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Role of Local Health Systems in India.
In pre-independent India, the Bhore Committee was one of the committees set up for the new Indian Government in making to make plans for the country's development. The health Committee was to study health problems and suggest the most appropriate health care system for the country. At that time allopathic system coexisted with homeopathy, ayurveda, unani, and siddha systems of medicines. There were many local healers in rural areas practicing traditional medicine. It was not a moneymaking business but truly for the well being of the community.
The Bhore Committee members were physicians with formal training specifically in allopathic (modern medicine). In India, many deaths were due to untimely treatment or the lack of knowledge about the diseases. There were deaths due to viral fevers, wheezing, cholera, etc. The Western world had conquered the mysteries of such difficulties to the health of human being. Immediately, the growth in the studies of modern medicine was connected to this success. Modern medicine had shown significant success in tackling epidemics through its technological solutions. So, the Committee found it right to promote modern medicine into India. As outsiders into this economy, they did a great job destroying the traditional systems. Though they did not ask for the other systems to be abolished, they stated that the term 'doctor' should be only given to formally trained physicians of modern medicine and practice in this field should be restricted only for 'doctors'.
The same Committee stated in a report (1946) its recommendations to the Government:
- No individual should fail to secure adequate medical care because of the inability to pay for it.
- More stress should be laid on rural areas since the economy rests on the agricultural populations.
- Health services should be as close to the people as possible.
- Greater emphasis should be placed on training basic level workers, more of whom are required than doctors.
Originally the system is supposed to focus on Primary Health Centres (PHC) that is supposed to provide a combination of preventive and simple curative services and is staffed by 2 or 3 doctors and 20 – 30 paramedical workers. Each PHC is to have 8- 9 subcentres attached to it and is staffed by an auxiliary nurse midwife (ANM).
However, this system turned completely upside-down. With the coming of the supposedly successful western model of modern medicine, which relied on high cost, hospital based, curative services provided by doctors using elaborate diagnostic aids and equipment, the importance given to nurses and paramedical staff reduced. To adopt the western model large teaching hospitals had to be built to educate doctors who will spear head the health care system. It was felt that setting these in highly populated urban areas would benefit more people. So, these high cost teaching hospitals were built in the urban areas. Though the Bhore Committee had suggested rural focus, the Government sensed profit by focusing in urban areas.
Specialization became the goal word of the health care system. Health care turned into a moneymaking business. More and more 'doctors' came into the field.
Private practice still existed which gave these 'doctors' the privilege to decide their own rate. Good health became a luxury. Most of the money in the economy went in building the big hospitals and medical institutes in urban areas. The left over money was given to take care of the rural health care services. This inequity is created by the act of continuously ignoring the rural areas, the home of the majority yet poor, and not due to lack of resources.
The health of an individual in a rural area is given the least importance. The Primary Health Centre is miles away from the village in highly populated towns. The villagers suffer in times of emergency. The Below Poverty Line (BPL) survey does not talk about the nutrition or health of a family. A healthy life is the basic need of any man/ woman/ child. Yet the health care system runs with such high level of ignorance.
However, the problem does not stop here. Indian Government has taken on a planned approach to the development of health services. The State would play the fulcrum of training, finance and management. By the mid- 1980's, the Government realized its inability to achieve such high fetched goals in health care and thought the incorporation of the private sector as good. As in many other departments, it gave birth to a mixed model with the growth of the private sector and the public sector being interconnected.
So, the limitations of the public health system in India are:
1. There are more Apex centres, mainly concentrated in urban areas, than subcentres and local clinics, and therefore fail to attend to the suffering poor.
2. There are more 'doctors' than paramedical staff, nurses and midwives.
3. Lack of nutritious food (2100 calories in urban areas and 2440 calories in rural areas as per BPL standards)
4. Large-scale unemployment and poverty prevents a huge population from accessing good health facilities; to repeat myself: Good health has become a luxury.
5. Lack of education about personal and public hygiene
6. Most importantly, privatization and corruption spearhead the downfall of the public health system. Government hospitals sell the medicines rather than providing it for their own patients, doctors promote particular medicines, which they are paid to market.
These limitations prevent the Indian public health care system from improving and providing the public.
