So what’s the diagnosis doc?

Parsa Venkateshwar Rao Jr Delhi

The hospitals are always overcrowded. The doctors are overwhelmed. The nurses are stretched to the limit. The government hospitals are bursting at the seams as it were. A general hospital is a picture of a bit of mayhem and a bit of bedlam. Yet, some of the best doctors in the world handle some of the most difficult cases ever in the most confused theatres of action. But the anarchy seems sustainable. Millions of people pass through the hospitals. Some of them are cured. Others die. Doctors go through the stress and strain, and then look back at it all with fond memories.

Private hospitals are also getting crowded. There, too, the poor and the rich jostle with each other. The rich pay it out nonchalantly. The poor borrow money to save the lives of their loved ones, and sink into greater poverty. Here, too, there are never enough doctors. And it looks like we need hundreds more of these posh, private hospitals to complement the civil and general hospitals.

As an official in the union ministry of health and family welfare admits, there are not enough doctors in the country. India has about 44,000 doctors, and there is need for more than double number. There are not enough nurses either. He says, “Even private hospital administrators say they are unable to hire even trained ward boys, who are so crucial in the running of a hospital. And even as they are trained, they move out.”

The public health system in India presents a paradoxical picture. On the one side, Indian doctors are winning plaudits in Europe and America for offering world-class treatment at nearly half of what it would cost in the western world, and which is giving rise to the temptingly lucrative vista of medical tourism. And a sense of smugness is palpable in the public sphere dominated by media, big businesses and the aspirating middle class. On the other side is a bleak, stark picture of a tottering system, plagued with myriad problems.

The paradox is well summed up in a World Bank paper of 2004, authored by Monica Dasgupta and Manju Rani:  “India has relatively poor health outcomes, despite having a well-developed administrative system, good technical skills in many fields, and an extensive network of public health institutions for research, training and diagnostics. This suggests that the health system may be misdirecting its efforts, or be poorly designed.”

The problems facing the public health system is spelled out candidly in the National Rural Health Vision document of the ministry. And the facts are bleak enough to dampen the spirit of the most sanguine optimist.

Of course, the strategies to improve the situation are laid out as clearly, and with all good intentions. The strategies indicate that the government would want to devolve the health care system to the village level, through the Panchayat Raj institutions. It is an ideal strategy on paper, but there are hidden problems.

The ministry official points out that the elected representatives in the Panchayat Raj are not equipped to monitor, assess and manage the health care system and they would not be in a position to allocate funds. What is needed is an army of public health officials to make the system work smoothly. And there are too many around.

Dr Piyush Jain, a medical expert from Old Delhi, agrees. He points out that there is a real dilemma whether qualified doctors should go into administration or whether it should be left to trained personnel. He does feel it is better if a qualified doctor is in charge of the public health system. He says that to maintain a good sanitation system, there is need for an engineer and a microbiologist, and not exactly a doctor.