CONTEXTUAL AND POLICY LEVEL ISSUES FOR THE FUTURE HEALTH RELATED WORK IMPORTANT OF THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
Item
- Title
-
CONTEXTUAL AND POLICY LEVEL ISSUES
FOR THE FUTURE HEALTH RELATED WORK IMPORTANT
OF THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA - extracted text
-
-
F
e
e
e
e
e
e
c
c
e
e
e
e
c
c
e
c
c
c
c
e
TWO THOUSAND AD AND BEYOND
LEVEL ISSUES
CONTEXTUAL
AND
POLICY
FOR
THE
FUTURE HEALTH RELATED WORK
IMPORTANT
OF THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
Findings of the Policy Delphi Method of Research
Dr. Thelma Narayan, Johney Jacob
€
C
°(
(
ANO
OOCU^*T,O\ )
c
c
c
c
e
:
I*
Advisory Group
©>
P.Ramachandran, Dr. Ravi Narayan
Dr . C.M.Francis, Prof .
e
e
c*
€*
e
4
>
-1
Community Health Cell
Society for Community Health Awareness, Research an
326, Fifth Main, First Block, Koramangala
Bangalore 560 034.
Ac ion
<r
050 tl
5
£
$
REPORT OF THE POLICY DELPHI METHOD OF RESEARCH,
.0
0
UTILISED
CHAI GOLDEN
3
0
3
AS
A COMPONENT OF THE
JUBILEE
EVALUATION
STUDY
Submitted to
The Executive Director and
3
the Executive Board of CHAI
3
5
3
3
3
3
3
3
3
3
in March 1993
by
I
Dr. Thelma Narayan,
Coordinator
CHAI Golden Jubilee Evaluation Study.
ft
3
3
3
3
3
I
I
3
3
3
3
3
5
*
Community Health Cell
Library and Documentation Unit
5)
3
3
•I
367, "Srinivasa Nilaya"
Jakkasandra 1st Main,
1st Block, Koramangala,
BANGALORE-560 034.
Phone : 5531518
X
J
s3
LIST OF PANELISTS
a
a
o
o
3
o4
3
a
3
3
3
3
si. No.
01
02.
03 .
04.
05.
06 .
07.
08.
09.
10.
11.
12.
13.
14.
15.
16 .
17.
18.
19.
20.
21.
22.
23.
24.
25.
26 .
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44 .
45.
46 .
47.
48.
49 .
NAME
Mr. Desmond A.D’Abreo
Prof. Alfred Mascarenhas
Prof V.Benjamin
Dr. Daleep S.Mukarji
Prof. B.Ekbal
Fr. Claude D'Souza, SJ
Dr. Prem Chandran John
Fr. George Lobo, SJ
Dr. Hari John
Mr. S.Srinivasan
Dr. Sulochana Krishnan
Mr. G.Kumaraswamy Reddy, IAS
Mr. A.K.Roy
Dr. R.Farthasarathy
Dr. Esther Galima Mabry
Dr. Rajaratnam Abel
Mr. Averthanus D’Souza
Dr. Jacob John
Dr. P.Zachariah
Dr. Gerry Pais
Mr. Alok Mukhopadhyay
Dr. Abhay Bang
Fr. S.Arockiaswamy, SJ
Prof. R.Srinivasa Murthy
Dr. B.M.Pullimood
Prof. Grace Mathew
Ms. Sujatha De Magry
Dr. Qaseem Chowdhury
Mr. P.O.George
Prof. E.P.Menon
Prof.(Sr) V.J.Kochuthresia
Fr. Joseph Thadathil
Fr. Theo Mathias, SJ
Mrs. R.K.Sood
Dr. L.N.Balaji
Francis Houtart
Dr. Marie Masceranhas
Prof. H.R. Amit
Sr. Francesca Vazhapilly
Prof. C.A.K. Yesudian
Fr. Harshajan Pazhayattil
Dr. K.V.Sridharan
Dr. N.S.Chandra Bose
Dr. P.N. Ghei
Dr. Ashok Dayalchand
Rev. A.C.Oomen
Mr. Babu Mathew
Dr. Mohan Isaac
Ms . Sakuntala Narasimhan
PLACE
Mangalore
Bangalore
Bangalore
New Delhi
Thiruvananthapuram
Bangalore
Madras
Pune
Madras
Baroda
New Delhi
Hyderabad
Bangalore
Bangalore
Bangalore
Vellore
New Delhi
Vellore
Vellore
Bangalore
New Delhi
Gadchiroli
New Delhi
Bangalore
Vellore
Bombay
Bangalore
Bangladesh
Kalamassery
Bangalore
Kalamassery
Thiruvananthapuram
Jamshedpur
New Delhi
New Delhi
Belgium
Bangalore
Canada
Sitapur
Bombay
Trichur
Bangalore
Delhi
Delhi
Pachod
Vellore
Bangalore
Bangalore
Bangalore
€
4
. -<
CONTENTS
e
e
e
e
Page No
1.
Background
05
2.
The Policy Delphi Method
07
3.
The Study Process
08
4.
Findings - Contextualising the work of CHAI
11
Predicted economic, social and political trends
the country and their impact on health
5.
C
26
in
India
6.
Findings - Important policy issues concerning
in the future
CHAI
6.1
Basic Premises of Health Work
6.2
Important Health Problems in the Country that
could Respond to
6.3
Components ’ of Health Care and Health Action
Promoted
6.4
Broad Strategies of Intervention
46
6.5
Constituencies/Groups for Focus of Activities
50
6.6
Redefining Roles in the Present and Future Context
54
6.7
Organisational
Functioning
56
7.
Conclusions and Recommendations
59
8.
Bibliography
64
Aspects
important
likely
c
in
Findings - Contextualising the work of CHAI
Major health problems and issues
during the fifteen years ahead
e
35
36
for
CHAI
39
be
42
to
Effective
c
c
c
c
c
c
c
c
c
e
o
e
c
A
-e
c
-
£'f
J
5.
3‘
5
-
3
1. BACKGROUND
3
<3
c
3
3
3
9
H
A
I
in
partnership
with
P
a
D n
E e looks
L 1 ahead
P i
H s
I t
s
for a
meaningful
role
★
situated in the broader
context of the situation
in India
★
relating to the health
problems and issues
likely in the next 15
years
*
identifying priority areas
in its work and its
functioning.
J
3
J
3*
The Policy Delphi Method of research was an important: component
of the CHAI Golden Jubilee Evaluation Study. It was employed to
identify broad contextual and policy level issues that would help
CHAI in its planning for the future. Key policy issues and
options are now available for consideration by CHAI as it plans
its future policy for the next 15 years.
The policy Delphi
rests on the premise that decision makers are not
method "rests
but rather
interested in having a group generating decisions,
have an informal group present all the options for their
consideration". (4)
The method was thus utilised in order to attain the
of the study viz.,
second
aim
Hospital
"To explore possible roles. The Catholic
the
of
India
could
play
in
the
future,.in
Association
the
of
the
national
situation
and
context
health
policv,
and
as
part
of
the
voluntary
national
" (1)
health sector
The specific
follows:
objective of the study pertaining to this reads as
"To determine the views of a select group of individuals
with
regarding the possible future role of CHAI
particular reference to:
its mandate;
ii. its role in the broader Indian scene, and
iii. the role it can play in Asian and other
countries" (1)
Regarding methodology, the project proposal stated,
of 50-75 people outside of
"Views of an additional group
w
CHAI, from diverse backgrounds (health and1 non-health,
church and non-church, NGO and government) will be
elicited.
The Delphi technique for forecasting or
futurology will be utilised" (1)
. re
6
e
The needs of CHAI members and their views regarding future
thrusts of their Association have also been elicited through the
other methods employed in the study. The issue has also been
raised during discussions with people who have been/are presently
closely associated with CHAI.
of panelists was to
Therefore the focus with the Delphi group ot
in some detail an understanding of the wider national
explore
This was a
general
situation and its impact on health.
exploration of important socio-cultural—economic-political trends
likely in India in the coming fifteen years that may affect
health. There was also an exploration of the major health issues
and problems likely to' affect people in the country during
during the
coming fifteen years. This Jscenario provides the context within
which CHAI will be functioning as predicted or forecast by a
group of
of people with wide and diverse backgrounds and with a
social concern.
The method was then used to explore the areas of priority that
need to be considered and taken up by CHAI in its future work. A
wide range of policy issues emerged from this exercise along with
a debate on some of the issues.
' , the Policy Delphi Method is not used1 for decision
Once again,
rightly is the prerogative and responsibility of
making, which
'
and the Executives of CHAI.
CHAI.
However, a range
of
Board
the
possibilities and alternatives are made available for
makers..
In todays
consideration of the policy and decision makers
complex world, this is important if groups want to have an impact
interventions
and if resources have to
as a result of their work
--- ----be effectively and efficiently utilised towards the achievement
of the goals of the association.
The methodology
following pages.
used and the findings are
highlighted
in
the
.-.e
e
c
e
c
C
e
c
e
e
c
c
c
c
c
c
c
c
c
c
c
c
e
c
e
c
c
c
o
C
o
e
o
e
-c
7
o
2. THE POLICY DELPHI METHOD
The Delphi
Delphi method of research was developed initially in the
nineteen sixties, based on earlier experiments.. During its early
years it was used primarily for technological forecasting,
particularly in the areas of defence, industry and business.
It
uses several geographically separated experts to make, forecasts
about the development of new technologies and their impact and
also to estimate the future markets for technologies/commodities.
a
a
a
o
a
3*
3
3
3
3
3
3
3
2
the
The method which hypothetically takes advantage of both
factual
logical left half of the brain and its processing of
information and the more intuitive right half, generated a lot
of interest among futurologists in general, The past decade has
Thus
seen it being used for a variety of differentt purposes.
in
used
by
the
Rand
Corporation
there is the "Classical Delphi"
for
in
1964
and
still
used
the USA for defence purposes
have developed to suit
technological forecasting. IModifications
--different purposes as for instance the "Decision Delphi" and the
“Policy Delphi". The method is therefore still in a process of
evolution.
‘ ; a group method utilising persons with known
The Delphi method‘ is
functions
expertise and experience in the field . It performs
similar to a committee, but is different in that :
a. anonymity is maintained, thus avoiding identification of an
opinion with a person.
b. repeated rounds of questionnaires are used viz., two to five,
depending on the purpose.
provide
c. the questionnaires not only ask questions, but
information and controlled feedback or summaries of responses
of the panelists.
d. a statistical group response for differnet options/issues is
also provided.
e. respondents are given the opportunity to react to and assess
differing viewpoints.
for the analysis of policy
The Policv Delphi Method is utilised
’ ■
--------t
j_s thus
a
issues and is not a mechanism for making decisions,
is
not
an
objective.
“forum for ideas". Arriving at a consensus i
though a rating is obtained, It infact tries to explore opposing
It is therefore an organised method
views on the various issues,
views
and
information
pertaining to specific
for correlating
•
allowing
the
respondents
the opportunity to
policy areas and for
It
tries to ensure
react to and assess differing view points.
on
the table for
that all possible options have been put
consideration.
References4. :
Linstone,, H.A. and Turoff- M.r 1975 (Eds)
Linstone
The Delphi Method - Techniques and Applications
Addison - Wesley Publishing Company, Reading, Massachusetts
e
e
3. THE STUDY PROCESS
After an initial period of getting references and meeting people
specific
to study and understand the method,keeping in mind the
the
main
needs of CHAI for which purpose it was being used,
steps followed in the study were as follows:
in the study)
was
1. A list of possible panelists (participants
drawn up by the CHAI study team, me
the Acvisory
Advisory Committee and
and
the CHAI team.
It was optimal to have about 40 panelists
therefore the first
selection was more than double this
and
number.
This
included people who had
expertise
experience in diverse fields; so that
CHAI could benefit from a
u
broad perspective.
