Time for doctors to play a larger social role
Securing the health of a nation and of its people is inarguably the responsibility of a state, as inarguably as securing its territorial integrity. But ensuring the health of 125 crore people, most of them poor people living in wretched conditions, is a mind boggling task and can be beyond the powers of even the mightiest and best-oiled government machines. Poor nations like India have no chance of doing this--unless they begin to think smart and find innovative ways to effectively harness their infinite individual human resources for collective social good.
Governments across the Third World struggle to nurture ecosystems conducive to good health largely because they lack the knowledge to design effective health policies, let alone execute them. This is not always because of lack of funds. India, for example, spends significant amounts of money on its public health system: Budgetary allocation just for its National Rural Health Mission (NRHM) more than doubled from Rs 6,788 crores in 2005-06 to Rs. 15,258 crores in 2010-11. But over the same period infant and maternal mortality rates fell at disappointing rates, much lower than say in China or Brazil. In 2013, out of every 1000 children born in India 41 died as compared to 169 in 1990.
Although this looks impressive, our performance compares poorly with other similar nations like Brazil and China, which recorded an infant mortality rate of 12 and 11 per thousand births in 2013 as compared to 76 and 68 in 1990 respectively. What this means is that while programmes like NRHM have made an impact and produced positive outcomes, the returns on the investment have not been satisfactory…a great deal more could have been achieved with better planning and execution involving the expertise of medical professionals and professional medical bodies.
For building a healthy nation India primarily needs a single integrated blueprint for the entire country, one that is authored in collaboration with its large and very capable healthcare community. For example, addressing basic issues like air pollution, water contamination and food adulteration in itself can help the nation bring down the incidence of communicable diseases by 40 per cent. To do this it will need to create standard protocols and stringent monitoring standards with a singular focus on quality. Professional medical bodies can help governments achieve this with their specialized knowledge.
Safety is another area where doctors can partner with governments and public institutions to make a significant socio-economic difference. Every year thousands of young Indians needlessly die or suffer from disabling injuries in accidents simply because of poor road design or the near absence of an effective medical emergency response mechanism that includes the availability of the ‘right’ pre-hospital care. The avoidable loss of large masses of people in their most productive years to medical emergencies not only causes social trauma but also inflicts huge economic damage on the nation. Clearly, this is one area where the nation can benefit immensely from a partnership between doctors and governments.
Government must treat doctors and professional medical bodies as equal partners in charting out its social health programmes if only because medical professionals possess superior knowledge and expertise on processes across the health spectrum than would an average bureaucrat. From preventive care, to diagnosis, treatment and management, professional medical bodies can and should work hand-in-hand with governments for producing optimum results. Resource deficient, developing nations like India in particular must make every penny of their social spend count to achieve noticeable results.
Alongside, it is time for professional medical bodies to go beyond organizing conferences and electing office bearers: they must re-engineer themselves and enhance their social relevance. They need to literally re-invent themselves and become dynamic think-tank organizations that have the skills, the resources and the intent to play a larger role and partner with the state in every aspect of building a safe, health-first nation.
The concept of health is far larger than diagnosis and treatment, which is essentially the domain of hospitals, and encompasses everything… public toilets, effective garbage disposal systems, safe roads, secure mobility, effective emergency response systems and so on. The Swachh Bharat campaign, for example, acknowledges the importance of public hygeiene for ensuring good health…the twin concepts of health and hygiene are inextricably inter-related and one cannot exists without the other. Sure, medical bodies may not have any special skills in the area of public hygiene and sanitation, but they can certainly create the necessary social awareness and help governments come up with integrated policies that address all issues related to public health and safety in a holistic way.