Mumbai: India is one of the fastest growing economies in the world but a recurring theme of successive budgets is the low allocation of GDP that is given to fields like education and health. India’s tiny healthcare budget holds up badly in comparison to even some poorer countries, who have promised to provide basic healthcare to its people and the question of why allocation to health fell low on the list of priorities is still being debated.
Adding to this debate is a new book titled, ‘Do We Care?’ by former Union health secretary K. Sujatha Rao that gives an insider’s account of our health system and the problems confronting it, at the same time detailing some of the bright spots -- the progress the country has made in eradicating polio and reversing the incidence of HIV/AIDS to a large degree. The book was released at an event held on Monday at the Tata Institute of Social Sciences.
Ms. Rao said she first thought of writing a book on her years at the National Aids Control Organisation. She said she wanted to document for posterity the lives of those persons who had dedicated their entire lives to working with the most marginalised and most discriminated. A later stint, however, at the Harvard School of Public Health, made her look at India’s health system from a point of view of leadership, where she found a blank.
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“There are no records to say what the thinking was and the ideas and problems that constrained (Jawaharlal) Nehru, who believed so passionately in a welfare state, to focus on health. And when one looks around at other countries like China that is an equally traumatised country, we find that despite their problems, they embedded health and education into their development dialogue.”
Apart from a leadership deficit, with some notable exceptions, she said that management failures in health have also been high and that there is a near absence of accountability. She said when she hears of incidents like when a small infant died of rat bites in an ICU in Guntur in 2015 for instance, the question of do we as a society care about these failures screamed out at her. “Why are we a passive people, why is there no outrage,” she asked.
The first part of Ms Rao’s book deals with these issues and questions the economic model that neglects the role of the state and public investment in an area of health and looks at the challenges of governance. The second part of the book details two success stories - of how India won the battle against HIV and how the rural health programme was scaled up and strengthened. “The two successes we have in our health history are interestingly those born of self reflection and looking at our own evidence and not allowing ourselves to be influenced by global agendas,” she said. She pointed out that while the rest of the world at the time was focusing on treatment for HIV patients, India was one of the only countries that focused on prevention and decided to allocate 70 per cent of funds towards this.
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In conversation with the audience after releasing the book, Ms. Rao pointed out that some of the challenges facing the health system from a governance aspect are that in India no one is gaining an understanding of how policies in health are being made and what are the institutions and mechanisms that make them. “It’s very important to know how to navigate those corridors if you want to get your point heard.”
She also pointed out that we don’t have a vision, based on national consensus, on what we want to achieve as a health outcome. “If you go to a country or like UK or Canada, for instance, and ask what do you want to achieve with your health system, they will say equity, that all patients rich or poor should receive the same standard of treatment.”
“Policies in India around health keep changing on the basis of which party is in power but why don’t we have a policy based on national consensus that we can all stand by,” she said. As an example of the lack of resources given to health, she pointed out that while there are now 46 institutions that deal with finance in the country, as the economy has grown and evolved in health there is still only the Ministry of Health and the Medical Council of India. “We need to also urgently have a department of public health but the question is, do we care?”