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Health-care inequalities: an Indian perspective
HEALTH INEQUALITY: INDIA
Health-care inequalities: an Indian perspective
and resistant organisms and r~ ecent advances in in~ - ~ formation technology, prevent the eradication of old .IK ~b~have forced underdiseases. standing of the vast difference Any discussion on health Kurien Thomas, K Sudhakar in standards between the delivery for the 21st century "haves" and the "have-nots", that does not address the globally and nationally. Although the dream of health for problem of HIV/AIDS will be inadequate. Competing all by the year 2000 was unfulfilled, we need to renew our demands on referral hospitals and health-care centres will commitment to an equitable and healthy world for the pose a major problem in the coming years. Carefully 21 st century. planned prevention programmes and pilot projects During the 50 years since independence, Indian dealing with care and support for HIV-infected health care and health-care delivery have had some individuals and families are essential. Fear, stigma, and remarkable successes largely denial are major hurdles in due to the vision of health optimising care. The private professionals and post-indeand public sectors need to pendence political leaders. forge partnerships to deal The establishment of with these issues and respond to the challenges by primary health centres for country areas and the early involving communities and success in malarial control political leadership at local, are noteworthy. The primary regional, and national levels. health centres may not now Studies in India have be functioning as expected shown that about 70% of and malaria has re-emerged the population obtain with a vengeance, but these medical help from private setbacks can be attributed to practitioners. Yet little loss of direction and comattention is given to this mitment. The diversity in sector; for example, services could be improved through standards of health delivery Urban slums: the biggest challenges to hoalth-earo flelivory in India needs to be continuing medical educaaccepted. The complexities related to managing the health tion. Antibiotics are widely misused for common selfof 1 billion people cannot be denied, but there is much to limiting ailments such as watery diarrhoea and upper be desired in promoting health-care equity, improving respiratory infections. In the state of Tamil Nadu, 78% of managerial structure, channelling non-governmental the population receive at least one injection and 40% resources, and promoting people's participation in health receive more than six injections in a year for perceived decision-making. Many less-developed countries in Asia illness. and Africa have common health problems, and we have Nearly half of those who seek medical help obtain it from alternative and traditional systems of medicine. The much to learn from each other. Equity in health cannot be isolated from social and practices and cures of these systems, which sometimes claim magic cures for common ailments, must be urgently economic equity. In most less-developed countries, less evaluated. Many people prefer the questionable efficacy than 3-5% of GDP is spent on health, which is a reflection of priority given to health by the respective and possible adverse effects to the loss in human values governments. Improvement in fiscal management alone that they face in dealing with modern medicine. could provide the essential additional inputs into health Improvement in health delivery should address this aspect without compromising the national priorities of the and make the practice of modern medicine more humane. countries involved. Immunisation cover as low as 25% in Understanding community needs, promoting more some states in India is sustained interaction between the traditional and modem systems, and involving the private sector in health-care evidence of poor supervision and input in this important delivery programmes may be the way of the future. Health managers have an unenviable position. There area, while there is a call for a computed tomography are no data on which evidence-based decisions can be unit and a medical college in made. The traditional hierarchical system of each district of the country. administration does not promote participatory decisionHealth-care delivery in making. If people are empowered to manage their own urban slums remains one of health, its delivery and accessibility will improve. Currently, the Government of India is planning a the biggest challenges in programme of developing a state-based action-oriented India. Data from this eversurveillance system with emphasis on people's growing population are so participation for generating and monitoring essential data unreliable that they are for action. This plan is a promising beginning. effectively no/i-existent. We can achieve these goals in a reasonable time if we With appalling poverty and set our minds to it. Resources must be found, and hygiene and complex social leadership must rise to the challenge. In the beginning of dynamics, the urban slums the 21st century, with attention focused on globalisation pose major hurdles in and free trade, we must not lose sight of equity, achieving health goals, governance, and people's participation as important because they foster the issues. emergence of new diseases s35
