A latest report led by the Institute for Health Metrics and Evaluation at the University of Washington has presented a very worrisome picture for Indian health system. It should cause concern to health care planners and providers as India appears to be lagging behind many of its South Asian neighbours like Bangladesh and Sri Lanka on several key health parameters.
Despite all its claims of growing economy, the report ranks India at 139 globally in terms of its reach in health delivery.
India is spending very little on healthcare. While there is a pressing need for increasing allocation for health care, authorities feel that the funds already allocated are not being used. This kind of attitude is going to worsen the general health-care scenario of the country. I think a fundamental correction is required in our healthcare system even as we need to ascertain our requirements.
There is a need of a strategic think tank which can calculate the timeframe for universalising healthcare in this country which is a huge challenge.
I feel there is a fundamental problem in the governance of child health and nutrition. India needs an operational plan to deliver and this can happen through engagement of qualified professional teams and gauging the reach of basic healthcare especially to the children. The country should look for a local answer to address the issues of healthcare.
Out of 26 million children born every year in India, a little less than 2 million die before they are five-year-old. Two-thirds of these deaths take place in the first year of their life. The question is how many of these children are reached by our healthcare system and physically examined and monitored. Every child in this vulnerable age group needs monitoring which unfortunately is absent in this country.
Due to the lack of basic amenities like clean drinking water and sanitation facilities, preventable diseases like diarrhea are still plaguing the subcontinent. All these things are part of the public health system. Even if all the mothers are supported to breastfeed their babies, thousands of the child deaths could be prevented.
I do not understand why the government does not take any action to encourage breast feeding despite all the data which shows the lack of it. Instead of just the lip service, government should ensure that a trained worker is available to the mother at the time of delivery. The social skills or the household skills acquired through our traditions have been lost to the so called modernisation. Government has issued very promising guidelines but I would be happy to see those guidelines translated into action which can be realised with a well thought out plan.
Private sector health system is another challenge over which health ministry does not seem to have much control.
The promotion by baby food industry has been banned by law in India since 1992-93. But the health system has not been involved in its duties of implementing that law. Even doctors’ conferences are being supported by baby food industries. The health ministry should check such practices.
There is evidence to blame that the big food industry and the advertisements carried by it are part of the problem. India’s figures from 1990 to 2010 have drastically changed with respect to non communicable diseases like the heart diseases which are notoriously known as one of the top killers. One of the objectives of the government’s future plans is to prevent such non communicable diseases.
Unless the government regulates the processed food industry like they have tackled the tobacco industry, the situation is not going to change.
In the long run, the processed food industry causing invisible losses to human lives is more dangerous than the tobacco industry. So, if health related conferences are supported by the big food industry, it provides legitimacy to the latter which unfortunately results in their products being consumed by the masses.
To top it all, recently, the health ministry has gone into collaboration with the private sector (defined as for-profit-corporate-sector globally). Ironically, the ministry has also issued guidelines called strategic approaches for engagement with private sector to work for children’s health.
The medical professionals are more influenced by the industry rather than the governments. The government should put its energy in setting up a complete system with delivery points for reaching out to people with the help of trained staff instead of doing things in a piecemeal manner. These efforts should begin right from the stage where a doctor, nurse or a health-worker is initiated in the system.
It is high time that the onus is put on the doctor to break the unholy nexus between the medical practitioners and the pharmaceutical industry. There is a strong case of regulation to keep the vested interests out of India’s healthcare system.
(Dr. Arun Gupta is Member, Prime Minister's Council on India's Nutrition Challenges and Regional Coordinator, International Baby Food Action Network (IBFAN) Asia Pacific.)