As In­dia hur­tles down the deathly path, its breath­less peo­ple bang on the doors of hos­pi­tals, and hos­pi­tals send SOS mes­sages to po­lit­i­cal ex­ec­u­tive, shriek­ing about falling Oxy­gen sup­ply lev­els, the en­tire de­bate has come to be fo­cussed on fix­ing the Oxy­gen sup­ply line, aug­ment­ing ven­ti­la­tor num­bers and adding a few beds here and there. Daleel with SP Singh ex­plores the In­dian health sec­tor in con­ver­sa­tion with Dr Man­meet Kaur, from PGI School of Pub­lic Health and Dr Pyare Lal Garg, Ex-Reg­is­trar, Baba Farid Uni­ver­sity of Health Sci­ences.

IN THIS IN­FORMED CON­VER­SA­TION WITH Dr Man­meet Kaur, from PGI School of Pub­lic Health, & Dr Pyare Lal Garg, Ex-Reg­is­trar, Baba Farid Uni­ver­sity of Health Sci­ences, we dis­cuss if we are still miss­ing out on a huge op­por­tu­nity to re­visit, re­design and reimag­ine our en­tire ap­proach to­wards health­care. It is much be­yond Oxy­gen, and while breath sup­ply needs to be fixed, things would­n’t work if we do not pay at­ten­tion to the struc­tural and sys­temic loop­holes the size of the In­dian Ocean in our health­care sys­tem.

No won­der, we haven’t even seen the be­gin­ning of any talk to make health a fun­da­men­tal right, some­thing we thought should have been the core of the de­bate when the pan­demic struck. Much like we missed the de­bate on the clever move by the Cen­tre to shift the en­tire fo­cus from sick­ness to pre­ven­tive health­care in the Na­tional Health Pol­icy (NHP) 2017. Many of our do-good Samar­i­tans seemed to ad­vo­cate the ‘pre­ven­tive’ part more than the ‘sick­ness/​treat­ment’ part, and the gov­ern­ment clev­erly couched its pol­icy to align it­self with ac­tivists’ rhetoric.

The de­bate brings out an in­ter­est­ing as­pect about money pumped into health­care. The NHP 2017 promised to in­crease the ex­pen­di­ture on health from 1.4% to 2.5% of GDP by 2025, even as cur­rently it is pegged at 1.4%. States ac­count for 0.9% of this 1.4% and the Cen­tre an abysmal 0.6% of the GDP. The to­tal health ex­pen­di­ture in In­dia is 4.7%, so the rest goes out from peo­ple’s pock­ets. As a re­sult, some 63 mil­lion peo­ple in In­dia, roughly equal to the en­tire pop­u­la­tion of Great Britain, are pushed into poverty as a re­sult of this high out-of-pocket health ex­pen­di­ture.

The de­bate also fo­cuses on the num­ber of doc­tors per mil­lion, a key sta­tis­tic that de­ter­mines if you will find a doc­tor when you are sick. In­dia has slightly more than a mil­lion doc­tors to treat its 1.3 bil­lion peo­ple, of which only around 10% (1.1 lakh) work in the pub­lic health sec­tor! Clearly, you don’t need an epi­demic, how­ever pre­dictable, for the pub­lic health sys­tem to col­lapse. Even when there was­n’t any Covid around, pa­tients shared beds, doc­tors were over­worked, and we had made peace with that rou­tine.  Pub­lic hos­pi­tals, in par­tic­u­lar, just end up be­ing places where the sick go to die.

A re­port by Shailaja Chan­dra, for­mer chief sec­re­tary of Delhi, said there were no large-scale sur­veys on quack­ery. She had au­thored the re­port on Un­qual­i­fied Med­ical Prac­ti­tion­ers that said 58% of doc­tors in ur­ban ar­eas had a med­ical de­gree while only 19% of doc­tors in rural ar­eas had one.

The pan­el­lists re­fer to the WHO re­port that says only one in five doc­tors in rural In­dia were ac­tu­ally qual­i­fied to prac­tice med­i­cine, while 31.4% of the “al­lo­pathic doc­tors” were ed­u­cated only up to Class 12 and 57.3% of doc­tors did not even have a med­ical qual­i­fi­ca­tion.

A re­port by Shailaja Chan­dra, for­mer chief sec­re­tary of Delhi, said there were no large-scale sur­veys on quack­ery. She had au­thored the re­port on Un­qual­i­fied Med­ical Prac­ti­tion­ers that said 58% of doc­tors in ur­ban ar­eas had a med­ical de­gree while only 19% of doc­tors in rural ar­eas had one.

Stick to the episode till the very end for a poignant tale about a man called Dana Ma­jhi, some­one we should never for­get if we want things to fall in place.