An agenda for health care in a developing country like India must include the following:
1. Establishment of more public health centres and subcentres
2. Good sanitation facilities, especially in slums;
3. Making medicines for common diseases available at low rates in all pharmacies
4. Employing more paramedical staff
5. Break the notion of the supposedly successful mode of specialization
6. Hold vaccination campaigns for all endemic diseases;
7. Education about basic hygiene, rationing of nutritious food stand as equally important measures to ensure a reasonably healthy society
For example, Barefoot College (Tilonia) has tried to set up an appropriate local health care system and have proved achievement. It was started in 1973 as a small curative dispensary providing free services and medicines to all the villagers.
They soon realized to enforce people participation the work should not limit itself to the framing of charity and a small fee was charged for the services. A team of doctors and nurses went for regular visits for routine health examinations. Today, more than 200 health centres serve villages throughout India.
Since 1986, they have been using biochemic medicines and semi-literate villagers are trained to prescribe such medicines.
In every village there is at least one health worker or svastha karyakartha trained to use the 12 root biochemic medicines. The College has developed 28 medicines from these 12 root medicines. The health workers can give artificial respiration in emergencies, and take a patient to the nearest government hospital when necessary. Health workers also teach villagers about basic health issues, including hygiene, the importance of vaccinations and other preventive measures.
They also hold health camps in villages. Health camps address specific health needs: eye disease, tuberculosis, blood donation, physically challenged, mentally unwell and other health or family issues.
Some of the other programs are:
The Physically Challenged: The College has since 1997 been involved in working with the physically challenged youth in villages. The youth have been trained as barefoot pathologists, to make wooden science toys as well as handling computers, working at telephone booths and the crafts shop in the campus. There are 50 such teenagers involved full time with the College.
The Mentally Challenged: Another new initiative taken up on an experimental basis in 1998 has been the working with the mentally challenged in villages. By organizing monthly Mental Wellness camps, the college has since continued the experiment on a regular basis. More than 100 village members including children, youth, men and women have regular access to advice from government psychiatrists as well as treatment and medicine regularly.
Mother and Child Care: From the time a woman conceives until her child is six years old, mother and child are taken care of by the village midwife or Dai. Every mother receives regular checkups during her pregnancy and appropriate preventive care. She is also educated about the importance of timely vaccinations, for herself as well as her children. The Dai also teaches the mother the importance of good nutrition and diet.
They have proved an appropriate health system as a possibility. If it is possible in one place it is possible in all others. There is no doubt to the fact that a good health system is the government's responsibility, but as being fellow human beings working out of are own hearts is not a sin. If we can do something to better the health system, apart from the government like the Barefoot College it is sure to bring only well, maybe in varied amounts. Ultimately every problem's solution boils down to the individual initiative.
The Bhore Committee members were physicians with formal training specifically in allopathic (modern medicine). In India, many deaths were due to untimely treatment or the lack of knowledge about the diseases. There were deaths due to viral fevers, wheezing, cholera, etc. The Western world had conquered the mysteries of such difficulties to the health of human being. Immediately, the growth in the studies of modern medicine was connected to this success. Modern medicine had shown significant success in tackling epidemics through its technological solutions. So, the Committee found it right to promote modern medicine into India. As outsiders into this economy, they did a great job destroying the traditional systems. Though they did not ask for the other systems to be abolished, they stated that the term 'doctor' should be only given to formally trained physicians of modern medicine and practice in this field should be restricted only for 'doctors'.
The same Committee stated in a report (1946) its recommendations to the Government:
- No individual should fail to secure adequate medical care because of the inability to pay for it.
- More stress should be laid on rural areas since the economy rests on the agricultural populations.
- Health services should be as close to the people as possible.
- Greater emphasis should be placed on training basic level workers, more of whom are required than doctors.
Originally the system is supposed to focus on Primary Health Centres (PHC) that is supposed to provide a combination of preventive and simple curative services and is staffed by 2 or 3 doctors and 20 – 30 paramedical workers. Each PHC is to have 8- 9 subcentres attached to it and is staffed by an auxiliary nurse midwife (ANM).
However, this system turned completely upside-down. With the coming of the supposedly successful western model of modern medicine, which relied on high cost, hospital based, curative services provided by doctors using elaborate diagnostic aids and equipment, the importance given to nurses and paramedical staff reduced. To adopt the western model large teaching hospitals had to be built to educate doctors who will spear head the health care system. It was felt that setting these in highly populated urban areas would benefit more people. So, these high cost teaching hospitals were built in the urban areas. Though the Bhore Committee had suggested rural focus, the Government sensed profit by focusing in urban areas.
Specialization became the goal word of the health care system. Health care turned into a moneymaking business. More and more 'doctors' came into the field.
