Health care: problems and prospects

[Guest guest]

Health care: problems and prospects

Chennai, October 19, 2010 Ramya Kannan

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 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 , 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.

Sea change

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.

HIV counsellors

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 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.

http://www.thehindu.com/arts/books/article837776.ece