The advances in medical care in India have unfortunately occured in private corporate hospitals. They cater to an urban middle class with rapidly expanding paying capacity for their health needs. They have also been quick to see and utilize the inevitable need for medical insurance to meet growing healthcare costs.
These swanky edifices with most modern gadgetary have however created a class divide within society. The poor, the official estimate of which is approximately 400 million, have only government hospitals to turn to. These crowded fly infested places with irregualr supply of vital equipment, medicines and doctors have left the not-so-rich frustrated. They are grossly inadequate: many do not have ultrasound machines, blood banks, standardized laboratories, a full complement of trained personnel, adequately stocked pharmacy or contemporary expertice.
The importance that our government gives to health can be gauged by the fact that a mere 0.8% of India’s GDP goes to health, compared withy 16% in USA and 7% in the UK. The costs of equipment, procedures and medications have risen steeply, as have people’s expectations from hospitals. Although there are over 150 government medical colleges in India, most do not even have the equipment and procedures that students are expected to see, use and learn during their training periods there.
Let us take 2 examples: while the curent appropriate treatment for gallbladder stones is laparoscopic cholecystectomy, over half the medical colleges do not provide this service. With around 5% of adult Indians estimated to harbour gallstones and many likely to become aware of their presence due to the ubiquitous availability of ultrasound clinics, most would get their surgeries done in private nursing homes or hospitals. The other example pertains to Hepatitis B: although 4% of Indians harbour this infection (40 million), the test for its detection is not available in the majority of these medical colleges. It is an essential part of anti-natal screening, but how can an expecting mother visiting these hospitals get themseleves tested and protect their newborns if the test is not available there at all? And while 160 countries have added Hepatitis B vaccination to their childhood immunization programmes, India stands out like a sore thumb as not being one of them due to financial constraints!
The selection of sites for creating new medical colleges also defies common sense. While the building can be constructed anywhere, and desperate students may travel to any corner, what about faculty and patients. Why would a talented faculty surgeon, with 2 school children stay in a remote place which does not have good schools? And are we trying to fill faculty posts somehow, or aiming to attract good faculty to ensure quality education for the nextgen docs? And why would poor patients staying in slums around big cities spend on transport to reach some remotely located medical college that is also often lacking in facilities? I leave it to you to judge!
There could have been reason for the government to argue that tertiary care, being costly, may be best left to the private sector, that medical colleges should strive towards good, standard-of-care secondary tier health care, and played a exemplary role in primary care and disease prevention. After all, foreach patient with lung cancer or heart attack, there are 100 who are waiting to be diagnosed and a 1000 at risk, waiting to get affected by disease. Our record of accomplishment in primary prevention has been dismal. The sales of tobacco, which accounts for 50% of all cancers in India, has infact gone up, alcohol shops have been allowed to crop up along highways encouraging drunk driving and road trafiic accidents, and polythene bag heaps around settlements explain why mosquitoe borne diseases continue to claim somany lives in India.
What should we expect in 2010. A thoughtful plan for our health services could be good for a start.
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