Panelists also were chosen from different
backgrounds
viz.,
secular,
church
related
(Catholic,
viz. ,
Protestant,
Orthodox),
religious and lay,
governmental
and
non-governmental.
A grid was drawn up to ensure represenation
of different disciplines/work streams viz.,
coordinating
agencies,
policy makers,
medical college
professionals,
(educators of health personnel), community. medicine/community
health practitioners, nursing,
educationists
(non—medical),
management professionals,
social
scientists,
theologians,
communicators, lawyers/advocates, politicians etc.
’~3
selected
2. Letters of invitation and participation.forms to 108
time
in
April
iyyz
giving
a
tentative
persons
were sent out
1992
---- as
49
panelists
agreed
to
participate
framework of the study.
panelists in the method.
represented all the different components of the grid
3. They
Church
except policy makers of the government and the
hierarchy.
4.
first
material
included a background
note,on CHAI
r J-r o o round of ...
----------- -----t
.
outlining the type and distribution of its memberhip, its aims
ganisational structure, the headquarters and
and objectives, organisational
f ew
its departments/units, funding thrusts in the 1980s and a
important points from history.
The
A brief
brief note
note about the Policy Delphi Method and the
confirmed panelists was also circulated.
list
of
5. The first round questionnaire was sent along with the above in
May 1992.
the
The first questioni was used to evolve a group scenario of
many
important economic, political and social trends
which
occur in the coming fifteen years that would have an irqpact■; on
This
provided the
broad
the health status of people in India.
r
.
which
contextual picture, generated by the panelists within
This
the health work/interventions of CHAI would be located,
issue was not to be explored further.
major health issues and problems of the people, of
This
likely in the next 15 years was also explored.
The
India,
formed
c
e
c
e
e
e
c
C
c
c
c
C
'e
c
c
c
c
c
c
c
e
e
c
e
e
e
e
e
e
.€
C
-€
1
3
5
9
J
the more specific context to which CHAI was responding in
work.
its
Initial ideas from panelists on what should be the issues that
CHAI should take up as areas of priority in its future work
during the next fifteen years were also elicited.
3
5
5
5
3
3
3
•3
Views regarding the role of voluntary organisations in general
were also explored. This however was not followed up later.
6. A reminder regarding the 1st round was sent in early June
(two
(11.6.92) and by end June, we received 35 responses
73%,
was
ones
came
later)
i.e,
the
response
rate
additional
summaries of the responses to the first two> questions viz. ,
concerning contextual issues were circulated to panelists on
27.6.92 and 4.7.92.
7. Responses to the specific question regarding priority issues
that CHAI should take up, were used to develop the second
This covered seven
round questionnaire mailed on 4.7.92.
broad areas viz.,
i. Basic premises of health work/underlying assumptions> that
must be considered by CHAI for their fu-trure work ((_perhaps
as a statement of philosophy)
3
5
ii. Important
to.
health probl.ems/issues that CHAI
could
respond
iii. Types of
promote.
health
that
CHAI
should
iv. Need to clarify constituencies/groups on which CHAI
focus its activities.
should
action/health
work
aspects or mechanisms that
could
be
v . Organisational
introduced or strengthened to enable effective functioning.
vi. Strategies of work or interventions needed to implement its
objectives and priorities.
vii. Need for role identification.
Thus all panelists were requested to respond to the spread of
ideas that emerged from the first round. Panelists also rated
These
each item using scales that were given for each question.
regarding"importance
for
most
and
desirability/necessity
for
were :
some.
It was also attempted to generate further debate
differences that were emerging eg:
on
areas
of
a. focus of activity primarily towards membership vs a possible
larger role.
13
b. focus
on
community
based,
non-institutional
health
interventions as against provision of good quality medical
care based in hospitals and dispensaries that are accessible
to the poor.
8. A first reminder regarding the second round was sent in early
August.
The same response rate of 73% (37) was received for
the round as well.
9. At this point the study team who were also coordinating and
involved with other aspects of the CHAI study were asked to
write a discussion document for the 49th Annual Convention to
be held in October 1992.
This document drew from all
components of the CHAI Study and was entitled "Seeking the
Signs of Times”.
It was to be used for regional ’ and
profession group meetings of CHAI members that were planned
during the Golden Jubilee year.
Contextual issues raised in the first round were given
chapter " Directions from Delphi"
in
a
10. Analysis of the second round was also made available to all
CHAI members in January 1993 as an additional background note
used for regional/group meetings.
e
-c
e
c
e
e
c
e
c
c
c
C
C
C
11. The complete analysis of the second round was
reported in
early February 1992. At this stage it was felt that since a
sufficient spread of ideas had been generated to serve the
purpose of CHAI, the Policy Delphi Method was closed with
this round.
e
12. It was also felt that it would be useful to share the ideas
generated from the method with the members of CHAI, and to
get members rating of issues that were specific to CHAI.
Therefore
a
modified
version of
the
second
round
questionnaire was developed with a common rating scale, This
is being given to participants of all the regional meetings.
c
Thus at the end of the year, before the Jubilee Convention, we
will also have members views about these issues which touch on
several crucial areas regarding the work and functioning of CHAI.
C
c
e
C
e
e
c
c
e
c
e
-e
c
c
■ c
-r
ri
J
5 .
i1
y..
4. FINDINGS- CONTEXTUALISING THE WORK OF CHAI
J
-y
$
5
ECONOMIC,
SOCIAL AND POLITICAL TRENDS IN THE COUNTRY
POSSIBLE IMPACT ON HEALTH
AND
THEIR
(This is an analysis of responses of Delphi panelists to question
one of the first round of the Policy Delphi Method. This report
was prepared and circulated to panelists on the 27th of June
1992 )
To facilitate collation and reading we have separated the three
factors, though
in reality they are closely inter-related.
There is therefore some overlap.
4.1 ECONOMIC TRENDS:
0
5
3
3
'1
3
3
3
0
0
3
These were foremost in the responses and are described first.
Twenty six panelists (80%) felt that
the new economic policy
recently introduced would continue for sometime and would have an
overall adverse effect on the health status of people and on
health care services, A summary of the broader economics related
scenario and health impact is given first and later the more
specific impact on health care services.
4.1.1 National and International Economic Scenario
a. With the new economic order we are now in a unipolar world.
The economically advanced and industrialised nations are
coming
together
and
dictating
terms.
The
underdeveloped/developing
nations will keep
on
seeking
grants/aid/loans
and gradually become overdependant
and
International trade has always favoured the
impoverished .
advanced nations since the Second World War.
The situation
will be worse in the unipolar world as there will be no
bargaining power at all.
trends
have been
variously
described
b. These
new
as
of
the economy,
economy z moving towards
a
globalization
more
capitalistic form of production and distribution, free market
economy,
the
neo-liberal
model
of
development,
the
Americanisation of our economy etc.
c. International agencies like the World Bank, IMF, IDA, IFC, and
ADB have become tools of exploitation, determining national
policies.
d. All this has been added on top of our already mismanaged
economy running on deficit financing and with a parallel
economy in black money over which the government has no
control!
J
1
e. There are very few options with the new policy, We will have
devaluation, privatisation,
liberalisation, an increase in
exports, a decrease in imports, an increased need
for
3
I
-c
€
e
repayment
spending.
€
of foreign
loans, and a decrease in government
Unscrupulous middle men and women will play havoc.
c
c
f. Decreased
government spending will occur primarily by a
and development
reduction of expenditure in the services
sectors as other changes in government spending would cause an
upheaval among the organised labour and elite minority.
Thus
several panelists felt that subsidies to health,
education,
housing and other services will reduce.
There will be a
reduction of budget allocation per person for health.
e
e
e
e
e
e
c
c
e
c
c
9- This economic process will benefit the business and industrial
community to become richer, with marginal benefit to the
organised sector of labour.
There will be a more affluent
middle class.
However the majority comprising the marginal
farmers,
workers
in the unorganised
sector,
landless
labourers,and daily wage earners will not be benefitted.
Among them the children, women and the illiterates will be the
sufferers.
Poor people(s) everywhere will lose control more
and more of the ability to determine their livelihood and
lifestyles.
Their health status will deteriorate and they
will be unable to avail themselves of the services of
privatised health, education etc.
4.1.2 Poverty
and
was widely felt that the gap between the
haves'
have-nots' would increase due to inequitable distribution of
resources.
a. It
b. Impoverishment and the absolute number of poor would increase.
4.1.3 Agriculture, Forestry
crops rather
a . The agriculture sector will move towards cash
This would further deplete available
than essential foods.
leading
food stuffs for the poor, especially the rural poor,
to greater malnutrition.
b. Pressures of modernisation, deforestation and replacement with
fast growing trees like Eucalyptus (used widely in
social
forestry programmes)
would cause decreased precipitation,
and
decreased rain, decreased water table, increased droughts
borne
floods and therefore also
an increase in water
diseases.
Deforestation would also cause loss of top soil,
food r
decreased fertility of soil, decreased production of
malnutrition and starvation.
4.1.4 Industry
a
lead to
present liberal
industrial policy will
a. The
the
throughout
proliferation of all kinds of industries
The
country,
causing pollution related health problems.
to
or
the
will.
government will not have adequate machinery,
safeguard the environment.
€
t-
C
c
'X
£
C
C
£
C
C
e
c
£
£
€
£
£
c
-•
c
O13
o.
a
o
o
b. The new economic policy would bring about a growth in consumer
based production geared to the world market, This would have
the following results, namely
lack of attention to local needs, which will affect
poor badly.
the
growth of large national and multinational agencies,
throttling the small scale industries, resulting in
Increased unemployment. Breakdown of mental health could
also result.
large scale environmental destruction
health hazards and avoidable deaths.
o
o
o
3
3
with
resultant
pursued
c. The technological model of development will be
needs..
It will have ill
vigorously to meet middle class neecs
effects on health eg., increasing power (energy) needs will be
met by coal (highly polluting) or dams (dislocating people) or
through nuclear plants (causing hazards due to radiation).
3
result
d. The opening of markets to multinational companies will
more
increased
availability
and
consumption
of
in
chemicalised, preserved foods, and artificially flavoured and
coloured foods.
This will cause dietary imbalances and
increased cancers.
3
3*
4.1.5 Lifestyle changes
As already indicated above, the market economy and growing
consumerism will affect lifestyles of the middle class and
create consumerist compulsions for the poor eg., there will be
a loss of traditional food habits.
4.1.6 Changes in Budgetary Priorities
a. Changing
attitudes to social concerns and the
reduced
availability of resources for
welfare’' will affect the
quality of nutrition, education etc., and consequently health,
particularly of high risk groups.
3
b. There will be a diversion of funds from the basic needs
health to the para-military and military forces.
4.2 Comments regarding the impact of these economic
health care services were as follows:
forces
like
on
4.2.1 Commercialisation and Privatization
a. Several panelists predicted an increased commercialisation and
privatization of medical/health services.
a*
b. This is already evident in the rapid proliferation of
polyclinics and in the Apollo Syndrome’.
private
5-
3
I
€.
e
14
e
e
c.
"business
There will be a further mushrooming of
corporate
along
facilities
health centres" with expensive, high tech,
with consumerist promotion and values.
C
at
the
C
Health professionals in general, and medical professionals
"artSular
succumbed to
the commerctaHsatuon
in
of
C
and
e
e
be promoted by the leaders of the
— -country
a
d. This will be promoted oy tne
cost of basic health services.
e.
C
curative services.
* ’ » services will flourish eg., new drugs
f. Only the profitable
diagnostics and certain higher specialities.
g-
The affluent middle class will create an demand on the system
for these type of services.
They \will
--- --be mainly urban based.
4.2.2 Accessibility
facilities will marginally increase, with little or no
a. Medical_lllt
.u specialised or super-specialised services for
accessibility to
jority^of the people, particularly the poor.
the ma;
keep
and1 curative medical services will
b. The cost of diagnostic
presently
galloping
rate.
