaria though not as successful as polio) or polio vaccine messages to every nook and corner of India. We can do it again and again for all important messages.

India has enough muscle and mind space to implement ideas it decides to do unambiguously — be it Moon or Mars mission at a cost nobody else in the world can do, or organising fair elections involving a billion people.  Then, why is it that reaching preventive and essential curative healthcare to ever-disadvantaged citizen is so difficult? One adverse major health episode means washing away of all savings of a family besides incurring a huge debt. Insurance sector covers a miniscule portion of population. Government claims it has no funds for that, but has enough funds to extend more and more privileges for the well off people.

In China, every single hospital has well integrated services available for allopathic and Chinese traditional medicine.  In India, most public systems do not even reimburse the health expenditure of Indian systems of medicine. The issue of integration has not been tried, exceptions apart, at great cost to the people. Indian system of medicine (which sustained the health and wellbeing of majority) has become an alternative system today. In a large number of primary health centres, ISM doctors anyway provide healthcare, since allopathic doctor do not want to work.  

I hope that various healthcare models developed by Dr and Mrs Abhay Bang, Aroles and many others will be given much more space in our consciousness than before. We can and must incentivise the doctors to go to rural areas for inculcating preventive healthcare awareness and other self-care competences. Several health trains should regularly go over the country and meet needs of the poor. India is a rich country with poor leadership and time has come to ask hard questions. I hope those aspiring for powers are listening.

Anil Gupta
The author is a professor at IIMA

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