Introducing a recently published book on healthcare
Vidya Bhushan Arora*
Besides Roti, Kapda aur Makan, healthcare is one of the most vital determinants of people’s wellbeing. India, like other countries of the developing world, faces a wide range of challenges in the health sector – from the lack of health infrastructure to severe lack of trained human resources. This results in stark imbalance in allocation of healthcare resources amongst the poor and the rich or the urban and the rural populations. Though the importance of healthcare has never been lost on the polity of India and despite inadequate outlays for healthcare in the federal and states’ budgets, it finds place in the manifestos of all major political parties at national or state level. The awareness at top political level has produced some positive results like the Aayushman Bharat at national level or the latest in this series is recently enacted Right to Health Act, 2022 in Rajasthan, but these efforts are like a drop in the ocean – too feeble to make any tangible difference to the overall messy situation in the health sector.
There has been no dearth of literature on various issues afflicting the health sector which, besides many scholarly books, include a large number of reports submitted by expert committees set up by government(s), health survey reports or the medical literature produced by the universities and research institutions. However, still there was a felt need of a comprehensive volume which would not only identify the problem areas and raise questions but also provide solutions – a book which can illuminate the multifaceted complexities of the health sector and put forth, in simplest terms, the possible resolutions of those issues. In the process, it should make policy-makers, politicians included, to move towards hitherto unexplored areas.
The recently published “Dream of a Healthy India : Democratic Healthcare in post-Covid Times” (Edited by Ritu Priya and Syeda Hameed and published by Penguin Random House) seems to fulfil this need as it contains over a dozen essays by well-known experts and academics from varied branches of the health sector. Besides, it has an exhaustive introduction by the two editors both of whom are well-known for their work in the healthcare. In their introduction, they examine various dimension of the health sector in a purposeful manner and present before the readers a possible scenario which can actually work. The introduction proposes that medical services will have to be seen as a social institution that is part of a wider range of preventive, curative, palliative and rehabilitative activities.
Editors : Ritu Priya and Syeda Hameed
Dwelling upon the possible solutions, the introduction points out that an approach which takes into account holistic-health-systems and examines the historical experience of health services development and gives space to people’s experience and knowledge, will generate the most cost-effective trajectory. It will be most easily operationalized if the government agencies and the community come together to play a leading role in health sector. The authors caution, this may look unrealistic dream at this juncture when a highly commercialized health service system seems to have got accepted as the norm. However, looking at the future with a positive note and with hope, Ritu Priya and Syeda Hameed remind the readers that societies, at various periods of time, including the present, provided treatment services as an altruistic or a philanthropic or state-sponsored free service for the ill and suffering. It is only in the past four decades of this neo-liberal era that we have witnessed a policy supported pervasive commercialization of medical services at unaffordable levels.
All essays in the volume present viable solutions along with the necessary explanation of the principles on which these are based. The editors hope that these solutions will be found feasible for giving shape to the vision of a what they call ‘public-community-partnership based system’ which can also be adopted by the private sector as a ‘win-win solutions’.
To provide the readers an insight into the book, we give you a glimpse of some randomly chosen essays in the volume. “Ensuring Health for All, in All Policies” an essay by K. Srinath Reddy, a renowned cardiologist and presently, President of the Public Health Foundation of India, advocates the provision for health impact assessment on the lines of environmental-impact assessment. Reddy writes, “Since the determinants of health lie in many sectors, we need ‘health in all policies’. To convert this from rhetoric to reality, we need to build capacity for health impact assessment and evaluate the potential and effects of policies and programmes in other sectors on human health and wellbeing. Health-impact assessment needs to be promoted on the lines of the environmental-impact assessment. It needs to be multi-disciplinary in its approach and assess both direct and indirect health impacts”. It is also necessary to bring people’s voices prominently into such assessments, he adds for good measure.
Imrana Qadeer, who moved to the public health from paediatrics and taught at the Centre of Social Medicine and Community Health, JNU for over 35 years, in her comprehensive essay, “A Scaffolding for Rebuilding Public Health Services in India” explores the principles of integrated planning in healthcare sector that were introduced by the early planners in independent India but neglected later. She observes that the laxity and distortions in interventions like the Universal Immunisation Programme, Child Survival and Safe Motherhood Programme, the National Rural Health Mission (NRHM), ICDS, PHC etc show how health sector reforms in India actually serve the interests of business at the cost of the majority and how public health has become a victim and a vessel for market expansion. The author ruefully adds that state investments in the health sector in India not only declined to the lowest in the world but were shifted over to the private sector through various mechanisms such as public-private partnerships, concessions offered to the private sector and the shift of personnel trained in the public sector. Imrana argues in her essay that strengthening primary healthcare infrastructure, its referral chain and components are critical for rebuilding the public health system. The author suggest that the private sector must either be compelled to conform to the conditions of partnerships or stand for itself and it must be made accountable for the responsibilities it accepts, and a level playing field promoted in its partnerships with the public sector. “This would necessitate that efficient regulatory mechanisms for both public and private sectors are built into the system,” she adds.
In her essay “Creating a System of Healthcare Providers for Universal Health Coverage”, K. Sujatha Rao, former Health Secretary, Government of India and a Takemi fellow at the Harvard School of Public Health lays emphasis on people and community resources and says that the more the engagement of the community, the better the quality of policy design and effectiveness of implementation. This was best demonstrated in the HIV and AIDS control programme where key population groups were engaged in policy formulation and implementation. Sujatha Rao also gives several useful and pragmatic recommendations in her essay to achieve the goals of Universal Health Coverage (UHC) which all seem workable. Since she has a long experience in governance at various levels, her propositions seem based on the practical wisdom gained in the field. For instance, she says that besides a focus on doctors, there is an equal urgency to make better use of nurses by delegating them routine functions and encouraging task shifting. They should be incentivised to upgrade their skills and undertake master’s course. Sujatha Rao also calls for reversal of policies that are commercializing medical and nursing education in her recommendations.
Similarly, other essayists have serious misgivings about the increasing role of private sector in healthcare. In an essay, ‘People over Profits : Reshaping India’s Private Health Care’, jointly written by Abhay Shukla, Shweta Marathe and Kanchan Pawar, authors suggest the possible means of regulating and socializing the private health sector services for public good. They argue that COVID-19 has shown a silver lining in terms of opening the way for re-imagining pubic engagement of private health care and building a wider framework of public obligation and social accountability of the private sector, driven by the public health system.
All other essays in this volume have an informed critique of the health sector as well as valuable suggestions. This compilation has certainly been successful, as the editors claim in their Preface, in demystifying the issues of healthcare and health systems for the general reader, as well as to simultaneously provoke rethinking on several critical dimensions by policymakers and academics.
Since it is not possible to do justice with the content of the comprehensive volume in a book review, we are giving a snap of the content page so that readers can get a glimpse of the wide range of topics covered in the book.
It may be mentioned here that this book is 9th in the Rethinking India series that Samruddha Bharat Foundation is publishing with Penguin Random House. The Series Editors are Aakash Singh Rathore, Mridula Mukherjee, Pushpraj Deshpande and Syeda Hameed. The Series Editors’ Note informs that the volumes in the series are outcome of a long process under which over 400 of India’s foremost academics, activists, professionals and policymakers across party lines have constructively engaged to take serious cognizance of India’s present and future challenges and to rise to them.
You can order you copy of the book here.
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*Vidya Bhushan Arora maintains this bilingual web magazine. Also writes on politics and literature.