Private practice still existed which gave these 'doctors' the privilege to decide their own rate. Good health became a luxury. Most of the money in the economy went in building the big hospitals and medical institutes in urban areas. The left over money was given to take care of the rural health care services. This inequity is created by the act of continuously ignoring the rural areas, the home of the majority yet poor, and not due to lack of resources.
The health of an individual in a rural area is given the least importance. The Primary Health Centre is miles away from the village in highly populated towns. The villagers suffer in times of emergency. The Below Poverty Line (BPL) survey does not talk about the nutrition or health of a family. A healthy life is the basic need of any man/ woman/ child. Yet the health care system runs with such high level of ignorance.
However, the problem does not stop here. Indian Government has taken on a planned approach to the development of health services. The State would play the fulcrum of training, finance and management. By the mid- 1980's, the Government realized its inability to achieve such high fetched goals in health care and thought the incorporation of the private sector as good. As in many other departments, it gave birth to a mixed model with the growth of the private sector and the public sector being interconnected.
So, the limitations of the public health system in India are:
1. There are more Apex centres, mainly concentrated in urban areas, than subcentres and local clinics, and therefore fail to attend to the suffering poor.
2. There are more 'doctors' than paramedical staff, nurses and midwives.
3. Lack of nutritious food (2100 calories in urban areas and 2440 calories in rural areas as per BPL standards)
4. Large-scale unemployment and poverty prevents a huge population from accessing good health facilities; to repeat myself: Good health has become a luxury.
5. Lack of education about personal and public hygiene
6. Most importantly, privatization and corruption spearhead the downfall of the public health system. Government hospitals sell the medicines rather than providing it for their own patients, doctors promote particular medicines, which they are paid to market.
These limitations prevent the Indian public health care system from improving and providing the public.
An agenda for health care in a developing country like India must include the following:
1. Establishment of more public health centres and subcentres
2. Good sanitation facilities, especially in slums;
3. Making medicines for common diseases available at low rates in all pharmacies
4. Employing more paramedical staff
5. Break the notion of the supposedly successful mode of specialization
6. Hold vaccination campaigns for all endemic diseases;
7. Education about basic hygiene, rationing of nutritious food stand as equally important measures to ensure a reasonably healthy society
For example, Barefoot College (Tilonia) has tried to set up an appropriate local health care system and have proved achievement. It was started in 1973 as a small curative dispensary providing free services and medicines to all the villagers.
They soon realized to enforce people participation the work should not limit itself to the framing of charity and a small fee was charged for the services. A team of doctors and nurses went for regular visits for routine health examinations. Today, more than 200 health centres serve villages throughout India.
Since 1986, they have been using biochemic medicines and semi-literate villagers are trained to prescribe such medicines.
In every village there is at least one health worker or svastha karyakartha trained to use the 12 root biochemic medicines. The College has developed 28 medicines from these 12 root medicines. The health workers can give artificial respiration in emergencies, and take a patient to the nearest government hospital when necessary. Health workers also teach villagers about basic health issues, including hygiene, the importance of vaccinations and other preventive measures.
They also hold health camps in villages. Health camps address specific health needs: eye disease, tuberculosis, blood donation, physically challenged, mentally unwell and other health or family issues.
Some of the other programs are:
The Physically Challenged: The College has since 1997 been involved in working with the physically challenged youth in villages. The youth have been trained as barefoot pathologists, to make wooden science toys as well as handling computers, working at telephone booths and the crafts shop in the campus. There are 50 such teenagers involved full time with the College.
The Mentally Challenged: Another new initiative taken up on an experimental basis in 1998 has been the working with the mentally challenged in villages. By organizing monthly Mental Wellness camps, the college has since continued the experiment on a regular basis. More than 100 village members including children, youth, men and women have regular access to advice from government psychiatrists as well as treatment and medicine regularly.
Mother and Child Care: From the time a woman conceives until her child is six years old, mother and child are taken care of by the village midwife or Dai. Every mother receives regular checkups during her pregnancy and appropriate preventive care. She is also educated about the importance of timely vaccinations, for herself as well as her children. The Dai also teaches the mother the importance of good nutrition and diet.
They have proved an appropriate health system as a possibility. If it is possible in one place it is possible in all others. There is no doubt to the fact that a good health system is the government's responsibility, but as being fellow human beings working out of are own hearts is not a sin. If we can do something to better the health system, apart from the government like the Barefoot College it is sure to bring only well, maybe in varied amounts. Ultimately every problem's solution boils down to the individual initiative.
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