By Shazia Salam
Published on 11th May, 2017
After almost seven decades of Independence and a nine per cent growth rate in the recent past, the Indian healthcare system is still in shambles. What makes half and-a-million children die before they reach the age of five?
These are some of the many basic and significant questions that are answered in this book. Sujata Rao provides an incisive look into the structural problems of Indian healthcare system from an insider’s perspective.
Having been part of the health sector for two decades, both in administration and in policy making gives her a specific vantage position. Her insights are particularly important in understanding the evolution of the Indian healthcare system which seems to have shifted from what she calls the tenets of “Fabian socialism to other extreme of a liberal state expounding minimum government and maximum governance.”
The book is written in a lucid manner with minimalistic use of jargon which makes it an easy and gripping read for a range of people interested in the subject. The narrative of the book is divided into two major parts.
The first part discusses the evolution of the health policy in India and explicates how financing and governance in health sector has changed over a period of time.
Rao argues that health is an area that has always been neglected from Nehruvian to the post-liberalisation era. In a very meticulous manner, she traces the shift from public to private and expresses the consequences of deepening privatization and reduction of public investment. The apathy of the government to regulate the standards of the private healthcare providers and stepping back from delivering its obligations is seen as a key impediment in the progress of deliverable public healthcare system for the common people.
Referring to the reasons behind the grim and chronic under funding that health sector in India has been receiving she argues that ‘ignominious distinction’of being a county that spends less than 1 per cent GDP on health has increased the burden borne by common people and resulted in serious impoverishment.
This intersection of political and economic brings forth the major consequences of the abysmal policy making of the government. Rao calls for getting rid of the archaic system of fund allocation to fill in the gaps between what the policy documents state and how they are implemented on ground.
Rao has substantiated her claims with many documents and interviews to give credibility to her narrative and reduce bias.
The second part of the book discusses at length reimagining the policy implementation and the way forward to restructure the healthcare system. It shines light on success stories of reducing HIV cases and the struggle to provide access to essential services in rural areas.
Rao points out that the flagship programmes of National Aids Control Organisation (NACO) to reduce the cases of HIV was a remarkable venture which was an evidence of how a certain kind of unprecedented leadership could bring about decisive changes even when the constraints are placed firmly. The section gives a detailed account of policy formulation, policy implementation and strategies crafted.
By way of various examples the book shines light on how agendas are finalized, how system responds to certain agendas and how perceptions of those in the position of power influence and ultimately determine how policies are translated into work on the ground.
The current crisis in healthcare system according to the book does not rest on one factor. There are many variables in action that hamper the progress of healthcare system towards a better future. Low funding priority clubbed with weak governance and deeply de-motivated leadership has resulted in an unstable policy “that seems to be in constant motion only to stay in the same place.”
Rao offers various recommendation towards the end of book in order to envision a better healthcare system that can reduce human suffering and erase disparities. If healthcare is neglected as severely as is being done now it can have long term consequences that can be devastating.
The book ends with both a note of hope and a warning. This is possibly the most important recent book about India’s healthcare system. Must read for anyone interested in Indian healthcare.