Tuesday, September 29, 2009

Missing Link – Indian Healthcare Crisis

I am writing this post with much anger and frustration. Or should I say I do not see any solution for the below explained problem. I watched Al Jazeera’s news video on Indian Health System which reinforced my inference drawn from our past experience of rural health care.

All these days, we are experiencing and learning a lot on rural development initiatives in India. We are seeing new initiatives that are specifically designed to bridge the gap between the ‘Rural and Urban’. It can be an Internet connection or a detergent which is now easily made available across the villages of India. Many organizations (Public, Private and Not-for-Profit) are backing the progress with respect to the rural reach programs. In fact it is turning out to be a good profitable business to reach the 72% of the rural population mass with some value added. We are seeing enormous wealth being created. In short we are trying to make our beloved ‘Visionary’ of India Dr. A.P.J Abdul Kalam’s dream PURA (Providing Urban amenities in Rural Areas) a reality.

Interestingly, while the focus is more on rural areas, we are still encountering a major challenge with respect to Indian Health Care System. If you read the below statistics (from Al Jazeera news report) you will know the major challenge that we are encountering:
  1. India spends only 5% of its GDP on Medical Care.
  2. It is a very tiny amount when compared to the 15% in the United States.
  3. There is a shortage of 2.2 million hospital beds.
  4. 53% or 67 million children below 5 years lack access to even basic health care.
  5. 72% population live in Rural Areas and 80% doctors are in urban centres.

While the rural mass is being targeted by many global players and organizations to create wealth, where is the Indian Health Care system heading towards? Why is it that it is getting difficult to address the Rural Health issues? And where is the missing link?

It was a very disappointing experience, in spite of our sustained efforts in trying our best to collaborate with many of the doctors and hospitals, we were unsuccessful in convincing ‘One’ doctor who can give his/her service in the Primary Health Centre of Kandavara village in Chickballapur taluk. We met with quite a lot of doctors and physicians to discuss about the non-availability of doctor in the village and literally begged for their services. We went on to an extent where in we requested for ‘One-day-in-a-week’ or ‘Four-hours-per-week’ types of services. We failed in all our attempts. The reason for our failure was not because we had no money to buy doctors, but, doctors were not keen on being in a village or carryout their professional services in a village. All they wanted is to be in the city limits and make enough and more money. I feel sad when I think about the reasons we got to hear from them. We also tried our best to get medical students to do their internship in the PHC of Kandavara. They came, they saw, they left with literally no response from their end. We met with many of the medical associations, many young and senior doctors in Chickballapur, but we could not succeed and the reasons weren’t deviating from where it was. We also took the help of journalism students, who did a commendable job in making a documentary by interviewing the government officials. But nothing substantially worked with respect to appointing a doctor to the PHC. Eventually, PHC was demolished and fortunately a Nursing school is being constructed in its place. Hopefully it will also have a hospital or a clinic attached to it. We will believe it only when we see it.

On the other hand, we have seen a lot of doctors who are committed towards the rural health, like the team from VGKK (Vivekananda Girijana Kalyana Kendra) at B R Hills run by Dr. Sudarshan, Vaatsalya HealthCare run by Dr. Ashwin Naik and team. They are doing remarkably well in keeping their promises on to the needy. They are going out of their way towards the primary and secondary health. Dr. Prashanth, who works at VGKK, to me, is a great volunteer. He has dedicated his life to the mankind by providing his services in the remotest villages of India. All the above mentioned gentlemen have the highest qualifications in their field and they are not doing this just for money. They are trying to make a difference with their dedication, knowledge and commitment to the society. They are the real altruists! And I am very certain that there will be many more like them.

But not enough! Absolutely not!

Is making money holding all the doctors going into the rural areas? Or it is the lifestyle that they need cannot be seen in rural areas? Why is it that there are no doctors, including a lot who are from the same rural background, are backing out of giving their services to the needy?

As per our discussions with the DC and ZP of Chickballapur, they were ready to compensate the doctors well. In fact, surprising to know is that government is finding it very difficult to recruit doctors to the existing PHCs. They are now depending on the voluntary organizations to help them. There were a lot of programs and schemes designed for the betterment of the rural health care during the era of the Ex-Principal Secretary of Health, Madan Gopal. But what is the use if there are millions of people without access to even the basic health care. And this is the story with most of the states in India. In the news report, an example is quoted says ‘a place in Andhra Pradesh, there is only one hospital for 35000 people’. There are many places where in patients walk a dozen kilometers to reach hospitals.

While we are having the world’s best health care technologies in India, world’s famous doctors and highly talented in house human resources, we are not using our strengths to reflect on our own problems. I am not too sure as to how to make the doctors come out of their current mindset, but I only know that this challenge remains the same unless we find that missing link!

