Importance of Rural India vis-a-vis Indian Healthcare Reforms

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Current Indian Healthcare

A major concern plaguing India is the health status concerning India's rural population, since they constitute a major chunk i.e. approximately 65% of India''s population. The concerns have been heightened on account of increased participation by private hospitals in healthcare sector. This undoubtedly has resulted in inflationary costs pertaining to healthcare, thereby the affordability is out-of-reach for the rural poor or the common man.

Rural India vis-a-vis Indian Healthcare Reform

India is the second most populous country of the world, only next to China. The ever-changing socio-political demographic and morbidity patterns across India are increasingly attracting global attention in recent years. Despite several growth-oriented policies and healthcare reforms adopted by the successive Governments of India, the widening disparities viz. economic, regional, social and gender are constantly posing challenges for the evolving health sector which is in its nascent stage of evolution. About 75% of health infrastructure, medical or healthcare manpower and other allied resources are concentrated in urban areas, where only 27% of the total population of India resides. Contagious, infectious and waterborne diseases such as amoebiasis, diarrhoea, infectious hepatitis, measles, malaria, pneumonia, reproductive tract infections, respiratory infections, typhoid, tuberculosis, worm infestations and whooping cough dominate the morbidity pattern, especially in rural areas. However, non-communicable diseases such as blindness, cancer, diabetes, hypertension, HIV/AIDS, mental illness, accidents and injuries are also on the rise. The health status of Indians, is still a matter for grave concern, especially that of the rural population. This is reflected in the life expectancy rate (63 years), infant mortality rate (129/1000 live births), maternal mortality rate (438/100 000 live births). However, some progress has been made with the passage of time in that direction.

In spite of impressive progress and rapid strides made in the all-round development process of Indian economy, the demographic and health scenario of our country is a matter of grave concern requiring urgent action with the implementation and achievement of the desired objectives. The ever-exploding population growth in India accompanied with little success of family- planning initiatives has an adverse effect on the health of our people, the quality of their lives and Indian economy at large. The mortality rates for women and children continue to remain high. Almost one-third of the total deaths amongst the children occur below 5 years of age. Efforts for raising the nutritional levels amongst the Indian masses have yet to bear fruit and see the daylight. The extent and severity of malnutrition along with worm-infestation continues to be exceptionally high especially amongst the rural populace of India. Many villages still lack in proper sanitation facilities including faeces disposal. Only 0.5% enjoys basic sanitation facilities. There is lack of sanitary education and hygienic standards amongst the Indians. Many individuals do not wash hands properly with soap and water after defaecation, thereby resulting in poor or ill health. Communicable and non-communicable diseases have yet to be brought under effective control and systematically eradicated in a phased manner. There is a high incidence of blindness, leprosy and tuberculosis amongst Indians. Only 31% of the rural population has access to potable water supply. Ignorance about basic facts is largely prevalent amongst the rural masses.

The existing situation has evolved by the wholesale adoption of health manpower development policies and the establishment of curative centres by blindly following the Western models. These Western models are inappropriate and irrelevant to the real needs of the Indian masses and the socio-economic conditions in our country. The hospital-based disease treatment and curative approach has provided benefits only to the upper sections of the society, especially those individuals residing in the urban areas and continues to elude the rural masses. The proliferation of this approach that has been adopted by the successive Indian Governments has been at the expense of providing comprehensive primary health care services to the entire population, whether residing in the urban or the rural areas. Furthermore, the continued emphasis and stress on the curative approach has led the preventive, promotive, public health, rehabilitative and wellness aspects of health care to be neglected. The current approach, instead of improving awareness and building up self-reliance amongst the Indian masses, has instead tried to enhance dependency amongst the masses and weaken the community's capacity to cope with various healthcare related issues. The prevailing outdated policies with regards to the education and training of medical and health personnel, at various levels, has resulted in the development of a cultural gap between the public and the personnel providing care. By and large, the various health programmes have failed to involve individuals and families in establishing a self-reliant community. Over the years, the planning process has become largely oblivious of the fact that the ultimate goal of achieving a satisfactory health status for all Indians cannot be secured without involving the community regarding identification of their health requirements and priorities pertaining to healthcare aspects accompanied with effective and successful implementation and management of the various health and allied programmes.

To effectively tackle the currently prevailing situation, the problems plaguing rural health are to be addressed both at macro (national and state) and micro (district and regional) levels, a well-balanced holistic method needs to be adopted to address the outstanding and unresolved issues in a time-bound manner with genuine efforts to bring the poorest of the population to the centre of the fiscal policies formulated by the Government of India. A paradigm shift from the current 'Bio-medical model' to a 'socio-cultural model', that should bridge the gaps and improve quality of rural life, is the current need of the hour and an answer to the prevailing scenario in India. A revised and suitably amended National Health Policy addressing the prevailing inequalities in the current scenario and working collectively towards promoting a long-term perspective plan, with main focus on rural health is crucial and imperative.

Progress Achieved

Since the attainment of Indian independence, considerable progress has been achieved in the promotion of the health status amongst the Indians. Smallpox has been eradicated from India. Instances of plague are under control. Mortality rates, on account of cholera and water-borne related diseases, have significantly decreased. Occurrence of malaria has been effectively brought under control. The mortality rate per thousand of population has been reduced from 27.4 to 14.8 percent and life expectancy at birth has increased to 63 years of age. An extensive network comprising of PHC (Primary Health Centres), dispensaries, polyclinics, nursing homes, hospitals, old-age homes, rehabilitation centres, de-addiction centres and institutions providing specialized curative care has developed. There is no dearth of qualified medical and health personnel at various levels. Significant indigenous capacity accompanied with cutting edge-technologies for the production of drugs and pharmaceuticals, vaccines, sera, hospital equipments, etc, have been established. With the advent of Information Technology, numerous multinational software and IT companies specializing in healthcare, have set up their offices, captive centres, call centres, Outsourcing operations viz. BPO (Business Process Outsourcing), KPO (Knowledge Process Outsourcing), LPO (Legal Process Outsourcing) etc. in India.

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The first 5 paragraphs of the article are meaningful. The suggestion - "A paradigm shift from the current 'Bio-medical model' to a 'socio-cultural model', that should bridge the gaps and improve quality of rural life, is the current need of the hour and an answer to the prevailing scenario in India" - is fine but how this is going to be implemented is the question. The answer is not to set up a new course for rural doctors.

The reason for the present state of affairs is the blind adoption of the 'biomedical model' of western medicine. The same has landed the health care scenario in the US in a state of mess by becoming unaffordably expensive, not to speak of the role played by the insurance companies.

Worldwide, mind-body-spirit medicine is being recognised as simplifying medicine and healthcare and is being talked about as Era 3 medicine. We have forgotten the philosophy of mind-body-spirit medicine, which is fundamental to our own Ayurveda and which is in consonance with our socio-cultural model.

The Medical Council of India needs to take a hard look into such basic matters, if a longlasting solution is to be found for the health care disparity.

Vijayaraghavan.P Sunday, April 4, 2010

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