Bureaucracy has no idea about health care trends

T Jacob John , professor of virology and paediatrics at Christian Medical College, Vellore, speaks to Raj Kishor Khaware on the state of health and environment in India

By Mario
Published: Saturday 15 May 1999

On the state of viral diseases in India:
India faces a bleak scenario as far as viral diseases are concerned. There has been an alarming rise in the number of hiv cases. It could well be more than 10 million, though the World Health Organisation ( who ) estimates that it is only four million. hiv has reached a stage that even if you bring down the number of cases, it will touch a new peak. The same is the case with Japanese encephalitis ( je ).

On the effectiveness of health strategies against other diseases:
We have been unable to handle diseases such as malaria and filaria. Some 15 years ago, dengue was restricted only to the urban areas; while je and malaria was limited to the villages. Now, almost all Indian cities report cases of malaria and je . This is because of contradictions within the health care policy. Urban areas are regions with a population of around 40,000. But civic authorities abandon such populated areas. As a result, vectors multiply in the abandoned areas. Change in vector biology is a result of mismanagement.

On the preference of drugs over vector management strategies to control vector-borne diseases:
Vector management must begin at the larvae level. Only then should drugs be used. Most people advise use of drugs because it is an easier option. Planners are clueless about field situations. One cannot control malaria if local people are ignorant of the havoc that mosquitoes can create. The people must be taught a low-cost method of cleaning the environment. Only then can diseases like malaria be controlled.

What are the other shortcomings of the health care strategies:
When an area is devectorised, the vector population is reduced. But only if you maintain eradication steps for longer periods can vectors be completely eliminated. If there is any additional incidence, it must be treated with proper primary health care ( phc ). I firmly believe that we cannot improve health standards without strengthening the phc systems. Squabbles between the Union and the state government on health issues have become commonplace. Since health is a state subject, the Union government does not take much interest in the matter. The states, on the other hand, blame the Union government for inadequate fund allocation.

Is the funding for health care adequate?
It is inadequate. We face an additional problem of individual funding for different diseases such as leprosy, tuberculosis and malaria. Instead, the people living in every district of the country should submit a budget for their health needs. phc s should be made accountable for the local health problems of the people. This is even better than empowering the panchayats .

Can teaching in medical colleges enable doctors to handle new diseases:
Teaching in medical schools has degenerated. No medical school deals with vector-borne diseases and none teaches pollution-related diseases. The bureaucracy and policy-makers have no vision about new health issues. Finance and agriculture ministries have a planning division, but the health ministry neither has any planning nor projection. Even their budget is minimal.

How can we improve the system?
Firstly, there is a need to break out of the present mould. Decentralisation is the key. Every district should have a microbiology laboratory. All policies should be formulated in an area-specific manner. Secondly, health priorities are set by the bureaucracy, not by scientists. If a disease is perceived to mainly affect the poor, the bureaucracy ignores it. When a politician/bureaucrat has a problem, he does not trust the system because he knows that he himself has been ignoring it.

Thirdly, there should be a proper training network. Health officers should train the panchayats that are ignorant of the technicalities of health issues. We do not have a good system of disease surveillance. Every time a physician conducts a diagnosis, it should be documented and passed on to the district health officer ( dho ). Unless we have data, we will have no clue on the effectiveness of health strategy. The system must also be user-friendly. We cannot progress without well-designed changes.

Has 'health for all by 2000 AD' made any difference to India?
A slogan is an important tool to organise a campaign. 'Health for all by 2000 ad ' is a good slogan. Unfortunately, in this case, the campaign has ended with the slogan. Unless we strengthen every area of health care, we cannot produce results. By further strengthening the phc , the campaign can succeed in about 5-10 years. If today's leadership is willing then we can achieve this target. But I have not seen any political will to implement it.

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