Many
services
on going up at a g
10beyond their reach in
affordable to common people will go 1
15 years.
compete
providing health services> will
c. Church based groups
share”.
their"market
’ to retain
——
with the private sector
be paid to 1Owr income gropps.
Overall>
insurance schemes for the
d. There will be an increase in health
public.
in the
money for the health sector
money
e. There will be less This
be
will
will mean that health care
government budget.
the
most
and
have
less
access
The poor will suffer 1-- —
neglected.
to medical
i______ services.
4.2.3 Type of Medical Care
in the
increase
there will be
indicated earlier,
oe an
an
a. expensive,
technological facilitiesbenefitting fewer people
p
at the apex of the pyramid.
These will primarily sa is y
y the
the
medical
caregivers.
There will be. increased dependancy on
rather than
system by people to. maintain their healt ,
promotion of self reliance.
hardly
system is
the government\ health care
b. Presently,
be
will
It
partly because of shortage of funds.
working z
the
on
increased demands and pressures
unable to• cope with
~Rural and tribal health care may
system in the future.
suffer.
I
I
*1
c
c
C
C
C
c
>
€
C
c
c
C
e
c
c
c
C
C
c
c
e
c
a
c
t
•c
€
■
J
3 3
3-
15
pharmaceutical
on
will be increasing dependance
c. There
multinationals at the cost of indigenous and traditional
health care systems.
4.2.4 Pharmaceutical/Medical Industry
0
0
a. There will be a sharp rise in drug prices due to
claims of intellectual property rights.
the
unjust
O
b. The pharmaceutical industry will now have a greater say in the
setting of priorities by the State and in determining the
direction that health and medical services will take.
3
3
c. There will be increased large scale experiments of new
on the poor.
drugs
d. There will be an increased pushing of mechanistic procedures.
far, tnere
there win
will ne
be a greater need for
In summary, so tar,
paradoxically. access to
services for the poor, while paradoxically,
services will be limited to the privileged groups only.
3
4.2.4 Health Personnel/ their education and aspirations
3
3
a
3
3
3
3
3
3
3
3
3
3
3
3
3
13
>
health
health
There will be an increasing commercialisation of education in
health sciences, with a proliferation of capitation fee based,
educational institutions turning out untrained or improperly
trained health personnel lacking motivationTheir education
will be inappropriate to the needs of people.
b. Doctors, nurses and other medical personnel seeking jobs in
India or abroad for a better salary and living conditions may
often fail to develop and maintain a correct attitude to their
profession and its practice.
4.2.5 Positive aspects
a. Three panelists (9%) felt that the economic trends at present
-- . were positive.
and those likely during the next 10-15 years
market
economy
would
increase income and
It was felt that the i
More
people
would
be
brought
above
the poverty
flow.
money
There
There
would
be
an
increased
production
of
goods,
line.
these
be
increased
and
better
transportation.
All
would
affect
the
health
status
of
people
positively.
would
b. There would be a growth of hospitals in the corporate sector,
greater professionalisation in hospital/health management and
the development of insurance as a means of third party
payment.
c. Communicable diseases would be eradicated or controlled but
there would be an increased incidence of heart diseases,
diabetes, cancer etc.
‘e
16
e
■ e
4.2.6 Other Factors
an
a . One panelist felt that improvement in education is
Economic
improvement
and
important factor affecting health,
reduction in population growth are often associated with
improved educational status, particularly of women.
was felt
b. It
improving the
growth.
industry,
that urban migration encourages
GNP, thus helping in bringing about economic
e
c
c
G
C
massive
4.2.7 Additional Perspectives
e
c
e
c
c
totally
a. Another panelist suggested that health was not
dependant on economic, political and social issues alone.
C
C
c. AIDS could cause a depletion of the workforce
economic losses.
with
b. It was felt that the questionnaire was not formulated to find
out objectively the causative factors of health and sickness,
so that one can ascertain in which direction to move in the
future.
c. It was felt that the economic and social status of people in
the world and in India would rise independant of any political
system. However haves and have-nots would increase.
e
C
C
4.3 SOCIAL TRENDS
c
4.3.1 Urbanisation
a. The process of increased urbanisation will continue and
be a major factor affecting the health of individuals.
c
c
c
will
b. There will be a continuing extension of big cities. The urban
poor have a lower health status than the rural population.
c. Adequate facilities will not be available for this group.
Sanitation
problems,
garbage
piles,
over
crowding,
insufficient civic services lead to degeneration of quality of
environment, subhuman conditions and more ill health.
d. Slum lords and mafias further deprive families in slums of
their earnings, resulting in further deterioration of health.
e. Increasing pollution due to industries.
4.3.2 Demographic Changes
as the sex
a. The health status of women is going to decline
Social
ratio over the years is going from bad to worse,
pressures and the low value for women and girl children will
continue for sometime.
c
e
e
c
o
c
c
c
e
c
e
o
e
e
C
c
-5
A
- 17
o
b. The increasing number of the elderly will bring about a
shift in health service needs.
O
O
3
major
pressure on
c. Further increase in population will put greater
existing services, with the result that they will be less
It will result in deterioration of other available
efficient.
resources.
4.3.3 Family Types
a. The single or nuclear family system will be more common.
b. The breakdown of the family unit would bring most
care from homes to the service sectors.
of
health
4.3.4 Education
3
O
O
3
3
3
0
o'
r of
a. As mentioned earlier improvement in education particularly
affecting
may
easily
be
the
most
important
factor
<
women,
the health of people.
4.3.5 Role of Media
a . Television will play <a major role in the
people leading to greater consumerism.
lives
of
change
b. For example, advertisements will bring an attitudinal healthy
with respect to food stuffs, moving people away from
natural foods to junk foods.
c. With a new culture dominated by TV
systems will be replaced.
3
social
propoganda,
old
values
4.3.6 Values/Spirituality/Religion
a narrow sense of
a . The sense of community will loose ground and
individualism will thrive.
1 ills like
b. Several health and related problems stem from common
responsibility
,
confusion,
lack of identity
and
man ’ s
and
lack
of
humanistic beliefs,
beliefs, false values
materialism,
spiritual strengths.
c. There will be a progressive erosion of values in social life.
3
Or
&
>
3
d. The most disturbing element in the present social condition is
moral degradation. From 1the highest offices of the country,
has
including the politicians, and the bureaucracy,
it
gradually started lengthening its tentacles to all types of
social insitutions and social services. A majority of.the so
of
called intelligentsia are willing to make any kind
1—
prosperity
.
compromise in their life for personal gain and
alone
has
opened
up
The system of accepting "capitation fees
a flood gate of corruption. Tax avoidance, unscruplous trade
e
:c
in ■
and business practices have crept into the social service
institutions in a significant manner.
Even institutions
related to various religious bodies are not free from dubious
practices. The tiny minority who try to stand against such a
wave are labelled as "unsmart" and "outdated".
Socio economic maladjustment is resulting in increased social
tension and violence of various forms, Mental disorders are
on the increase. Many modern health problems originate from
social problems eg., drug abuse, AIDS, Sexually Transmitted
Diseases, etc.
e. Churches will loose their popularity,
splinter groups of Christianity.
c
-C
C
c
c
c
c
There will be many more
C
4.3.7 Cultural Changes
C
leading
a. There will be accelerated cultural alienation
of traditional systems of medicine and
abandonment
traditional food practices.
to
of
c
C
b. Many will follow a westernised way of life.
c. There will be a continuing marginalisation of sections of the
population^ including of dalits.
C
4.3.8 Change in Life Styles
C
a. There will be an increase in smoking, drinking of alcohol,
change in dietary habits and an increased use of vehicles.
a
b. Changed life styles will alter the epidemiological scenario of
the country, The problem of chronic non-communicable diseases
will increase, while most communicable diseases will be
eliminated or controlled.
c
C
C
C
c
c
c. Need patterns and health patterns will change.
c
d. There will be increased levels of tension and stress (NB: This
is not related to life styles alone.)
c
4.3.9 Fundamentalism / Separatism
c
C
a. Regional, ethnic, linguistic; communal and caste conflicts
will lead to large scale victims who will have to be treated.
This is already happening in Jammu and Kashmir, Punjab and
other places.
c
c
b. Religious consciousness, probably without god-experience as
love, and the consequent communalism could be on the increase
affecting social and individual life and health.
c
c
c. The associated problems of mental health and adjustment
need greater attention.
will
c
¥
€
£
3
3;
3
3.
3
3
3
3
3
3
3
3
3
3
O
3
3
3
19
4.3.10 Social Problems
a. Social problems like crime, delinquency and prostitution
increase.
will
b. There will be increased social disharmony and social tension.
4.3.11 Awareness
a . The awareness of people will grow and a sort of helplessness
may grow leading to greater unrest and violence, This will be
exploited by vested economic and political groups.
b. The public are going to be more aware of their rights
medical services, There is likely to be more litigation
the health field.
to
in
c. Consumer protection councils will make all government jobs
less attractive than now, causing even currently employed
personnel to leave the government service.
4.3.12 Social Trends - the positive side
a. Educational levels and coverage will increase. Therefore
need for freedom and better living standards will be on
rise.
the
the
hands
of
3
b. Science and technology will be increasingly at the
people with techniques and skills to improve life.
3
c. Greater focus on ecological and gender issues in public policy
is a positive trend.
4.4 POLITICAL TRENDS
4.4.1 International
a. Politically we are not going to be
future, as we are today.
as
in
the
through
the
autonomous
b. There will be greater neo-colonial exploitation
oppressive "new world order".
c. India will be more and more subject to one new world order,
dictated by the West and Washington, with the cooperation and
cooption of the local elite.
d. The fall of communism in Europe will adversely affect
concept of national health insurance in other parts of
world.
e. Changes in the Soviet Union will have an impact on
parties.
J
-3
s
3.
3
the
the
political
r
«>
20
‘C
f. The
relationship with the United States of America will not
be very good as our country works toward
greater selfsufficiency and development.
g. A disturbing
though small
nations.
element mentioned was that some
in number, serve the interests of
politicians,
the foreign
4.4.2 National
a. Several panelists raised the issue of political instability
and inadequacy. It was felt that there is hardly any political
party with the goals of good government based on a policy or
sense of direction.
And there is no reasonable chance of
continuity.
Health will be one of the difficult areas which
cannot be improved in a developing country without political
will and stability.
Unless ofcourse, effective health care is
possible outside the governmental system.
b. There will be greater criminalisation of our politics.
c. Political power is grabbed at whatever cost.
d. There will
be negative political activities
confusing and
confounding the average person at the grass roots level.
At
present there are many political parties working in an
aggressive and competitive way, each decrying the other party
and the party
in power in a particular state,
making
it
difficult
for constructive and progressive work to
be
undertaken to completion in the overall
of the
interests
people and country.
People at the grass-roots who need the
services of health personnel will not get it as there will be
artificially created hurdles.
e. With political instability at the national
level and other
separatist/fundamentalist movements and divisive forces of
language and caste working on a political level,
health and
social welfare programmes for the marginalised will
be most
affected.
f. There is a serious fear that communalism is on the ascent,
if
by any chance such parties gain control, the whole political
life will change.
This would seriously affect all voluntary
agencies,
especially as foreign money for social
services
will be seriously curtailed.
The church will be asked to
remain within
the four walls for Sunday worship and not to
enter the field of health or education.
9-
The
principle of
"divide and rule"
is being used
by
politicians of all
ideological colours.
Communalism
is
dividing the poor also,
so that they are unable tb get
together in an organised movement and fight or struggle for
their rights,
with regard to health and other basic human
necessities.
e
C
e
c
e
e
e
e
e
e
e
e
c
o
o
C
C
A
■
if •
e
CJ
c
C*
o
o
o
e
1
3
a."
