December 2010

Healthcare needs surveillance grid

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‘Fixing the sick’ approach should give way to a preventive care and diagnostics system, especially for the rural people

As a speaker invited to talk on the trends in healthcare sector in an event in Chennai recently, I was pleasantly surprised to hear Dr Mahesh Vakamudi echoing noted futurist Jim  Carroll’s forecasts for year 2020. Mahesh is head of Anesthesiology and Critical Care at Chennai’s Sri Ramchandra Hospital.

Quoting Carroll, my fellow speaker put forth the proposition that India needs to transform the present healthcare system, which “fixes people after they are sick,” into a more proactive preventative care and diagnostics system.

Unfortunately, for India, a decade may not be sufficient to achieve this paradigm shift. And there are too many odds stacked against it.
Today, the biggest challenge that the country faces is not that of ‘availability’ of quality healthcare; the country has sufficient number of best-in-breed healthcare facilities to meet needs of urban population segments. Instead, India is grappling with a huge challenge of ensuring ‘accessibility’ of quality healthcare facilities to all, particularly for the rural populace.

According to the data made available by the Union Ministry of Health, curative services favour the non-poor in India – for every Rs 1 spent on the poorest 20 percent population, Rs 3 is spent on the richest quintile.

All this, despite the National Rural Health Mission (NRHM), which has not been able to achieve anything remarkable in improving the state of health facilities in rural hinterlands.

Yes, NRHM can claim to have made some impact in neo-natal care and immunisation, but ill health continues to be a major risk factor for the rural poor in the country. And the reasons are clear for anyone to see: lack of adequate healthcare  services in rural and remote areas and very high direct and indirect costs of accessing them elsewhere.

Non availability of a ‘neighbourhood’ healthcare facility adds to the loss of ill person’s contribution to the household economy and leads to a diversion of time – particularly of women in poor rural households – from productive activities to caring for the ill.

And the impact is severe. Over 40 percent of hospitalised Indians are believed to borrow heavily or sell assets to cover their healthcare bills, while 25 percent of hospitalised Indians fall below poverty line because of hospital expenses.

To transform from a not-so-efficient curative care nation to Carroll’s vision of treating citizens “for the conditions we know they are likely to develop, and re-architecting the system around that reality,” India needs to quickly set up a nationwide disease surveillance grid, something that had been piloted in bits and pieces but never quite rolled out.

While the NRHM mission document does talk about strengthening capacities for data collection, assessment and review of evidence based planning and village-level disease surveillance system, the government now needs to drive the agenda as part of its integrated Mission Mode Project under the National eGovernance Plan.

It should also create a mechanism to fund the initiative as part of the state’s overall budget allocations, and link the disbursal to a time-bound, milestones-based implementation plan with a fixed project deadline and fund expiry date.

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