This is a never ending crisis!

Here is the link to Al Jazeera's news video.



Narasim said...

It is nice to see how your frustrations result in angry prose. It seems to me that there are not enough people who are outraged enough to mitigate a problem.

Your detailed description of efforts to persuade a single qualified medical professional to spend even half a day a week in Kandavara tells a great deal about the value system of professionals who benefit from societal investment in them. One would like to think that after securing training in a med school largely funded by the state, graduates would have a sense of social responsibility. It is very clear that you and your colleagues did not run into a single doctor with any sense of paying back to society while making a good income. For them, it was just a bother.

If you had trouble in securing the services of a family physician for a PHC that is no more than 90 minutes from Bangalore, it is nearly inconceivable for me to see how a doctor would go to more remote villages and towns.

The story about VGKK and Vaatsalya demonstrates that all is not lost. May be, we should all focus on such people and leave the others alone.

My suggestion for you is: don't get discouraged by the vast majority. History is never made by the majority. All history in the past five millennia has been made by determined minorities.

Reading your angry essay tells me that you are one of those determined minorities. Good for you.

May you live long and prosper while serving the needy.

Vaishnavi said...

This question of doctors and medical students not wanting to do rural duty is quite sad. I mean, personally, as a journalist, I would love to go to rural India to work and do stories.
When a doctor has the power to change lives and improve health conditions, why can't he/she dedicate some time of their lives and knowledge to help the villages?
By the way, now the people of Kandavara have to go to the Chikballapur Hospital for any treatment? And when is the nursing school likely to be ready?

Sudhi said...

This blog reflects a true picture of healthcare sector in India. But this is not just one sector but few other sectors are also facing the same crisis.

I think the basic problem lies in our education system which gives us a specific skills but never teaches about the importance of such skills in serving the overall society which is lacking in our society. Everybody is just running behind money forgetting sociatal values.

We need to correct this, then only these kind of crisis will end.

sunaath said...

Well, look at the other face of the coin, Shrikant!
First, why we spend less on health care. Because we have to spend more on military and arms. Do you know why we are keeping mum when China is inching into India? Because India is not in a position to wage war with China. Not even with Pakistan.
Second, why doctors should not serve in rural areas. They should because there is social investment on them. But there is social investment on IIT engineers also! Why they migrate to lush pastures?
The solution is harsh. India should forcibly make the Indian citizen aware of his social responsibilities. But that means less democracy which is a holy cow!

Raghu said...

Well, your post truly exemplify the problems faced by the people of country side with respect to healthcare. The solution to this is not simple as we all usually think. I believe, a solution to this can be found in the combination of below factors:
1.Increased and sustained efforts from Government,
2.Increased role of voluntary organizations
3.More importantly changed mind set of people towards the rural cause and lastly
4.Increased awareness on hygiene and health by our rural mass.

Srik said...

Thank you for all your comments.

@Sunnath: The solution is harsh. India should forcibly make the Indian citizen aware of his social responsibilities. - You are absolutely right in saying this. At the same time, in my post, i did not mean they should not invest towards the war. Let them do it. But let them also do a fair job in investing for basic problems. Else we will go no where.

Prashanth NS said...

Very passionately written. As a person who has served within and outside the system, I try to tell myself not to get disillusioned. While on one hand, the State laments that no doctor serves in rural areas, on the other hand, they pay pittance to rural doctors. There is a total neglect of primary health care and a poor organisation culture at district level leading to corruption and insensitivity. It is indeed unfortunate, but I would see your blog as a call for action rathen than for lament.

Thanks for sharing.

Just another minor point - India spends less than 1 per cent of it GDP (not five even!) on health care. The five per cent quoted by you is total spending on health care including those from PEOPLE's pockets! Yes. That's how staggering the numbers are - 80% of money spent on health care in India came from people's pockets. The remaining paltry sum is the one that the State spent - amounting to around 1 per cent of GDP. However, the encouraging thing is the commitment of GoI through NRHM to increase public spending on health. But for that to be successful, I sincerely hope we have a stronger value system at district level.....so that all the increased spending actually translates into health care for all not wealth for few.

Narasim said...

Dear Prashant,

Thank you for educating me on the simple metric that in fact, India spends only 1 percent of GDP on health.

You are a gem for the simple reason that you have consciously elected to serve the needy when you could have easily chosen to seek wealth and comfort.

What is so disconcerting is that so many who secure their professional qualifications and pursue wealth come from families with very modest means. Guess the very roots of their emergence propels them to disregard their origins. A very understandable motive but not an admirable one.

Srik said...

Thanks Prashanth for your educative comment. I only hope all these hard facts enters the right space to get a better treatment. There by giving an opportunity to impact the millions of lives who are in need and ofcourse with more and more dedicated people like you joining the cause.