Opinion - Editorials   

A foundation for public health

Six decades after the Bhore committee set the agenda on health care, few will dispute the truth that India has failed to build a quality public health system to meet the basic needs of its people. Public health concerns arise from diverse sources and demand urgent measures. HIV/AIDS, tuberculosis, malaria, polio, and leprosy are being addressed through national programmes although care delivery is inefficient in large parts of India, in particular economically backward regions and States. Communicable diseases affect millions of people, especially the poor, in the absence of reform in sanitation and water supply. Maternal and child mortality rates are unconscionably high. The burden of chronic diseases — diabetes, cardiovascular, respiratory, and renal ailments, not to mention cancer — has increased cruelly. Some 53 per cent of deaths, many of them preventable, and 44 per cent of disability-adjusted life years lost can be attributed to chronic diseases, according to a 2005 Lancet article co-authored by Union Health Minister Anbumani Ramadoss. Private provision of health care has grown by leaps to a point that the majority of outpatient visits are to private doctors even in rural areas. More than three quarters of national expenditure on health care is met out of personal funds, with patients often forced to take loans or sell hard-earned assets. The network of public institutions has generally deteriorated. Government spending on health care as a percentage of GDP has fallen since the arrival of economic liberalisation in 1991-92. It has also been difficult to strengthen the state-led system on account of a severe shortage of trained and willing professionals in medicine, epidemiology, economics, and health communication. A 2004 study done by McKinsey & Company found a national shortfall of 80,000+ personnel with the qualifications needed to staff health sub-centres; at the next level, primary health centres needed an additional 5,000 medical and paramedical staff; and community-level centres required a further 2,500.

Against such a bleak background, the Public Health Foundation of India (PHFI), launched recently by Prime Minister Manmohan Singh, is a promising initiative. PHFI has set itself three key goals: establish world-class Indian Institutes of Public Health (IIPH), each of which will train 1000+ public health professionals a year; strengthen quality standards for public health education across India; and create a think tank that will do research on critical health policy issues, and advise health decision-makers. A 20-member founding governing body that includes distinguished experts, most notably Nobel Laureate Amartya Sen, will steer the autonomous foundation towards its goals. PHFI, which is being funded largely by institutional and individual donors, plans to establish a minimum of five and possibly seven IIPHs at a total project cost of Rs. 500-700 crore over a five-to-seven year period. They will offer multi-year academic programmes (a one-year Diploma in Public Health, a flagship two-year Master's in Public Health; and a Ph.D.) as well as short-term (typically a six- to 12-week) training programmes responding to specific needs, for paramedical personnel, nurses, health officials, journalists, and so on. There is an overdue recognition here that building human resource capacity will be the key to the success of public health interventions; and, as Professor Sen has pointed out, sustainability can be ensured by "the integrated scope of the effort, addressing supply and demand simultaneously." Such large-scale capacity building with an eye to quality is expected to raise the productivity of health expenditure, which the Centre has promised to increase to six per cent of GDP from less than one per cent now. But such promises have been made many times before, notably in election season, and the eyes of everyone committed to the prioritisation of public health will be on delivery and implementation.

Printer friendly page  
Send this article to Friends by E-Mail

Stories in this Section

A foundation for public health
Need not be a central monopoly
France in ferment, anger on the streets
Corrections and clarifications
The roads from Chitrakoot
Shops and slums — a city divided
Laughter really is the best medicine
Musharraf pardons several prisoners
High Court vs E.C.
SBI strike
Deplorable attitude
Skewed priorities?
Office of profit
Unsparing exposé

Copyright © 2006, The Hindu. Republication or redissemination of the contents of this screen are expressly prohibited without the written consent of The Hindu