A medical check-up for India on World Health Day
1950: The historic year when India adopted a Constitution and became a republic, was also the year when several nations acknowledged the importance of working together on issues of health. Since then, April 7 has been celebrated as World Health Day to mark the anniversary of the formation of the World Health Organisation (WHO), with an aim to raise public awareness towards health.
A merry heart doeth good. A broken spirit dries the bone.
Depression is the theme of this year’s World Health day.
Persistently depressive – that is the diagnosis of the health of our nation, 67 years hence, barring a few encouraging manifestations of happiness in the form of polio eradication and AIDS control programs. Here are a few vital signs, out of a long list, of India’s weary and long-faced health report:
- One-third of world’s unimmunised children are in India.
- 63 million persons are pushed to poverty every year due to catastrophic healthcare costs. India is already home to 26 per cent of global extreme poor – that is, 260 million Indians survive on less than $1.90 per day.
- There isn’t even one hospital bed available per 1,000 persons in India. The WHO recommends having five per 1,000 persons.
- 55 per cent of practicing doctors (allopaths and AYUSH) in India don’t hold a medical qualification
- India is a hot-spot of antibiotic-resistant superbug infections. The national policy for containment of antimicrobial resistance has been on hold since 2011.
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| India’s miserable health condition is self-inflicted. |
India’s miserable health condition is self-inflicted. One reaps what one sows – the spending on building infrastructure, access, and skill for healthcare delivery has been consistently and grossly deprioritised for decades. In shameful contrast to the golden performance on GDP growth, India’s per capita spend on healthcare lies far below the average amount of that of the lower and middle income group of countries.
The under-budgeted health system is frail, inadequate, and of low quality. Overburdened by the unfinished task of tackling infectious diseases (tuberculosis, leprosy, HIV), it is crushed further by the rising epidemic of lifestyle disorders such as diabetes, stroke, heart and neurological ailments.
With that, there’s no room left to worry about occupational health hazards faced by farmers and factory workers or to even think of preventive health.
Doctor? Who?
Hippocrates, the father of modern principles and practice of medicine described it as "a craft so long to learn, for a life so short". Truly so. A physician is only as good as the finesse of her healing hand, sharpened through years of experience and collected wisdom.
For a physician, learning doesn’t cease ever; one must stay abreast of the latest developments in methods of treatment and the myriad ways in which old and new diseases erupt and manifest themselves in patients of different compositions.
Finding access to a trained and knowledgeable physician in India is a matter of luck and economic status. In urban India, eight out of ten allopathy physicians work in the private sector. As a patient visiting a private practitioner in a city, say Delhi, there is a 40 per cent chance that one’s doctor may not hold a medical degree.
The odds of meeting a degree-less, allopathic-doctor-by-experience is up to 70-80 per cent in rural and urban areas of the states of Uttarakhand, Punjab, Haryana, UP, Bihar, Jharkhand. The risk of finding a quack is nearly zero in public sector healthcare centres.
The big apple: Keeps the doctors away
In the public healthcare organisations, one finds well-qualified, over-worked, under-rested, knowledge seekers as junior doctors and residents, who aspire to eventually find more hygienic, organised and better-paid job opportunities within India or abroad. The pitiable conditions in which they patiently serve at work, and live (in ill-maintained staff quarters) is a price too low for the priceless experience and mentoring they garner as professionals.
Their mentors, the senior consultants, are those masters of their craft, who have held their conscience and passion to serve and teach too dear to move in to the private sector or out of the country just yet.
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| What explains the uncivil, neurotic behavior of patients and their caregivers against health workers? |
India’s broken health system is one of the major reasons why Indian immigrants comprise the largest chunk of immigrant doctors in the world as reported by The New England Journal of Medicine in 2005. One in every 20 practicing doctors in the US is an Indian or an Indian American.
The stress-training, skill and resilience gained through the same system is also a contributor their stellar performance. A recent study from Harvard Medical School found that patients treated by international medical graduates showed better health outcomes than those treated by US medical school graduates.
Across the globe, to train and excel as a physician, the skill matrix of perseverance, thoroughness, forthrightness, empathy and analytical aptitude holds valid. The recent incidents of violence against doctors in public hospitals of Delhi and Mumbai mandates that training curriculum of health workers in India be updated with a critical life skill - self-defence.
These are shameful and disappointing acts of the community, oblivious to the risk of losing their good fortune of having a trained doctor at their service, to the rest of the world.
What explains the uncivil, neurotic behavior of patients and their caregivers against health workers? The grief of irreparable damage or loss due to medical negligence is justifiable. The recent incidents, however, didn’t carry a proven case or semblance of negligence.
Verbal abuse and manhandling of health workers and doctors in public hospitals is common. In 2006, similar incidents led to a study conducted by the Centre for Studies in Ethics and Rights, Mumbai. Neha Madhiwalla and Nobhojit Roy, the study investigators, found that hostility and distrust of patients and their kin towards health workers is a result of strong-rooted frustration, build-up over years of dealing with a crippled and exhausting health system.
When one’s dealing with personal grief of seeing a near-or-dear one in pain, the slightest hint of cold, insensitive or irresponsive behavior of a health worker triggers an emotional, violent response.
On the other hand, doctors and all health workers have to perform, with no scope of making an error, in the same environment – marked by scarce resources, overcrowding, bad working conditions, long hours, and low pay. Their stress is compounded further, when dealing with agitated caregivers of patients, resulting in demoralisation and breakdown.
Such conflicts will continue to emerge at one place or the other unless the pressure and stress is drained out of India’s health system.
Rx: Health Policy 2017
Earlier this month, the ministry of health and family welfare released the latest National Health Policy after a gap of 15 years. Envisaging the highest possible level of health and well-being for one and all, the document lays down the goals, principles and objectives to achieve marked improvements on several aspects of the health system by 2025, with a bold assumption that the healthcare budget of India will be doubled – from 1.15 per cent to 2.5 per cent of the GDP. A legitimate, and a much-needed, long-pending ask.
The health policy acknowledges the criticality of human resource management to strengthen the health systems. It proposes an increase in the number of health workers and facilities in the high-priority districts. It strongly recommends the integration of AYUSH personnel, mid-level health workers and the private sector into the current system for expanding primary care access within the country.
It doesn’t, however, speak of specific initiatives or proposals to improve the work settings, workload and pay scale for doctors and health workers in public sector. Financial and non-financial incentives for rural postings and retention do find a mention.
India is ailing – she critically needs qualified doctors, nurses, paramedics and allied care providers in huge numbers to treat and care for her people. Alongside, she needs concerted policy actions to provide a respectable, safe environment, and optimally-resourced facilities for her health workers to do their job with rigour, passion and empathy that their profession is respected and revered for.
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