0
3
0
a
0
a
a
a
0
J
a
3
3
3
3
3
3
4
3
3
a
3
21
h. Political support to corruption and dishonesty at all
of the government health care delivery system, forces
to go to non-governmental and private agencies.
levels
people
i. Politically it will be the moneyed who run the country.
will be efforts by the marginalised groups to
extremism.
J • There
take
to
j- The organised might of the organised sections
efforts to mobilise the unorganised millions.
will
1. A strengthening of the conservative agenda of
government
will set the climate for national
Health budgets will be reduced.
the current
development.
resist
m. Politics and politicians in the country have earned a very
negative image because of the degraded form of political
culture pursued since 1947. Honest politicians interested in
the welfare of common people cannot survive. They will be
attacked mentally and physically even - all under the Gandhian
veil of non-violence. People who protest get labelled as
terrorists and disruptionists.
Most nefarious socio-economic
violences are skillfully protected by the guardians of the
country, with no punishment meted out.
n. The overwhelming majority of politicians are self-seeking.
The odd idealists here and there cannot give their work the
shape of a movement to bring changes.
o. It was felt that the left wing is totally unnerved by recent
political changes in the international scenario. They never
did have a big say in Indian politics, neither is any
significant change expected. The right wing is divided into
two basic groups viz., social democrats and the ultraright,
The so called social democrats have substantially
lost
popularity and power as they could not demonstrate social
interest,
they did not try to distance themselves from the
self-seeking (investor class of) politicians, Gradually their
image was tarnished. The emergence of fundamentalist forces
could be even disastrous. But people are more or less tired
with both Gandhian and non Gandhian democrats, they are aware
about all the big promises since 1947, and opt for a change in
the coming elections. There is reason to believe that the
fundamentalist group may try to change and adapt to secure
their position in Indian politics. It is the unscruplous who
are jumping into it, their attraction is big money, big name
(may be due to notoreity), big position in society. All black
deeds, stupidity, failure could be covered up quickly by the
miracle touch of "money force".
P. It was also expressed that Indians, as people in Soviet Russia
and other countries, will hate violent social movements and
Marxist analysis, separating or focussing on the poor or weak
*
3
LIBRARY
I.(
\\
AND
'k-
U MIT
lorc.
I
,,
•U
a
fc22
alone, creating an imbalance in approach to social issues
so to health issues.
q. There will be stabilisation of the Government by the
as a political party.
and
- «e
e
-c
e
€
Congress
€-
r. Rightist and communal forces will be on the increase,
Several
panelists
felt that the latter will affect health services
adversely.
C
was felt that the decline of trade unionism will make it
s . It
possible for hospitals to run without too much labour trouble.
caused by
t. The growing disparity between haves and have-nots
inequitable distribution of resources shall result in social
strife,
disturbance,
de-stabilisation,
increased
tension,
criminal activities seriously affecting quality of life.
u. More specifically regarding effects on health services, it was
felt that at a national level, there will be an increasing
political consciousness and literacy.
Hospitals will need to
give more personalised care.
C
C
C:
■'
c
c
c
c
r
v. There will be an increase in student movements.
absence of a positive national
interest by the
w. The total
that
leaders
in the public services and the various sectors
contribute to the health of people is a negative factor.
e
e
-c
c
4.4.3 Regional
C
states
may
a
c
b. Instability of government at the regional level (as is already
happening
in the North-East, Punjab and Kashmir) will
affect
health care services
(government and private)
and health
status too.
C
a. Problems of
intensify.
separatism
especially
in
border
This
will
c. There will be increasing autonomy to the states.
local
by
require hospitals to satisfy local needs and abide
laws .
and
d. There will be increasing consciousness among tribals
dalits.
Assertion by ethnic groups and subgroups, politically
such
and economically, resulting in increased autonomy by/for
groups.
These demands and needs will have to be satisfied by
hospitals/health services.
c
c
c
c
c
G
Q
e. There will be a greater awakening among the marginalised,
It would
especially dalits, tribals, and backward classes,
mean their participation in social,
political and economic
processes in the country will become a demand, and justly so.
be
People centred, participatory health care processes will
the demand.
6
X
e
3
-3.
23
0
o:
0
3
0
f. It was feared that increased regionalisation will lead
intolerance of people from other regions in the country.
to
4.5 EFFECTS ON HEALTH/HEALTH CARE - due to a combination of
various factors (other than those already mentioned)
the
4.5.1 Basic Factors
£
3
3
The basic factors influencing the health status of the population
and contributing to the quality of life are water supply,
sanitation, housing, food (nutrition), environment, education
(awareness), and overall socio-economic conditions (including
safety and security). Trends in the different factors are:
4.5.2 Water Supply
O
3
3
3
3
Some quantitative improvement in coverage (through tube-wells
etc ) is expected. But maintenance of quality (safe, potable
water) will not occur in the next ten to fifteen years.
Mortality is already reduced, but morbidity due to water borne
diseases will remain high.
The two other views were that due to deforestation and increased
water utilisation for agriculture, the availability of drinking
water will become critical, leading to increased water related
diseases.
3
3
O
4.5.3 Sanitation and Housing
for this sector are meagre as
Presently committed resources tor
compared to the need, There could be a marginal improvement in
relating
this.
However incidence of air borne diseases
particularly to housing, will remain high.
4.5.4 Nutritional Status
3
' a
t
p3
I
However
There could be a major breakthrough in food production,
chances of improvement in nutritional status of the poor are low.
Withdrawal of subsidies will cause further rise in food prices
the impact on pulses and oilseeds has already created havoc.
Production costs are rising disproportionately due to use of
improved
farming methods and technology hybrid
seeds,
irrigation, use of chemical fertilisers and pest control methods.
The distribution system is also faulty.
There is increased
export of food items to meet the foreign exchange crisis.
The
lot of the common people will therefore remain unchanged.
4.5.5 Environmental Degradation
I
r1'3
This will continue, The small movements here and there are like
ripples that will not develop into a tide in the near future.
Manifold effects on health will result.
I ’k
I3
3
!
€
e
-e
7^
4.5.6 Education (Awareness)
There will be improvement in literacy rates, but there is cause
The new education
for pessimism regarding real "education".
policy and the system promotes mass production of technocrats.
There is a neglect of the humanities and overemphasis on science
and
technology,
which will produce
more
technologically
knowledgeable "inhumans". Schooling facilities for the poorer
sections will be inadequate. The government schools are already
overcrowded and in a poor state•
The holistic approach to health is practicable in an
society only.
educated‘
4.5.7
There will be an increase in tobacco related diseases including
cancer, respiratory tract and cardiovascular disease, The huge
profit margins of the cigarette manufacturing companies are clear
evidence of this.
4.5.8
The pandemic spread of HIV and AIDS could result in the» reversal
estimate
of the gains of other health programmes. A conservative
----- is that over one million people are effected by HIV.
4.5.9
Increased cancers and other diseases due to industrial pollution,
and dumping of industrial waste including nuclear waste,
from
rich countries into the Third World.
4.5.10
The increasing complex drugs in the market will be used and
prescribed indiscriminately,
so that iatrogenic or medicine
and side
induced illness will increase, for example allergies,
effects/adverse drug reactions.
4.5.11
medical
problems relating
to the use of modern
Ethical
for example provision of
technology have already surfaced,
services for diagnosing and eliminating the female foetus.
Le
c
C
e
c
c
e
c
c
c
C
C
c
c
C
C
C
C
c
c
c
c
e
C
C
c
c
4.5.12
Wholesale adoption of allopathy, without critical evaluation,
will create new health hazards and economic exploitation.
€
e
3
3
0
0
0
25
‘
4.5.13
3
The weaker sections will realise that unless they have a
significant say in the running of health services, they will be
cheated of their rights to health, as in education.
3
4.5.14
3
3
0
3
3
3
3
O
0
3
3
3
0
3
3
3
3
3
3
3
3
a
3
3
T
Monopoly in the medical system - in our vast country, there is
room for many levels of health workers, who need to be trained
and deployed to do their jobs responsibly and competently,
With
a strong support system (up and down and sideways) and with good
team leadership, the impact on health will be positive,
However
professional councils do not want to change with the times, and
continue to act selfishly in isolation, for fear of losing their
monopoly.
a.
26
t
.e
5. FINDINGS
CONTEXTUALISING THE WORK OF CHAI
C
AJOR HEALTH ISSUES AND PROBLEMS OF THE PEOPLE OF INDIA LIKELY IN
THE NEXT FIFTEEN YEARS
This is an analysis of responses to the folowing question of the
first round of the Policy Delphi Method viz., What are likely to
be the major health issues and problems of the people of India in
the next fifteen years ?’
The panelists, listed out a wide range of problems and issues
that would be significant to the health scenario in the next
fifteen years in India. Some ideas seemed to be of much greater
concern to a larger number, than some others which were brought
up by one or more participants only.
During the analysis the
c
c
c
c
c
responses were classified as follows:
C
i. Specific health problems
ii. Broad health issues
iii. Health care issues - broad and specific
c.
more
classification
was arbitrary to allow
for
a
The
the
responses
.
understanding
of
the
responses.
Most
of
comprehensive
ten
not
used
such
a
distinction
and
their
list
of
panelists had
While
or more ideas had combinations of all these subsections,
listing the more frequent ideas initially, we have included all
the responses in the scenario to represent the wide rangei and
There is some overlap between sections
diversity of concerns,
is— —
inevitable
in an exercise of this nature.
but, this
.. —■ ~ —
— - _-
HEALTH SCENARIO IN INDIA IN THE NEXT FIFTEEN YEARS
The health problems of the people ot
of India will show a complex
epidemiological picture in the years ahead.
While .we shall
continue to have problems relating to poverty, poor hygiene, poor
nutrition and poor environment, we shall increasingly experience
the problems of development, affluence and modernization.. New
diseases will come up along with the resurfacing of older disease
double
problems
with newer trends and -patterns. While this
ci
resources
,
burden1 of disease will severely stretch our limited
the
our ability to deal with the situation will be hampered by
broader socio-economic, political, cultural factors emerging on
the national and international scene that will determine our
development, welfare and health policies.
c
m-C
C
4
€
€
€
€
C
€
C
c
€
€>
€
€
5.1 SPECIFIC HEALTH PROBLEMS
The significant health problems that we will have to
the years ahead, will be : -
tackle
in
€
.C
€
1
3.
27
53
3-
3
3
3
3
3
3
0
3
□
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
,3
3
3
3
1*
5.1.1 Nutrition Related Problems
This will include undernutrition, which will continue to increase
due to a variety of factors viz., poverty, increasing population,
deforestation, and the effects of the new economic policies of
the government on the poor. These will be further complicated by
increasing adulteration and chemicalisation of our foods, the
promotion of junk foods by the food industry, and decreasing
state/governmental intervention in nutrition programmes.
5.1.2 Waterborne Diseases
This will include diarrhoeas and dysenteries, gastroenteritis,
typhoid, cholera, hepatitis B and parasitic infestations,
While
rural areas will continue to be affected due to inadequate
resources for sanitation, urban areas including metropolitan
cities will not be spared due to grossly inadequate services.
This may be further compounded by increasing waterlessness' due
to indiscriminate harvesting of the water table, destruction of
natural forests, monopolising of water resources by commercial
interests, urbanisation and cash cropping.
5.1.3 Communicable Diseases
Some
of
the major communicable
diseases
like
malaria,
tuberculosis, leprosy, kalazar, acute respiratory infections and
preventable childhood diseases will continue to take their toll.
While resources/knowledge are available for their control and
prevention,
these are neglected or inadequately utilized and
complicated by the problems of inadequate therapy and problem of
resistance.
With decline in public health measures and health
care investment by the State, national programmes for these
diseases will suffer.
5.1.4 Non-Communicable diseases
Chronic z non-infectious health problems such as heart disease r
hypertension, diabetes and cancer will increase due to the
present mode of development. This will occur especially in the
middle classes with changes in food habits and life styles r
increase in stress, smoking, obesity,sedentary occupations and an
ageing population.
