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Time to abandon fragmented healthcare programmes

Despite an increased overall expenditure on health, increased number of postgraduate medical seats, and development of some of the health centres in villages, this year’s union budget was full of empty rhetoric and no real strategy on the part of the government.

Dr Kamal Mahawar
Dr Kamal Mahawar

Let us face it. There is no way we will be able to eliminate diseases like kala-azar, leprosy, tuberculosis etc in the time scale mentioned. Whilst we continue to waste large sums on ineffective programmes, the budget revealed no effective strategy to upgrade rural health centres into clinics where doctors want to work and can provide quality modern care.

For, far too long, India’s public health strategy has focussed on individual programmes and goals without any acknowledgment of the fact that a comprehensive healthcare should incorporate the development of a complete healthcare infrastructure rather than patchy focus on individual diseases and programmes. It’s time we moved away from such short-sighted approach and started developing our healthcare infrastructure in a planned way.

I like the idea of upgrading some rural health centres though. We should, however, make sure it is not a wasted opportunity by building facilities fit for purpose and equipping them with gadgets for basic blood tests, imaging, and scans. In this day and age, it should be possible for scans and X-rays done in a village to be reported by radiologists in medical colleges. These clinics can be and should be connected to medical colleges through teleconferencing where specialists are available for consultation in a timely manner. I am not denying this will need significant investment but we will have to develop these things at some stage and now is as good a time as any.

Furthermore, the government will have to ensure that doctors and qualified nurses can be attracted to work in these rural health centres by paying them a significant rural service allowance. They will then not need to force doctors and nurses to work in rural areas. On the contrary, if we developed a Postgraduate course in Primary Health Care or Rural Medicine, we might find junior doctors wanting to come here to work and train. But to force junior, inadequately trained doctors to work in villages without any supervision, without proper diagnostics, and without help from trained nurses is simply admitting that rural lives don’t matter. I wonder how it will affect the votes for our politicians if our media could successfully take these sentiments to the masses.

So that those needing in-patient hospital care can be appropriately referred and transferred to a hospital from these clinics we will need to ensure we have a fit for purpose ambulance service and medical colleges with hospitals in at least every district of the country. It might all sound like a dream but can be translated into reality if we start taking some concrete steps today.

Following his graduation from Calcutta Medical College and post graduation from Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Dr Kamal Mahawar is now a Consultant General and Bariatric Surgeon with Sunderland Royal Hospital in the United Kingdom. He is also an Associate Clinical Lecturer with Newcastle University and editor of renowned scientific journals. His recent book ‘The Ethical Doctor’ published by Harper Collins India examines some of the serious issues affecting Indian healthcare.

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