I was attending a conference, a couple of years back. The speaker, who is a very well-known CEO of a state of the art hospital in India, and an eminent doctor, responded to a question asked by me, whether in India we could have cycling tracks; he snapped back at me with an imperious gesture, that you are asking for cycling tracks in the cities, where half the India doesn't have roads. I wondered, cycling tracks were for road safety in the cities and to prevent environmental hazard, how would that be a counter argument for constructing rural roads. But, I was too intimidated to speak, I had a very senior doctor admonishing me.
A research study done by Dr. David Bishai, from JHU, reiterates that there is a zero sum game between preventive and curative care. It says,"too often, only a single, limited government health budget is available for investments in both non-personal preventive and curative personal health services. the growth of curative care services can crowd both fiscal and policy space for the practice of population level prevention work, requiring dramatic interventions to overcome these trends." In India we have seen that primary health care always receives lesser funds than the secondary and tertiary health care. Under Ayushman Bharat, there was an announcement made to transform 150000 sub-centers into Health and Wellness centers in the country by 2022. The budgetary allocation for these centers has been Rs.249.96 crores in urban areas and Rs.1349.97 crores in rural areas, for the year. This means about Rs.107000 to each center. Even if you have the same allocation for the next three years, it will be just Rs. 3,00,000 per center. It will be very difficult to fulfill the infrastructural requirement alone, with this much of money. At each HWC, we need to have a community health officer, supply of drugs, diagnostic facilities, paramedics and yoga instructors, it is clear that this much is not enough. Should we generate CSR funding for HWCs? I will write more on that in a separate blog.
Health is a human right. The earliest health system was created to respond to this basic right of a human being. For years, it continued to function like that and health care providers offered their services with an altruistic ardour. Modern healthcare system positioned health in a market system. The demand and the supply determined the price. Preventive care took a beating under the argument that the more the people fall sick, the more there would be a demand for healthcare. The lesser the supply the bigger price it could fetch. Market economy argument is based on allocational efficiency, but health and education are such sectors, where allocational efficiency is not determined by market forces as there are huge externalities generated by these services.
I was talking to Dr. D.K.Mangal, my senior colleague and a veteran public health exponent, about Dr. Bishai's proposition. He said that with the advent of allopathy, health care providers turned into providers of curative care and the entire system is centred around that. Resultantly, primary health always takes a back seat. He said, one solution to the problem could be to change the construct of curative care and bring it totally under the public good/service domain by banning private practice entirely, and connect it to primary health. The other solution to the problem is to delink the healthcare from curative centred infrastructure and create a parallel primary health infrastructure based on preventive and promotive health models to create a balance.
A few months ago, I was having a discussion with Dr. David Bishai, and he said that a 'community health officer', preparing a quarterly report on the health data, collected by him for the people registered at his HWC, bringing to light, the 'winnable battles', for his area, would illicit very quick action from the providers. Public health interventions could be planned based on these reports provided by the CHO, so that the healthcare reaches 'the last mile'.
'If we don't take active steps to address the problem, perhaps the technology will force us to do it, science will', was how Dr. Mangal concluded his discussion with me. I too agree with him. Technology is a great leveller. Dr. Narayan Murthy, talking about technology said, "It has improved transparency, conquered distance and class barriers. It has the potential to create a fair society and enhance the accountability of the rich, the powerful and the elite to the poor and disenfranchised in every society."
The word 'Arogya' in sanskrit means 'overall well being'. Conventional Indian thinking around the idea of health was prevention of disease rather than treatment of disease. If we focus our entire attention towards developing a model of healthcare, which is clinic driven, the system will merely diagnose the disease and treat it. The system will never focus on the environment from where the patient is coming from, the possible psychological, environmental and physical causes of disease, and to address those causes. Allocation of human, physical and monetary resources, in that case will also be on 'cure', and it will result in a very inefficient allocation. Research in the right direction of 'arogya' will not happen. It will require a complete revamping of the health system. To achieve a preventive or 'arogya' focus, the redefining of the roles and responsibilities of all major stakeholders, be it doctors, pharmacies, diagnostics, patients and policy makers. A more judicious and efficient allocation of resources will be possible only if pursue 'arogya'.
The word 'Arogya' in sanskrit means 'overall well being'. Conventional Indian thinking around the idea of health was prevention of disease rather than treatment of disease. If we focus our entire attention towards developing a model of healthcare, which is clinic driven, the system will merely diagnose the disease and treat it. The system will never focus on the environment from where the patient is coming from, the possible psychological, environmental and physical causes of disease, and to address those causes. Allocation of human, physical and monetary resources, in that case will also be on 'cure', and it will result in a very inefficient allocation. Research in the right direction of 'arogya' will not happen. It will require a complete revamping of the health system. To achieve a preventive or 'arogya' focus, the redefining of the roles and responsibilities of all major stakeholders, be it doctors, pharmacies, diagnostics, patients and policy makers. A more judicious and efficient allocation of resources will be possible only if pursue 'arogya'.
Digital Health, Data Analytics, Tele-medicine, Internet of things, Artificial Intelligence, and Genetic Engineering will help in developing a fair health system. Would it create a balance between primary and tertiary, preventive and curative health care systems in future? Will science develop to an extent that the gene would be modified and be made into a 'designer gene', so that the disease and old age will be eliminated? But, for that too we will have to allocate the resources in the right direction.
We all think alike, across geographies, nations, sectors and age-groups. We are a minority though, but waves of change could be felt.