5.1.5 AIDS
This was predicted to become a major public health problem due to
i) neglect of measures in hospitals to prevent spread, ii)
breakdown
of values and taboos that have determined
sex
iii) change in sex hygiene and habits, iv) infected
behaviour, iii)
blood
donors,
v) increased migration and
tourism,
vi)
vii) lack of proper awareness,
ineffective control measures, vii)
viii) present apathy about the problem and time lost
in
recognising
its significance.
Other
sexually
transmitted
diseases will also increase for some of the above reasons.
28
e
5.1.6 Problem of Mental Ill Health
C
These will include the whole range of stress related disorders,
psychosomatic and psychological problems, suicides, dementias and
other mental health disorders.
They will be caused by i) increasing stress, ii) effects of
urbanisation and increasing unemployment, iii) family breakdown,
iv) increased social disparity and dissatisfaction, v) increased
competition, vi) loss of meaning/significance of life, vii)
breakdown of family and traditional support systems, viii)
increased family and community violence, ix) breakdown of values,
x) increased miseries in an economy of lopsided distribution and
security, xi) reduction in.vital faith and motivation, xii) lack
of positive powerful myths' to sustain society and breakdown in
the ideals of honesty, compassion, socialism and nationalism.
5.1.7 Addictions and Substance Abuse Problems
narcotic
and
These
will
include
problems
related
to
hallucinogenic drugs, alcohol and tobacco. The problems will
increase due to i) increased tensions, ii) breakdown of religion
and values, iii) profiteering by pushers, iv) changing cultural
values, v) and inadequate efforts to create awareness, prevent or
control the problem. Some of the factors described above will
also contribute to the increase in the problem.
c
e
c
c
c
c
e
c
c
C
e
. e
c
5.1.8 Pollution Related Diseases, including allergies, asthma and
other hazards
C
These will increase due to increasing environmental pollution of
ii)
air,
water and oil by chemicals and other hazards,
adulteration and harmful additives in food, iii) pesticides and
other occupational hazards, iv) inadequate dumping of nuclear and
industrial wastes,
wastes, v) increased pollution by fuel burning and
smoking, vi) increased covering up of facts by commercial
interests and, vii)
inadequate measures for prevention and
control.
c
c
c
c
c
5.1.9 Disabilities and Handicap Problems
c
This will be a major problem particularly affecting children due
to i) inadequate pre-natal care and immunization programmes, ii)
neglect of curable blindness, iii) increased drug iatrogenesis,
iv) genetic diseases, and v) decreased mortality. This problem
will be further compounded by breakdown of traditional family and
other support systems and inadequate intervention or
non
availability of better solutions/methods for handicap care,
putting a strain on the families and increasing the distress of
the affected children.
5.1.10 Health Problems of the Aged
c
C
*
€
Problems of the aged (geriatric problems) will increase due to an
ageing population caused by increased longevity. There will be a
£
-e
c
-e
6
379
O'
lonely,
neglected z
increase in the number of
inadequately cared for old people, As in the problem
of ^disabilities
disabilities '’mentioned
mentioned above,
above, this
this will
will be complicated by
a breakdown
breakdown of
of 1traditional
family
support
systems especially the
------joint family system.
consequent
5.1.11 Iatrogenic Diseases
3
J
a
3
0
3
5
J
3
J
0
This will get greater recognition in the future as a new and
increasing problem in the country. These medical, drug-related
medication, ii) overproblems arise due to i) indiscriminate meaicarion,ii
drug
iii)
gunshot
’
therapies,
iv) irrational
prescription,
use
of
spurious
drugs,
vi)
inadequately
tested
drugs
therapy, v)
unbridled
‘ r~ ~ introduced
into the market, vii) and the unbridle..
being
advertisements of pills, among other related factors..
5.1.12 Accidents
Both road traffic vehicular and occupation related accidents will
increae due to urbanisation, industrialisation and increase in
transportation and travel. This will be further compounded by
increasing violence in society - social conflicts, at the work
pla.cez on roads and in the family.
hazards will also
At work
work apart from accidents, occupational
increase a great deal.
Apart from the above 12 major groups of diseases and problems
which the panelists commonly identified a few other problems were
included/i)
more rheumatic fever
and related
mentioned. These’-----■
,
ii) ulcers and pries,
piles, 111) iron
heart conditions in children, n)
•
--) resistance to drugs,
deficiency anemia, iv) iodine deficiency,
v,
7 ill health
- ■ and1 sub-optimal functioning m daily work
vi) chronic
emphasised
particularly among
among women.
women, Some of the participants < ~
affect the poor and
that many of these problems would primarily more
affected.
among them women and children would be even
5.2 BROAD HEALTH ISSUES
health problems and
Related to the above groups of specific or complicating the
oonuxto
them (as mentioned above),
contributing
of health issues
situation further, the panelists listed a number
ithat would gain significance in the-next fifteen years. These
are given below:
with
be
■ ?
■
5.2.2 Challenge of Environmental Sanitation
sanitary
Inadequate provision of safe potable water, poor
including
disposal
of
facilities or solid wastes management,
and
increasing
garbage and night soil due to inadequate resources
30 -
e
disparities.
Large segments
segments of the population will
this basic requirement for good health.
5.2.3
Urbanisation and its
health the urban poor
be
denied
to
consequences/contribution
e
the
e
. of slums will probably become unimaginabie» due to
The problems
resources, inadequate
12 planning,
inadequatei financial
inadequate
]
abilities
for providing
concern or
c
housing and
u**—. lack
---- of government
,,
increased
There
will
be
essential amenities to slum dwellers,
urban
poor,
increase
in urban
increase of the i_-_
migrant labour,
stress, unemployment and all the related consequences.
e
e
ee
e
5.2.4 Breakdown of family
due‘ to
Many panelists have predicted1 increased family breakdowns
problems
.
separation and other marital [
problems of divorce,
up• of
Increased
family disorganisation and violence and break
systems will
—
i
and
support
the traditional
joint familysystem
also on the
on
the imental
------ health of people, as
have consequences
in
especially
handle its health problems,
family 1s ability to
aged and the handicapped.
the care of children, the <
cc
c•
5.2.5 Ethical issues in medicine and medical care
*»
range
will become very important and will cover the whole
These
issues such as invivo and invitro fertilization, human organ
of
in
trading
transplantation,
use of foetal tissues, euthanasia,
becoming
cheap
human organs
for transplants, with poor people. -Medical
ethics and
suppliers,
drug misuse, overuse and so on.
------
-
*
■
values will be increasingly focussed upon.
t'
5.2.6 Rational Therapeutics
growth of multinationals in
in the
the pharmaceutical
pharmaceutical industry,
"“tbA^market
factors of' the
».ai=al consumerism
consumer^ and the
thejaetor^o^
the ~
The
ln„Cse
Lj increase the problems.11
to
Exploitation ^y the ^ug^indnstry
^^as^?ian?Peindigenous
drug industry and
and i
increasing
SlXVisT^icted.
6 •
the cost
unbridled
Unbridled
and tonics will contribute to aggravating the problems.
5.2.7 Population Issues
h coupled
of population growth
The problem of increasing pressure --- on resources a.. and health
with high illiteracy and its consequences
efforts
__“2
There
will bei need for increasing
--have been predicted.
will
be
---- 1 control, but these
in family planning and population
:
newer
include
issues which
complicated by family planning
infanticide,
female
foeticide,
abortion,
foeticide
,
contraceptives,
abortion/sterilization
invivo/invitro fertilization, effects of
health, especially of women and so on.
C
C
0
0
-A
-
3*. -
31
-
£
O
O
3
O
o
o
3
3
1°
! 3
-rO
j*
I
some panelists added the
In addition to these broad issues
to the list.
following
and their adverse
Influence of2 international politics
related problems.
effects on health
h
life span but poorer quality
The paradox of longer
of life.
In more incurable
Incurable ailments - caused by
Increase
technology
po-r g-^tion ■ ^iation tela-ed^d^
like microwave, TV ana compuuex
and nuclear installations.
decisions
iv. Irrational and
and non-consistenc
non-consistent political leading
to
alcohol
use/prohibition Polj;cy
about
alcohol use
poisoning from spurious brews,
increasing death due to
of control of technology and the type o
The
issue c
v.
operations
in
India
with
its
multinational from the perspective of medical ethi
implications dlvSopmen?
of
indigenous
research
and
the
capabilities and foreign exchange.
5.3 ISSUES OF HEALTH CARE
oecific health problems; <and broad health
distinct
from
the
s
P
’ • ■ 3 also
id^.
identified many key
AS
earlier, panelists
issues outlined be classified as3 health
care issues or issues
Lissues which may the development■; cof health
care service systems
-These
significant to
evolving health scenario.
that could respond to the c.included:
challenges and problems
5.3.1 Health care planning
host of questions and issues:
This would include a
at
y of comprehensive health care planning
i. Inadequacy
lack of coordination.
level
and
overall
sophisticated
11 ?SiO“iema
’of
basic
health
of basic health care
care vs.
“• h«lth care - problems of perspective.
of existing health care
iii. Increasing inappropriateness c.
health care
and
non-availability
of
basic
service
services for the majority.
complex
a
limited resources of
Pressure
on
i.e. ,
iv.
situation in the future
epidemiological
of
diseases
and
poverty
diseases
of
occuring
side
by
side.
development/modernization
A'.. Ehlin
'go’ver^St^prtoSrw'hlgh
Increasing9, rural
- u--technology
viiL
to
referral
referral
care/centre.
ix. Effective
system
05041
J
beyond ^primary
health
r
• -e
e
-e
- 32
* r in content, direction,
x. Need for greater clarity
strategies
of public health policy.
objectives and f
role
of
public/private/NGO
philanthropic
xi. Clarifying l
Harmony with
development
of services.
groups in c._
.
autonomy within a negotiated overall framework of
policy and priorities.
of health care delivery,
xii. More equitable distribution
(2L-‘-- ’---corresponding to population distribution and need.
5.3.2 Costing and
investment
Financing
of
Health Care
The
issue
c
e
C
e
e
of
e
These would include issues like:
i. Less and less government allocation of funds for
health care.
■ j belt
ii. Tightening
L-- and increasing austerity - affecting
welfare and health investments.
iii. Rising prices of food, drugs and equipment.
iv. Higher
cost
of
treatment, beyond
beyond the
the economic
economic
capabilities of the majority.
.
.
v. Escalation of cost of drugs and equipment by MNCs in
the name of quality, intellectual property rights
etc.
of consumerism
economy.
vi. Rise ------------ and the market
..
.
health
vii. Increasing privatization/commercialisation
care.
technology
viii. The question of affordability of higher
medical care.
ix. The quest for cost effective medical care.
and
x. The challenge of organising self-financing
cooper
a
t
ivies
self-reliant systems, including health
6tc.
e
c
e
r
e
i-
c
c
c
c
e
C
5.3.3 Health Personnel Development - challenges and problems
This will include on the one hand inadequate supply of the
type of doctors to run the system because:
e
right
for our
i. Medical education remains imappropriate
needs.
declining
ii. Mushrooming
of medical colleges and
quality of medical education.
iii. Over-specialisation among doctors and inadequate
availability of GPs.
iv. Lack of committed medical personnel.
business
v. Medical profession becoming a lucrative
doctors
rather than a service profession with
becoming very money minded.
e people
On the other hand, there will be a lack of intermedia
based health
with medical expertise as well as lack of village re-looking
at
There will be need for seriously
workers.
categories of health training including doctors.
e
c
c
c
€
C
€
€
' €
<
33
5.3.4 Rational Drug Policy
delivery
The availability of adequate drugs for the health care
that
clearly
be
ensured
by
a
rational
drug
policy
system must
availability
,
u.-- roles and limits for drug production,
identifies
distribution and sale for the government, multinational and small
industry sector and controls medical advertisement as well as
misuse, overuse of drugs.
o
0
o
o
5.3.5 Primary Health Care Issues
The commitment to Health for All (HFA) through
Care , will include the challenge of providing:
Primary
Health
Primary Health Care services - accessible 'to all.
