A series of papers recently published by The Lancet points to worrisome trends in the management of India’s primary healthcare system, particularly in the area of infectious diseases. Clearly, the country’s march to economic growth has not had the desired impact on healthcare. Despite the right to health being recognised as a fundamental right, quality healthcare remains elusive for the deprived sections of our society. With barely three per cent of the gross domestic product earmarked for the sector, health inequity is bound to increase. A reversal of trends can only happen with a complete revamp of the primary healthcare policy, but there is little indication of that taking place as the Union Ministry of Health is content to let matters drift. Inadequate research material also makes revamping difficult. As the journal says, a well-planned research programme is fundamental to the improvement of healthcare in India. Unfortunately, the proportion of health research published in India is barely five per cent of what is published worldwide. And even these documents, as The Lancet says, under-represent the priority areas relating to communicable and non-communicable diseases. This has made it difficult to track the efficacy of the healthcare system and stunted our understanding of whether it is addressing the needs of the people. With only one in four public health reports found to meet international quality standards, it is no wonder that the steps initiated by the Government on the basis of such documents continue to flounder. Organisations like the Indian Council of Medical Research, the National Institute of Epidemiology and the Public Health Foundation of India have some answering to do on the quality of research produced. Ideally, they should have been collaborating to provide universal healthcare, but since they have been busy fighting turf wars, it is time to create an overarching body that will coordinate their efforts and help create policy papers that are rooted in ground realities and do not just look impressive as power point presentations.
Government has neither will nor policy
The ground realities are disconcerting. In 2009, the country had two million new cases of tuberculosis — the highest for any country in the world, with 2,80,000 persons dying of the disease. In addition, malaria claimed between 1,25,000 and 2,77,000 lives, according to independent estimates, although Government reports provide a much lower figure — 1,144 — for deaths in that year. Child and maternal care indices are also disappointing. Mortality rates for 2010 were at a high of 62.6 per 1,000 live births. More than half of the deaths among children under five years of age occur in the neonatal stage, due to sepsis, pneumonia and tetanus. Of those that survive, 48 per cent suffer stunted growth primarily as a result of malnutrition. By this reckoning, we will be far away from meeting the Millennium Development Goals in healthcare.
Government has neither will nor policy
The ground realities are disconcerting. In 2009, the country had two million new cases of tuberculosis — the highest for any country in the world, with 2,80,000 persons dying of the disease. In addition, malaria claimed between 1,25,000 and 2,77,000 lives, according to independent estimates, although Government reports provide a much lower figure — 1,144 — for deaths in that year. Child and maternal care indices are also disappointing. Mortality rates for 2010 were at a high of 62.6 per 1,000 live births. More than half of the deaths among children under five years of age occur in the neonatal stage, due to sepsis, pneumonia and tetanus. Of those that survive, 48 per cent suffer stunted growth primarily as a result of malnutrition. By this reckoning, we will be far away from meeting the Millennium Development Goals in healthcare.
