Fixing India’s health profile

Many committees have sat and gone since the Bhore Committee in 1946, plenty of policies have come and gone at Nirman Bhawan. A lot has been done, but some problems like malnutrition, anaemia, mental health, non-communicable diseases, vector borne diseases have continued to surround us which have created an implementation nightmare. Fixing India’s health profile needs the art of medicine and the skill of public health in full measure. There was a time in health care when bedside diagnosis and history taking was paramount.

Health systems across the country are overstretched. With emerging and re-emerging diseases in circulation, hyper-information over search engines, everyone from every corner seems to advice on what to eat, what to drink and what to consume and at times, which medicine to take.

Extending medical service to over 1.4 billion people is complex, diverse and challenging. While recent decades have seen reasonable advocacy around strengthening the health profile of the country, we are still very far away due to our inability to pursue talent. In broad strokes, here are some ways in which we can begin to alter the course of India’s journey in health care, provided we begin now.

India’s health profile can be fixed by transformative public health. This essentially means, a bottom-up approach alone, will fix our woes. All health policies being planned unless integrated and cross-thematic in nature, it will have limited potential for change in a rapidly changing environment. We need to look at transformative public health beyond New Delhi’s corridors. No doubt health is a state subject, but the needed inspiration is often derived from the central government’s hand holding systems. We need to look at the challenges faced in terms of awareness among the people, access to health care, affordability that surrounds the cost involved – both direct and indirect cost, availability of skilled health care professionals and doctors and accountability of the health system at large. All these challenges require a grassroot level mapping in every district of the country, subsequent to which solutions can be found.

The collectively absence of focusing on preventive health care instead of curative health demands a very serious line of re-thinking which is necessary to protect a population of 1.4 billion and counting. Resurrecting a fragile and broken health care system will need people with vision, ambition and the craft for navigating new policies with existing means. It will mean looking at patients as people and not from a prism of a statistical number.

More than 100 institutions around the country today offer Masters of Public Health (MPH). However, the National Classification of Occupations 2015 finds no mention of the degree at all. Epidemiologists and public health specialists are absent in the classification of occupations list. The ministry of labour and employment should have long amended the same and updated it, besides mainstreaming public health professionals who demonstrate superior competence and craft over many other disciplines.

The health department must solely be run by community medicine doctors and public health qualified professionals if we want to see serious results in the country.

The focus must be to invest in public health care now and make world class public hospitals at all levels of caregiving and also build social protection for every Indian.

This article is authored by Dr Edmond Fernandes, honorary director, Edward & Cynthia Institute of Public Health.