VI Monograph: Forgetting Health

'FORGETTING ' HEALTH

Perhaps in India health planning has only followed what happened to health care as a concept decades ago at the international level. Although health is one of man’s most precious possessions, we must know that health was “forgotten” when the Covenant of the League of Nations was drafted after the First World War. Only at the last moment, was ‘World Health’ brought in. Health was again “forgotten” when the Charter of the United Nations was drafted at the end of the Second World War. The matter of health had to be introduced ad hoc at the United Nations Conference at San Francisco in 1945 (Evang, 1967). Thus even in the scale of values of a body like the UN it cannot be said that health occupied a prominent place. No wonder then that it is easily side-lined due to pressure almost everywhere. Health is often taken for granted and not fully appreciated till it is lost. The modern thought that health is not merely a precious possession, but also a resource in which the whole community has a stake and which it is desirable to maintain and promote, has still to percolate to the individual and collective consciousness of the Indian people and its governance.

Probably our History has a role to play here. One of the two indigenous systems of medicine, Ayurveda, was highly advanced during the Vedic period and Emperor Ashoka’s time. But it underwent an eclipse with the Moghul invaders who brought in the Unani-Tibb system with them. The British halted the progress of both. They established an infrastructure for their own people (and the ‘natives’ who served them) by bringing in the ‘Allopathic’ system. The rest of the country was left to its own fate — the system of indigenous or home-made medicine that never underwent any upgrading. Some benevolent Zamindars set up charitable dispensaries/ hospitals, as did some missionary organisations. But they served only certain sections of the population. Establishment of Medical Colleges and Hospitals paved the way for modern medicine in India for which the British deserve due credit. But it served to further stunt the growth of the indigenous systems. They were looked down upon. Prejudice and lack of patronage encouraged quacks and charlatans to monopolise and further discredit these systems, a state from which they have never really been able to look up.

The training centres for medical and paramedical personnel set up by the British were on the lines of their own country. They became incurably elitist and created a firm though artificial barrier between the common man and the products of such institutions. The medical centres became preserves of donors and founder-philanthropists. They sincerely attempted to run these institutions along British lines after the British left, but could not in any way involve the community as a whole in the planning, propagation and working of these institutions.

To offset the static and elitist nature of this colonial reality has been the major thrust of community medicine all over the Third World. Hence the slogans “Primary Health Care’ and ‘Health for All’. The Chinese came up with their concept of ‘barefoot doctors’ which has had its own significant role to play. India experimented with Multi-Purpose Health Workers (MPW), recommended by the Kartar Singh Committee of 1973; (Government of India, 1973), a sort of barefoot doctor-cum-immunising technician cum -health educationist-cum- family planning advisor. The scheme envisaged that by the Sixth Five Year Plan (1980-85) there would be 2 MPWs, one male and one female, at each sub-centre to serve a population of 5000. Though the scheme is claimed to be implemented vigorously by the Ministry of Health and Family Welfare even today, it has still to be popularised and mounted on a war footing because of obvious difficulties that such schemes enter into with policy planners — both amongst the august medical bodies and the government. The former is more concerned with upholding medical standards and understandably scoffs at such schemes. The government which could have promoted this and similar schemes hardly gives health planning the pride of place that it deserves. Even a cursory look at the Health Budget will show that in progressive Five Year Plans its percentage has been decreasing (from 3.33% for the First Five Year Plan, 1951-56, to 1.9% and 1.7% for Sixth and Seventh Plans 1980-85 and 1985-90, respectively; and a measly 0.95% for the VIII Plan (1992-97).* Since community medicine lacks both the glamour and the clout that the curative medical establishment has in ample, it is only natural that primary health care, health planning and implementation remain more a dream goal than a reality in India.

In sum, as things stand, there cannot be Health for All in this country unless the people unite and raise the slogan All for Health. If the goal is Health for All, the commitment has to be All for Health. They will have to become more aware of their health rights and obligations and will have to stress this need through various socialwelfare, consumer and political bodies. And we need a government having the political will to put these aspirations into practice. That this is no mean expectation should be obvious considering the apathy, callousness, and cover-up that resulted after the Bhopal tragedy. Moreover the people should not forget that health is not only a commodity that a benevolent government/institution/ individual can bestow on them. It has to be earned and maintained by the individual himself. And for this it is essential both to motivate individuals to accept responsibility for their own health as also to sufficiently deprofessionalise medicine so that such motivated laymen can play a greater role in their health care, without jeopardising the legitimate importance of the health care professional in the field. How these could be brought about should engage the attention of at least some of those who have the welfare of this nation’s population at heart.

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* Figures for IX Plan (1997-2002) and X Plan (2002-2007) not available, but may be expected to reducefurther. Percentages calculated from Table 3 given by Park, 2003, p639.