Primary education for all.
Minimum housing facilities,for all.
Increasing health education and health awareness
in
building, in the community and particularly
schools.
Need
for appropriate technology in health care.
v
government
vi. Need for increased accountability of
health care services.
i.
ii.
iii.
iv.
O
5.3.6 Secondary/Tertiary Care Issues
O
These will include the issues of affordability of high technology
medical care, priorities and need for appropriate choices at
different levels. Quality of care will also become important.
This concept will need definition as well as the development of a
system of quality assurance.
5.3.7 Health Education
This will be an important issue and will have to be actively
pursued to develop more positive health attitudes and capacities
good health at all levels and stages of life.
towards attaining
<
a
The school systems will need to be more involved in this effort,
Consumers also need to be made more aware of the available
services.
Care will have to be taken not to allow health
education efforts to become commercialised.
5.3.8 Integration of medical systems
western
There will be need to integrate various healthsystemsr
r with
overall
system
of
service
delivery
and indigenous r into an
For
this
fertilization
between
systems.
mutual learning and even
have
inadequate
emphasis
and
promotion
of
other
systems
will
the :
development
be
changed
towards
a
more
supportive
d
—
1
-to
researching and priority setting in
standardising, regulating,
:
these systems.
-*-- > of medicine and research on herbal
Efficacy of indigenous systems
will
medicines and home cures \--- become important issues.
3
I*
*
e
e
3/i
e
si.
5.3.9 Research in Health Care
health scenario will be:
Issues for greater research in the new
research into alternative approaches to medical and
health care including efficacy of other systems
ii. deeper study of social psychology to understand
health behaviour.
11. increased focus on womens'’ health issues, care and
health
iv. increased research into holistic
L
related issues.
i
1
5.3.10 Towards Holistic Health
holistic/wholistic health in'the context of
Finally the issue of model will become increasingly important with
a positive •wellness
five basic dimensions of self responsibl y,
stress on the
physical
awareness, environmental ... sensitivity,
nutritional
-■
>
and
management.
This
will
have to
stress awareness
fitness and
""our’own rich heritage and culture of positive health
be build on our
Ayurveda and Yoga systems.
especially in the
’■’i scenario painted by the panelists may appear
health
positive
The overall
and bleak but looking at it from a more
somewhat stark
could conclude that the scenario of health and health
angle one the next fifteen years will need a creati , multi
this
care in
--- j
and
dimensional, multi disciplinary and holistic response
such
organisations
challenge facing health
will be the greatest
as CHAI by 2000 AD.
■ -organisations and groups
-• ■ , a number of different
Besides the State,
health care problems and issues
stiudied
respond to the
1-- various health,
These issues need to be
board,
raised by the Delphi panelists,
CHAI
by the
and reflected upon on an <ongoing basis the level of their
members at
1
executives and staff and by
groupings.
in
regional/professionwise
institutions or
■ > be identified, strategies
Critical areas of intervention need to
consistent manner, with a
drawn and then worked upon in a and methodologies.
flexibility to adopt new priorities
e
e
e
c
e
e
e
e
e.
e
e
e
e
e
e
cC'
c ■
e
e
<se
c
c
i
j
e
e
<4
■e
9
0
-•35-
*
£
o
o
a
3
3
3
3
3
3
3
3
3
3
3
3
3
L
3
1
3
3
¥
*
FOR CHAI IN THE FUTURE
6. FINDINGS - POLICY ISSUES IMPORTANT
•
cnAo-ific Question pertaining to CHAI, posed to Delphi
panenS
"W^t^Sid bl the issues that CHAI should take
'
panelists,
nriority in its future work during the next
order of priority and
fifteen years? Please list upto five in
in.order
give reasons as to why they are important”.
Interestingly, besides identifying external' issues i.e.z those
affecting the health and lives of people which CHAI needs to
highlighted.
address, other important internal' aspects were
organisational
These include basic philosophical assumptions and
of
implementation
aspects
that would be crucial for the —
strategies in the thrust areas.
ideas that emerged fitted into seven broad
The wide spread of
round
the second
groups.
These were used to formulate
This was done so as to get a group response to
questionnaire.
all the ideas
if-- --and to generate further debate.
------ - j_s given in the following pages.
the group responses
A summary of
1
of the items,
The group. rating by the panelists for each
is given
expressed as a percentage of the highest possible score.
beenhrnadlv
broadlycategorised
categorised as:
in brackets. Items have
Those with a group rating of more than
First Order
70% of the highest possible score.
Priority
Second Order
Priority
: Group
rating 50%
possible score.
of
highest
Third Order
Priority
: Group rating less than 49% of
possible score.
highest
69%
could be considered as very important,
These three categories
important and s lightly important respectively.
Additional comments by panelists have also been given.
The broad areas covered are as follows:
1. Basic premises of health work;
country that CHAI
2. Important health problems in the
could respond
care/health action to be promoted;
3. Components of health
strategies of intervention;
4.
for focus of activities;
Si
- and future context; and
6. Redefining roles in the Present
important
for
effective
7. Organisational
aspects
functioning
76
€
€
6.1.BASIC PREMISES OF HEALTH WORK
€
The following basic premises of health work need to be considered
by CHAI for their future work. This could possibly be written as
a Statement of Philosophy. There is a need for a clear "mission
statement" that in a few lines states CHAI’s essential goal and
strategy, that is acceptable to all. Once this is clear, other
aspects of identifying thrust areas and strategies would fit into
that mission. There was a high degree of agreement by panelists
on most items. The first three items got almost a unanimous vote
(above 90%).
e
Many of the aspects below form part of what could be called a new
or alternative paradigm of health. They have emerged from the
experience of several groups and individuals with the lives of
people at the grassroot level. There is a distinct shift from
the biological, mechanical, institutional model,to a people based
and people centred method. This signifies a fresh understanding
and approach to health and sickness.
€
t
t
t
tt
First Order Priority (More than 70%)
t
t
e
t
e
6.1.1 Need to focus on a preferential option for the poor (92%)
To promote work in remote rural and backward areas, particularly
of underdeveloped states, in urban slums, among tribal groups,
marginalised groups, and indigent populations.
It was felt that there is an absolute need for a bias towards the
poor.
CHAI should highlight the needs of the poor and support
efforts by groups to bring them to the centre stage.
This would also then lead CHAI to help evolve with
theologians
and interested people a spirituality that is based in the context
of
struggle for human liberation and social
justice,
a
spirituality of commitment and solidarity.
6.1.2 Focus on the justice dimensions of health/health work (90%)
and not only on health care service issues, to support and build
the organisational capacity of people, to demand a more just
health and social service system, to act as a counterve;iling
power to the pharmaceutical industry and to vested interests.
6.1.3 Focus on enabling/empowering people in health work (90% ) ,
to enable individuals to take care of their own health and be
able to analyse and respond to their health problems themselves,
to
avoid
everything
that creates
dependency
and
nonparticipation, to support a peoples’ health movement, to enhance
liberation
and
growth of people, to
increase
community
responsiblity for health work.
CHAI cannot directly focus on enabling or empowering people in
health.
It can empower members/the church to empower the
people/communities they work in.
e
_c
e*
t*
e
e
e
e
o
e
c
e
ii
-e
f
Ow■
37
■
W-
The above three points could be considered as being
highest priority, as they have a rating score above 90%.
of
the
6.1.4 Promotion of a wholistic approach to health (84%) i.e.,
harmony in body, mind. spirit, society and with the environment.
It
This is closely related to the spiritual dimension of health,
is totally non-sectarian.
6.1.5 Promotion of community based, non-institutional health work
(82%)
O
i.e., to demystify medical knowledge, de~professionalise as far
as possible, to build on peoples' health knowledge and practices
and to be sensitive to their culture.
there
There is a need for greater focus on community health, but
is a place for good institutional health care too.
o
o
6.1.6 To improve accessibility of the poor and underprivileged
to medical/health care services (82%) viz., to good quality basic
health services and to life saving bio-medical services.
O
It was felt that CHAI need not/should not focus on expanding
institutional care, as it can be taken up by others ie., by the
private sector and government.
among
6.1.7 To develop a sense of understanding and caring
health workers and in health institutions (78%)
I
This can be brought about primarily by member institutions.
Within institutions already existing and elsewhere the strength
of CHAI/CHAI members should be caring and the demonstration of
caring and concern in action.
6.1.8 The need to promote a sense of community and belonging as
being critical to well being and wholeness (78%)
I
i?
by helping make people inter-dependant and concerned about each
other.
The primary responsibility for health care lies within
the community itself - to take care of each other.
Hence
creating
healthy
communities that
receives,
accepts,
forgives, heals’ and commissions is of the highest priority.
This .is also thus related to enabling and empowering people, with
a deeper dimension of inter-relatedness.
6.1.9
Therefore not surprisingly, the need to focus
spiritual dimensions of health and healing (78%)
on
the
This is intricately linked to wholeness and a wholistic approach
to health. Several of the points raised (1.1 - 1.4, 1.7 - 1.8)
relate to spirituality, which was considered to be working
towards making a dehumanised situation more human.
-
%
6.1.10
I
i
1
i
To nurture members of the health care team
means for fellowship and mutual support
and
provide
C
C
C
It was also felt that an important premise missed earlier, was
the focus on members of the health care team, in its broadest
sense.
If health team members are not able to maintain their
motivation and to conform to their ideology, all else will fail.
if they can be sustained and maintained, they will make headway
inspite of deficiencies in the rest of the system.
It is
therefore important to nurture those involved in ideologically
oriented health work and to provide means for fellowship and
mutual support among themselves.
c
e
e
e
c
6.1.11 The need to focus on gender related issues (76%)
e;
i.e., on womens’ health status, their access to health care and
the impact of technology on womens' health. among other factors.
C:
Women's health and other gender related issues, especially in
India, are intricately linked. Therefore CHAI can r~
encourage
discussions of patriarchy and its manifestations in caste.
_, class,
ecological destruction, militarism and sexism. It was reiterated
that health
J
issues cannot stand alone, without dealing with its
relations with all other aspects. However it was stated by
another panelist that this aspect could be considered as a part
of preferential option for the poor and disadvantaged, as upper
class women are likely to get good health care and enjoy a better
health status, One panelist felt this issue was not important
for CHAI.
6.1.12 To create an awareness on environmental/ecological
as they relate to health (74%)
e-.
A
issues
It was felt that these issues are going to be in the forefront by
2000 AD and therefore, knowledge about it must spread to the
community at large.
6.1.13 To strengthen/foster self-reliance at all levels (73%)
by promoting herbal and home remedies, non-drug
cost care and appropriate health technology,
dependance on drugs and the medical industry.
therapies r
low
And to reduce
Second Order priority (50 - 69%)
6.1.14
To promote an integrated approach to medicine and
(68%)
health
by studying, understanding and using Indian and other systems of
medicine, viz., Ayurveda, Siddha, Unani, Homeopathy, Acupuncture
etc.
It was felt that an integrated approach does not help as it tends
to lower the standards of medical care. A question was also
■■■
I
3
'i
39
O._
O
raised as to whether it is ethical to promote herbal medicines
The
unless they are proven more effective than placebos.
question who should prove this was also raised.
Among the general comments were the following:
1. All the above points are important as components of a
Statement of Philosophy on health, healing and wholeness by
CHAI. However a prioritization is done and is necessary with
the assumption that all cannot be addressed with equal
emphasis.
Therefore, some items though important in genral
have been given a lower scoring.
(eg., C - insignificantly
relevant) as they are not important as far as CHAI’s future
role as catalyst.
Too many focus of attention will only
dilute CHAI’s work.
<3
2.
