This is the story of India in almost all fields – pockets of excellence but rank callousness in everything else. Perhaps primary health is one of the worst, followed by education, sanitation, pollution. The list is long.
Dr. K Sujatha Rao’s book ‘Do We Care – India’s Health System’, published by Oxford University Press in January 2017, is a stinging attack on the lack of vision for a healthy Indian state even after 70 years of Independence. India’s HDI (human development index) global ranking hovers around 130 to 140. If India is to be ashamed of anything, it is this ranking.
The author wrote this book after she retired as a top bureaucrat in the ministry of health and family welfare, so the facts and context is highly current. After she retired, she says she was able to have a ‘citizen’s perspective’ to healthcare owes. It’s a pleasant surprise to see an activist tone throughout the book. Hope it rubs off on her bureaucrat friends and colleagues, who might influence their bosses into coming up with a robust health policy.
“India’s health policy is often described as good on paper but weak in implementation with wide gaps between what the policy documents state and the actual achievement on the ground…. Why are hospitals dirty? Why do children continue to die of diarrhea or respiratory infections or are let unimmunized even when the required funds have been provided? These are legitimate questions but have no simple answers.”
The author doesn’t mince words in blaming the leadership of all governments without taking any sides. It’s clear that the ills of governance, insufficient investment stem, poor infrastructure, poor quality of health education all stem from the absence of a vision-driven policy. Even if there were successes on addressing a few diseases like HIV and polio, they have been ad hoc.
Inconsistencies in policy is a greater sin, she alludes. “Policy inconsistencies reflect a lack of will to govern, with the political executive failing to carry out their responsibilities, names institute laws, reform and revamp the institutional architecture to suit the changing scenario, build systems to guarantee transparency and accountability and ensure implementation of policies with professional oversight.”
Fortunately, the book goes beyond cribs and lays out an exhaustive systems driven action plan. That’s where the book becomes valuable for policy makers and policy implementers.
Research & Data
Dr. Sujatha says, “There is still a lot of latitude available for instituting evidence-based and data-driven process and ensure outcomes with better supervision, close monitoring, and good management practices.”
The data in the new regime should reflect wide difference in almost everything even between two adjoining districts in India. While qualitative targets should reflect national vision, she says, quantitative targets should be based on an assessment of state and district data. That’s when differential planning makes sense – instead of one plan-fits-all approach.
Her big insight is for the Centre to let go of its control on health and give enough powers and funds to the states and the states in turn make districts responsible. This will also impact better delivery system through better access.
Since 70% of outpatient and 60% of inpatient treatment and 80% of specialists, partnering with the private sector seems inevitable – this calls for new expertise and capacities that are currently non-existent in the public system. The other challenge facing the government, which it has to resolve quickly, is how to constructively engage with the non-commercial – NGOs or for profit social enterprises for public welfare.
She hits the nail on the head when she says that “waiting for our elected leaders to provide leadership to the health sector appears to be futile. Ultimately, it is the people who will have to assume responsibility….They have the power to make the system more accountable and flag health as an election issue. Only then will the government act and respond to address this crisis.”
Do we have a manifesto for the 2019 elections, then?