T h e L a n c e t Perspectives • 356 • D e c e m b e r • 2 0 0 0
Health-care inequalities: an Indian perspective
and resistant organisms and r~ ecent advances in in~ - ~ formation technology, prevent the eradication of old .IK ~b~have forced underdiseases. standing of the vast difference Any discussion on health Kurien Thomas, K Sudhakar in standards between the delivery for the 21st century "haves" and the "have-nots", that does not address the globally and nationally. Although the dream of health for problem of HIV/AIDS will be inadequate. Competing all by the year 2000 was unfulfilled, we need to renew our demands on referral hospitals and health-care centres will commitment to an equitable and healthy world for the pose a major problem in the coming years. Carefully 21 st century. planned prevention programmes and pilot projects During the 50 years since independence, Indian dealing with care and support for HIV-infected health care and health-care delivery have had some individuals and families are essential. Fear, stigma, and remarkable successes largely denial are major hurdles in due to the vision of health optimising care. The private professionals and post-indeand public sectors need to pendence political leaders. forge partnerships to deal The establishment of with these issues and respond to the challenges by primary health centres for country areas and the early involving communities and success in malarial control political leadership at local, are noteworthy. The primary regional, and national levels. health centres may not now Studies in India have be functioning as expected shown that about 70% of and malaria has re-emerged the population obtain with a vengeance, but these medical help from private setbacks can be attributed to practitioners. Yet little loss of direction and comattention is given to this mitment. The diversity in sector; for example, services could be improved through standards of health delivery Urban slums: the biggest challenges to hoalth-earo flelivory in India needs to be continuing medical educaaccepted. The complexities related to managing the health tion. Antibiotics are widely misused for common selfof 1 billion people cannot be denied, but there is much to limiting ailments such as watery diarrhoea and upper be desired in promoting health-care equity, improving respiratory infections. In the state of Tamil Nadu, 78% of managerial structure, channelling non-governmental the population receive at least one injection and 40% resources, and promoting people's participation in health receive more than six injections in a year for perceived decision-making. Many less-developed countries in Asia illness. and Africa have common health problems, and we have Nearly half of those who seek medical help obtain it from alternative and traditional systems of medicine. The much to learn from each other. Equity in health cannot be isolated from social and practices and cures of these systems, which sometimes claim magic cures for common ailments, must be urgently economic equity. In most less-developed countries, less evaluated. Many people prefer the questionable efficacy than 3-5% of GDP is spent on health, which is a reflection of priority given to health by the respective and possible adverse effects to the loss in human values governments. Improvement in fiscal management alone that they face in dealing with modern medicine. could provide the essential additional inputs into health Improvement in health delivery should address this aspect without compromising the national priorities of the and make the practice of modern medicine more humane. countries involved. Immunisation cover as low as 25% in Understanding community needs, promoting more some states in India is sustained interaction between the traditional and modem systems, and involving the private sector in health-care evidence of poor supervision and input in this important delivery programmes may be the way of the future. Health managers have an unenviable position. There area, while there is a call for a computed tomography are no data on which evidence-based decisions can be unit and a medical college in made. The traditional hierarchical system of each district of the country. administration does not promote participatory decisionHealth-care delivery in making. If people are empowered to manage their own urban slums remains one of health, its delivery and accessibility will improve. Currently, the Government of India is planning a the biggest challenges in programme of developing a state-based action-oriented India. Data from this eversurveillance system with emphasis on people's growing population are so participation for generating and monitoring essential data unreliable that they are for action. This plan is a promising beginning. effectively no/i-existent. We can achieve these goals in a reasonable time if we With appalling poverty and set our minds to it. Resources must be found, and hygiene and complex social leadership must rise to the challenge. In the beginning of dynamics, the urban slums the 21st century, with attention focused on globalisation pose major hurdles in and free trade, we must not lose sight of equity, achieving health goals, governance, and people's participation as important because they foster the issues. emergence of new diseases s35
T h e L a n c e t Perspectives • 356 • D e c e m b e r • 2 0 0 0