Many of the factors are also interdependent and interrelated.
It would be important to identify the major plank
or
foundation for developing an equitable human caring system
The next step would be to identify factors which are
first.
going to support, supplement or complement such a system.
3.
It was also suggested that as we all grope in the dark,
research would be a very important activity/attitude to be
considered.
O
•O.
It
L ,
i
I®
6.2 IMPORTANT HEALTH
respond to
PROBLEMS IN THE COUNTRY
that
CHAI
could
The first round of the Delphi Method indicated the major health
problems the country would be facing 15 years from now. Given the
strengths and specificities of CHAI, the following important
health problems in the country that CHAI could respond to, have
been identified.
They are arranged in descending order of
priority according to the ranking given by the panelists.
A. First Order Priority (more than 70%)
6.2.1 Women’s Health Care (86%)
6.2.2 Child Survival (83.76%)
r»
Through growth monitoring, oral rehydration,
health education, nutrition and immunization.
breast
feeding,
6.2.3 Urban Health Care (73.07%)
6.2.4 Communicable Disease Prevention (73.07%)
It was felt that the scope of CHAI's work should be in those
areas not covered by the growing government programmes. While
the
communicable disease control is the responsibility of
different
implementation
of
programmes
varies
in
government r
States and regions.
■>
%
54
r
*
42
*
6.2.5 AIDS and STDs (73.07%)
This would include educational work for prevention
developing hospices for AIDS cases to die in dignity.
and
also
c:..
6.2.6 Substance misuse (73.07)
This includes alcoholism, tobacco use and drug addiction.
C:
Second Order Priority (50 - 69%)
6.2.7 Mental Health (68.46%)
e?
Counselling including for people who are chronically ill, and in
terminal care hospices. Promoting positive mental health is also
very important
.
i
CK
Mental health should be approached in terms of the individual,
family and community psychology and sociology, It should not to
be too medically oriented.
6.2.8 Disability Care (67.56%)
Community based rehabilitation and prevention.
6.2.9 Occupational Health (64.86%)
Particularly
sector.
of
unorganised
5 ,
labour, women
and
the
organised
4
4
6.2.10 Care of the Aged 64.86%)
Geriatrics in hospitals/dispensaries,
houses/day centres for the elderly.
and
also
opening
of
It was felt that the emphasis should be to help families accept
their aged and encourage community/home based support and care of
the elderly, not only as patients but as people.
point was reemphasised by another panelist who mentioned
assumed
Indian culture had a system where children
"Do we need to ape the
responsibility for their old parents.
Instead teach
West and put our parents into Homes for the Aged,
people/children to look after their old at home".
This
that
6.2.11 Natural Family Planning / Population issues (63%)
Family welfare programmes, family counselling, with a mention by
Though rated
some panelists that NFP has not been successful,
this point merited a large number of additional
the lowest,
comments viz.,
v..
.4
NFP could have been presented as an independent item
separate from population issues which certainly can be
as A.
i.e. ,
rated
e
c
‘C
■r
■
41
O.
- Population reduction issues should be approached more
vigorously,
as it is critical for the entire health
CHAI needs to take a bold initiative and go
sector.
beyond NFP.
O
3
o
o
- Population issues should be approached from a wider
developmental, environmental and women’s perspective.
- Population growth should be altered and lowered in a
balanced way. We need a Net Reproduction Rate where every
women has 2.1 children. Contraception and abortion pave
the way for Minus or Below Replacement Rate and will lead
us to pro-fertility procedures as in Scandinavian and
other countries, of In Vitro Fertilization (IVF) etc.
The great value of NFP is in preserving:
O
O
O
a) women’s health
b) family stability
proportional) and
(contraception
and
divorce
are
c) respect for life.
3
O
This has not been studied or understood by CHAI. This is not
a religious issue.
NFP has an important role. There is a need
regarding up-to-date scientific methods.
for
knowledge
o
i
o
Q
- There is an urgent need to represent to Church authorities
the view of a large number of health workers that NFP is
not always feasible, hence need for search for other
effective and less harmful methods.
NFP is a failure.
failure. Can promote condoms which will
AIDS/STDs, as well as unwanted pregnancies.
s
E
£
W-- R
There were several other valuable general comments.
given below:
prevent
which
are
a. CHAI could address important health problems’ by a collective
look at relevant statistical data and projection - perhaps on
a
regional/state
basis.
Normative
ranking
would
be
inappropriate.
b. There is a need for a wholistic approach - not a
vertical’
programmatic approach. If CHAI deals with these directly, the
main objective of providing perspective, finding the best
solution according to the context will become diluted.
It
could therefore provide consultative services in approaching
the above problems according to a new perspective.
£
€
42
c. CHAI should do a few things well.
It is unrealistic for CHAI
to undertake too many roles and functions and thus project a
global, all embracing image.
d. CHAI should take an organizing, coordinating, supportive and
consultative role and not that of providing direct services.
e. CHAI does not need to have such a large number of specialists
in it to deal with all these problems. As it is, -CHAI is
tending to be too much of a bureaucratic set-up. There will
be other organisations which can provide
responses
to
specific health problems.
f. The scope of CHAI should be in those areas not covered by
growing government programmes.
the
g- Looked at from various angles all these health problems seem
to get special attention in some form or other, in one place
or other in India in the coming years.
h. CHAI should take a wholistic approach, with primary focus
child survival and care of the aged.
Emphasis should be on mother and child health and
community education for health.
family
on
and
e
e
e
e
e
c
e
e
e
e
C
c
c
e
e
e-
j • Focus on wholistic health with spiritual values.
k. Focus on community based, primary health care promotion.
1. Iatrogenic problems also need to be considered.
m. In terms of helping, guiding and providing technical
all are important.
support,
•c
C
C
6.3 COMPONENTS OF HEALTH CARE / HEALTH ACTION TO BE PROMOTED
Various components of health care have been identified that need
to be promoted by CHAI in its future work.
These are listed
below in descending order of priority.
A. First Order Priority (more than 70%)
c:
£
6.3.1 Health education (92.79%)
Education for health using effective communication
skills,
regarding
developing
effective material, public
education
understanding of health.
Additional comments were regarding the importance of child to
child and child to mother communication, need for clear basic
messages, use of minimal reading material and increased use of
art work.
.A
3
3
43
o-
Primary Health Care, Preventive and Promotive Health
(90.09%)
Care
Find
ways of effectively implementing the principles
components of Primary Health Care towards Health for All.
and
6.3.2
0
o
-3
6.3.3 Rational Drug Therapy / Policy (83.78%)
Introducing
the
concept actively
campaigning at the national level.
3
a
o
a
is
6.3.4 Community Health (81.08%)
Staffing of community health care units
spiritual health,
social work personnel,
health,
para-medical staff.
a
3
An additional comment
was that it
encompass all these functions.
3
a
3
6.3.5
3.
3’
3
3
3
0
i
I
insitutions,
member
It was felt that promotion of a Rational Drug Policy by CHAI
more• important than working on rational therapeutics alone.
3
t
in
3
3
eit
Improving
(81.08%)
will
unrealistic
be
hospital/dispensary based health
care
to
systems
This could be furthered by introducing spiritual and counselling
rational
mental
health care, health
education,
methods,
technologies
that
therapeutics , effective lowcost humane care,
can be taken closer to the community and by making services
in .view the
accessible to the rural and urban poor. Keeping m
privatization
of
health
services,
the
small
clinic and
growing
role to
member
institutions
of
CHAI
have
an
important
hospital
play in the future.
It was felt that CHAI member hospitals should be models in this.
■?3
k3’
with mental health,
besides medical and
6.3.6
Involvement
(80.01%)
in determining training of
health
CHAI could work towards a more community oriented
health personnel;
personnel
formation
of
Participate in evolving nursing curricula, eg., inclusion of
women’s issues, AIDS, addictions, role of new technologies etc.
"3
I
■
'
1
♦<5
The increasing specialisation in the nursing profession is making
it competitive with allied professions;
Need
for training
para—professionals/non professionals
comprehensive health care work;
Participate in re-orienting, reorganising medical
produce more socially sensitive physicians.
It was additionally felt that:
education
for
to
*•
A4
*2
t:
This is an important role and is not being done sufficiently by
others.
Education and training are weak areas
of
many
organisations including CHAI.
e
c
e
Nothing much will come out of more community oriented formation
and in reorienting medical education to produce more socially
sensitive physicians.
The professionals will not allow the
training
of
para-professionals/non-professionals
for
comprehensive health care to develop as there are too many vested
interests. These are also not the money spinners.
c
Training of para and non-professionals should not be connected to
a hospital.
Not should they work as part of a hospital
programme.
e.
e
e
6.3.7 Medical Ethics (76.57%)
c
c
c
C
Issues relating to human fertility, abortion, end of human
use of human organis and tissues.
life,
e
It was felt that this area has been very biologically defined.
Probably these are issues which perturb the Catholic mind,
They
need to be broadened.
e
Medical ethics should include health care issues.
The more
glaring issues - who gets care and who does not, multinationals
and
drugs, ethics in occupational
hazards,
environmental
destruction etc. ,
are wider ethical issues relating to health
that need to be tackled. Malpractices need to be addressed.-
There is a need to promote holistic human values in health work.
C?
<
c
c
C
6.3.8 Research and Documentation (74.77%)
and
care
e
c
c
Planning, personnel management, improved service effectiveness,
concept of total quality management,
identifying performance
indicators, developing management information systems, increasing
inter-institutional cooperation are areas that could be pursued
by CHAI.
c
there
Additionally r while management was considered important,
was a word of caution, otherwise our health care will look like
business enterprise’.
£
of
major
health problems, health service
research,
evaluation could be undertaken. Research in primary health
and in preventive health is important.
6.3.9 Management principles and skills in health (74.77%)
6.3.10 Pastoral care / spiritual health (70.27%)
Training courses ior lay and religious personnel on an inter
religious basis.
It was felt that publications in this area are also needed.
*T\s
4
o-
45
■
O’ ■
B . Second Order Priority (50 - 69%)
6.3.11 Traditional / indigenous health knowledge and
Alternative methods of healing(69.36% )
systems
There is a need to develop a pharmacopeia for use by primary
health workers and for their training, promote investigation and
study, prepare teaching materials for members,and to integrate
different systems of medicine/healing into health care services.
It was also felt that while this was crucial, there was a need
for tackling the prevalent neo-colonial mentality that may resist
use of these methods.
6.3.12 Lobbying for
regulating the standard
health services (69.36%)
O
O
of
operation
This was considered very important, if it could be done,
is a need to cooperate with others in the process.
of
There
6.3.13 Understanding of public health principles and epidemiology
(67.56%)
including the changing epidemiological scene in the country
its implications for health services.
>>
and
Additionally it was felt that there is a need for understanding
tropical diseases better and for adapting textbooks.
6.3.14 Health Care Financing (67.56%)
improved cost effectiveness, innovative models.
6.3.15 Multidisciplinary health team functioning (67.50%)
With equal respect for people from the different disciplines.
Health planningj now utilises a multidisciplinary approach and so
and
other
of health management like organisation,
do
G--- elements
--evaluation.
pattern of
The p
- religious always holding leadership positions> in
Catholic hospitals should change. More lay participation based
Christian presence
on competence and commitment is needed.
cannot be due solely to the leadership and authority of the
religious, but has to be in the whole health care team.
Additional general comments were:
a . Much depends on the clear cut policies and resources that CHAI
will have. All issues are inter-related.
b. CHAI should promote those objectives that are necessary and
extremely important,
fulfill.
important, which other bodies cannot
Whatever has a multiplying effect at the national and regional
levels should have priority in its objectives and strategies.
