Sunday, August 15, 2010

My two-wheeler diaries - week 2 : Health care and inclusive development a thought on 15th August

For my Two-Wheeler diaries - second week, it seems quite opportune that the Sunday for the post falls on Independence Day!

We've been away from the days of the Raj for all of 63 years now. A long time indeed. We do have a lot to feel proud of. from groveling in poverty, without enough to feed our own burgeoning population, we've become a food grain exporter. We've managed to curb population explosion without draconian laws like a one child policy and so on. We've managed to build our expertise in the service industry, such that the term IT Services is now synonymous with India. We've held on to our core competence of having a large English speaking population and with bills like the Right to Education coming through, we seem to be on the right track when it comes to legislation and policies.

But what I've seen over this past one week, and as promised, here are true blue insights - that in the real world, the story is not so rosy. On the macro level, we are extremely powerful. We're doing the right things, saying the right things at the global forums. But like we say, the India story is unprecedented. We cannot be judged only at the macro level. India is all about micro and grass roots. So, take the example of health care provision. The least that is needed is to ensure that all our people have access to good health care. And the key word is ALL. Granted, India is the hub of a multi million dollar medical tourism industry. We treat and give a new lease of life to struggling patients from Afghanistan, Scandinavian countries, and even provide affordable super specialty treatments to people from the West. I myself saw several African patients at the kidney research hospital, that goes on to prove my point!

But what about our own people? Why does treating malaria become so tough? Why do so many people still die of Malaria in India? Come monsoons, the water logging, and the resulting stagnant water becomes a malarial parasite breeding ground. And let's face it. Quality health care in India is not affordable to everyone. Over the past week, I have been appalled at sights of poor families crowding around the bed sides of patients, having to eat their meager meals, right next to the patient hooked on to a tube of IV fluid. Post surgical patients have to languish in the tropical heat with just a swiveling fan overhead, and that too shared by 2 beds! The floors are unclean and the walls are cracked. Civil hospitals are a worse sight. The cleanliness of the building premises is appalling. Granted, these hospitals have all possible departments - from a general ward to oncology and even kidney and liver transplantation. This clearly shows that the medical proficiency is very good, perhaps excellent. But the upkeep is downright terrible! Even this is minor, given that the pathogens are in check in these hospitals and the patients are in extremely proficient medical hands. But what about post-op treatment? Or ongoing treatment for chronic cases?
Take drug availability. In the absence of IPR protection, several large international firms were reluctant to set up a base in India. And now, with a strong patent regime in place, these research based firms are warming up to the idea of helping India heal. But then again, they have large inherent costs in drug discovery which makes their life saving drugs not easily accessible to all. But that does not preclude the socialist government from neglecting those who can't afford good health care drugs. Like the government is a lender of last resort, in a socialist setting, it is the government's responsibility to protect her people. It would be anti-socialist to let the poorer people fall by the wayside, just because they cannot afford the treatment that they need. A capitalist hospital can perhaps adopt methods of differential pricing to its patients, by segregating the payers from the poor, and it can also adopt cost cutting measures and procure the cheapest alternatives. But the government, which perhaps has the deepest pockets thanks to taxation is responsible for helping out those who can't help themselves! Restricting the high figure of life expectancy to only the affording class is a mockery of a country's population and a failure of the state at some level.
Clearly, all inclusive growth is missing. Clearly, we seem to be in a state where we want to follow the winning stories, for they look rosier and we want to wish away the morbid poverty that is unfortunately the truth for a greater part of the Indian populace. And if we don't act fast enough, the years would keep rolling by, the 63 can become 630 and yet we will have a divided billion Indians.

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