It is indeed ironic that while the role of the provider in health care is debated with much passion among users of such services, there is very little literature available from a non-clinical perspective on the various factors that impinge on their ability to provide care. Kabir Sheikh and Asha George seek to fill this gap in their rather prosaically titled compilation, Health Providers in India.
Health providers do not work in isolation. They work within distinct systems and are susceptible to the vicissitudes of a market economy. Their styles are sometimes cramped by political and bureaucratic ineptness. They are often over-burdened with work in settings that lack even basic infrastructure. All this however has only just started to figure in policy-making processes affecting the retention of human resource in the public health sector.
In an attempt to tackle the nagging problem of getting doctors to work in the primary health centres, governments at the Centre and in some of the States are engaged in incentivising postings in remote and rural areas. But only some of them are looking at the basic cultural, social, and gender issues that critically influence the efficiency of health care delivery.
This book categorises and discusses the diverse group of health providers under four broad heads: government health workers, who form the bottom bulk in this country; private health care providers and their tryst with public good; the legitimacy of traditional and home care providers; and personal experiences in professional spaces. While George, in the first chapter, focusses on the harassed auxiliary nurse midwives (ANMs), who constitute the bottom of the pyramid, Malvalankar et al attempt to document the changing role of the midwife in the Indian health care context.
Rama V. Baru highlights the sea change the profile of the public health worker has undergone in the era of commercialisation and the fast-spreading corporate culture in hospital management. She brings out sharply the wide gap that exists in working conditions, patient load, salaries, infrastructure, and access to technology. She makes the point that these differences effectively devalued the professional in the public sector and generated a sense of frustration, which in turn got reflected in their attitude towards patients.
Faith-healing and traditional systems of medicine can, by no means, be ignored in the Indian context. Lokohare and Davar offer riveting accounts of encounters between faith-healers and patients with mental illness in Maharashtra, and these should hold for the rest of the country as well. If this genre of health providers enjoy some element of popularity among those desperate for a cure, it is because they are easily accessible and allopathic care is rather difficult to access. Traditional orthopaedic practices in southern States —‘marmakalai' in Tamil Nadu and ‘kalari' in Kerala — and information about orthopaedic management under Ayurvedic and Siddha systems are analysed in a different chapter.
Specialised health interventions in the care of persons with HIV have come to rewrite the protocols in generalised health care delivery in India over the past decade and a half. Not surprisingly, the book devotes substantial space to chronicle this important development. Vasan and Ramakrishnan record the experiences of HIV counsellors in voluntary counselling and testing centres in Karnataka. Counselling was clearly revitalised by HIV/AIDS programmes. The work done by an NGO, Population Services International, in roping the private health care providers into public health intervention for people with HIV is a case in point. Gender is a recurring theme in the book, from the cultural and social contexts that constrain the ANMs to the personal experiences that include sexual harassment of female staff nurses by co-workers and patients in hospitals. Adding value to the personal experience component of the book is a piece of poetry from Gieve Patel, a doctor-poet.
Sheikh and George believe that their book will be a valuable resource for those engaged in health policy formulation. There is little doubt that the volume will serve as a good starting point for serious deliberations on issues related to health care providers in the country. Given the overhauling of public health care envisaged under the National and State Rural Health Missions, one would also think the book has come at the right juncture.