>
: a
Mt
I
r
46
■C
■e
- e
c
c. It must not duplicate the work done effectively by VHAI etc.
d. Some of these issues
are excellent,
but beyond
abilities,
like helping government hospitals.
and
research.
e
e
e.
e
c
e
e
CHAI’s
doing
6.4 BROAD STRATEGIES OF INTERVENTION
Various strategies of work or intervention can be utilised to
address major health problems and to promote health action,
They
would help CHAI to implement its objectives,
Some of these have
been identified by Delphi panelists and are listed below• in
descending order or priority.
e
e
6.4.1 Continuing education for members (88.28%)
Human resource development for various types of health workers
through workshops, seminars, training programmes - to introduce
greater professionalism into peripheral health care programmes of
CHAI members.
£
It was suggested that workshops and seminars should be conducted
by non-religious.
The religious personnel should be exposed to
the stark reality the common person faces.
6.4.2 Focus on and encourage/support members to move to work with
the most needy, the margnialised groups and the most dehumanising
health problems (88.28%)
e
e-
This was considered a strength of Catholics.
It was felt that new initiatives should not include institutional
health care approaches.
6.4.3
Networking
(82.88%)
with
voluntary
programmes
of
health
at national, regional, local and international levels,
sharing and collaboration, avoiding duplication.
6.4.4
Evolving
(82.88%)
models/innovative
programmes
of
care
increasing
health
care
that would be viable, applicable by religious and non-religious ■
workers,
affordable and sustainable by the people,
taking into
consideration the socio-economic-political structures.
It was felt that every little programme should be a model, based
and developed according to the need of the area.
The word "nonreligious worker" was not appreciated "since every worker in the
field is religious’ whether he/she is conscious of it or not".
!
i
r
...V
.
r J.
33
47
6.4.5 Developing education / training models (82.88%)
O’
0
3
3
3
3
3
3
3
in tune with our realities, at various regional levels in
regional languages, to support the models developed and to cater
to^ the vast majority of people still outside the 1health
1L
care
system.
It was felt that these are weak areas
including CHAI.
of
many
organizations,
especially
to
This should be done while respecting the autonomy of members
agencies.
and
6.4.6 Appropriate health personnel development,
meet new needs (80.18%)
6.4.7 Advocacy/lobbying/campaigning
level (73.37%)
for
change
at
national
a
so that basic health needs,
for example, clean water are
satisfied for all, and for government to revise priorities to
emphasise health services for the poor. Also against alcoholism,
drug addiction, environmental degradation.
It was felt that advocacy should include the areas of
health, respect for life, and natural family planning.
women’s
I
As a start, it was suggested that clean drinking water in
villages covered by churches could be provided by placing wells
in the village and not in the parish compound.
6.4.8
Re-assessment, reorientation, rejuvenation of Catholic
resources in health care to the urgent priorities of the
time (76.57%)
3
6.4.9 Publications (74.77%)
3
more in regional languages to support community primary health
care workers; in English about healthy living, causes of illhealth, health hazards, drug issues etc.
3
' 3
3
3
3
r'
I
It was felt that this should be pursued in areas not provided for
already by VHAI (Voluntary Health Association of India), ISNFP
(Indian Society for NFP) etc.
It was not clear why such a distinction was made in
between regional languages and English.
the
focus
Keeping in mind that, a number of community health
illiterate r creative methods need to be developed.
workers
are
: -i-
h
I
>-
4-,
e
6.4.10 Developing a capacity for policy level input into national
health policies/plans (72.07%)
It was once
policies.
again considered important
to
influence
national
6.4.10 Bold Media coverage (70.27%)
At the national and regional level to educate and inform people
regarding components of at the health, causes of ill-health, what
ails the system, etc. Use of audio-visuals should be emphasised.
It was felt that media publicity should not be about CHAI.
This
should be attempted only "once we have set our house right".
6.4.11 Organising national/regional consultations and conventions
(70.27%)
c
c
e
c
c
c
e
e
c
Cl
c?
6.4.12 Intersectoral coordination(60.36%) in regions of the work
area,
area,
and
of members to demonstrate the need and scope in this
need
to
get
involved
with
non-health
issues
that
impact
on
the
eco-farming,
health,
for example,
water shed
management,
developing credit systems for poor and for women.
e
c
c.
life
c
6.4.13 Make a conscious effort to maintain a simplicity
style and structures within CHAI (59.45%)
of
Also encourage members to live in simple temporary dwellings.
Present concrete structures make them far removed from reality.
t?
We should promote a culture of simple life and not an affluent
and materialistic life style.
This could probably be encouraged
by enrolling more lay members.
o
It was felt that if temporary dwellings in the long run are going
the latter
to be expensive than simple concrete structures,
should be preferred.
Inexpensive dwellings are to be encouraged,, but they should
compatible with health requirements of the occupants.
e
£.
be
should
simple
This is a matter which religious congregations and others
If point No. 3,
is practised,
themselves attend to.
lifestyles will follow.
Additional comments were :
Though desirable, there is a limitation to involvements.
CHAI will be effective if it limits itself to a mission and
and not by becoming too diffuse.
role
This is good, but is not CHAI's role.
important
It is
issues.
to link direct health
--4
services
with
related
•X
■O
J
49
3'3
•3
-3
•3
On the other hand inter-sectoral and even intra-sectoral
transectoral coordination was considered very important.
or
Additional General comments regarding strategies of intervention
a. one of the panelists suggested an alternative approach:
Instead of CHAI concentrating on particular issues in health
health care, the focus could be more on:
3
0
0
0
0
WHO ?
o
o
o
WHERE OR FOR
WHOM ?
- Catholic health professionals/ lay
health care institutions
and
people,
who see a role for themselves in health and
and
and who need to acquire
healing
maintain a faith based motivation.
- Disadvantaged regions of the country;
Marginalised everywhere;
segments
Unpopular
much
involving
dehumanisation.
, 0
HOW ?
of
health
suffering
care
and
- Whole person or wholistic approach;
low cost, effective care approach;
- Participatory with people accepting as much
responsibility as possible;
with a conscious foundation or motivation
in faith, values or ideology on the part of
the care giver.
£
i
*’3
3
3
3
5
*
of work should be based on objectives and
b. priority areas ot
philosophy of CHAI as well as on the national health policy.
Thrust areas depend on the objectives and philosophy.
c. Let CHAI start work on a few of these strategies. There is a
possibility that if all^are recommended to CHAI, the religious
decisions concerning CHAI will fill it
:
authorities, who make
specialists ” (generally from one. state in India), and
with ‘•specialists
of
make it fit much more than it already is, into the mould
top heavy ecclesiastical bureaucratic structures.
d. A national consultation once in two years involving a wide
project
experts,
researchers,
academicians,
range
of
- j is a must.
If conducted properly, it will
coordinators etc./
important issues and prioritising them.
help in identifying
:
of
documentation and dissemination is also
An objective system
important.
-7.1
50
e. CHAI will have to find that part of the health
care system,
where is can be most effective in
coordination with other
health care providers - both private and public.
Spreading
far and wide is best avoided.
A i
f . Work on all 3 levels
local, national, global.
g- Link with CHAI of USA, Canada etc
of pro-life, pro-choice.
but keep away from policies
e
h. Keep a balance between institutional and community approaches.
6.5 CONSTITUENCIES/GROUPS FOR FOCUS OF ACTIVITIES
Given below is the rating given by Delphi ipanelists
'
regarding
constituencies/groups on which CHAI should focus its activities.
They are given in descending order of priority.
A. First Order Priority (more than 70%)
6.5.1 Developing/strengthening working links with other
level health associations (84.68%)
national
*.
viz., with Voluntary Health Association of India, Indian Hospital
Association,
Christian Medical Association of
India,
Indian
Society for Health Administrators, etc.
These are important to
achieve Health For All and to help in restructuring of health
sectors in both the voluntary and non-voluntary sectors.
It was felt that co-operation is vital.
There is
being inspired by and also inspiring others.
a
6.5.2 Interacting with/influencing government in
and legislation (81.08%)
policy
need
A
;■
for
t'
making
in association with the entire Voluntary Sector.
It was felt that its best possibilities are to network with other
health action groups to influence policy formulation and to speak
on behalf of the poor and voiceless.
A panelist felt that this was particularly important
planning and abortion.
in
family
6.5.3 Better operational links with non-Catholic, secular
organisations (72.97%)
health
e
C'
C
c
C.
at the national, regional and local levels.
cc
6.5.4 Focus Primarily on its membership (69.36%)
c
i.e.,
to support, strengthen and to challenge members.
To meet
genuine needs as felt by them, though they might be in conflict
with CHAI’s most important agendas, but this is the only way that
they can have a sense of belonging.
0-
£_
&
c-
-«r-
3
o.
51
V. .
v>
On the
support
CHAI.
other
those
hand, another panelist felt that it should not
who aim at variances with the basic policies of
0
It was also considered unfortunate that membership now is open
only to catholics. Unless membership is open to people of all
faiths which are "catholic” (universal) in nature and
not
fanatic, it was difficult to answer this question regarding
constituencies.
0
B. Second Order Priority (50 - 69%)
O
0
0
6.5.5 Linking with development groups/volags at the grass
(62.16%)
0
0
CHAI itself
members can.
O
O
cannot deal with agencies at the grass
roots
roots t
its
o
o
Its best possibilities are to network with other health action
groups to influence policy formulation and to speak on behalf of
the poor.
□
6.5.6 Focus on society at large (57.65%)
O
mobilize public opinion. While it is important to influence
society at large, this may be too broad and difficult a role for
CHAI.
0
i
0
It may also be spreading efforts too thinly, However
could be evolved along with other voluntary groups.
0
6.5.7 Supporting/working
with
organisations (54.95%)
3
in different fields eg., environmentalists,
dalits, labourers, working children.
3
activist
strategies
groups/people 's
women's
movement,
6.5.8 Developing functional links with government
I?
One
is not sure
functionaries.
how
lasting
this
can
be
with
changing
(Less than 49%)
C. Third Order Priority
6.5.9 On Church membership (41.44%)
3
3
k
the
lay congregation,
educational system.
I
It was also felt that the institutional hierarchy must
sensitized to the struggle of members in the area of health.
be
The focus on church membership should be only in as much as
can work for health care.
they
r
3
the
religious, the
structures,
the
‘3
^3
»
05041
< OOCUMc^tation
UNIT
♦
L .
------- ------ - —’W- •
-- rw-.'r-.—trs.-w-.-
I
5?
■ c
6.5.10 On Youth (37.83%)
Focus on youth can be one of the most important inputs, This age
group wishes to achieve something, but they also expect quick
results and want recognition, which older people rarely give.
Associations are usually oriented to their own harmony and their
own needs.
c,
e.
c
Youth are going to be the most important segment of the country
and therefore we should take a lead not only for them in India,
but also in SEARO anmd SOASE also.
Difficult to see what would be the special
matters like use of alcohol and drugs.
focus
except
e
for
6.5.11 Work at Parish level (28.82% )
C
C
This is the smallest unit, composed of families in a geographical
locality that worship in a Church.
Perhaps CHAI could be a (consultant
’’
'
(very
close relationship) with
a project to test some new ideas at this level.
C
CHAI can
c
only work at the parish level if it is accepted by the
Church. Someday the relationship between CECI and CHAI needs to
be worked out.
Given its present institutional base, it will be
CHAI to operate at the Parish level.
r'
for
C
Working at the parish level will get health care bogged down with
ecclesiastical structures. This should be handled by Diocesan
and other agencies.
c
c
difficult
6.5.12 Play a role in South East Asian countries (21.62%)
C
This would need be alongside work within the country as well.
C
c
it was :felt that CHAI has enough challenges and problems before
it in India,
It should not attempt at this juncture to play a
wider role in South East Asia, except perhaps in sharing of
information.
c
Another panelist thought it is good to begin co-operation
South East Asian countries.
There is much to learn
experiences of people in the Republic of China.
with
from
It was also felt that if CHAI has
relationships could be explored.
such
something
to
offer,
O
0
Working at the national level, trying to address large and
complex health problems and relating to the professional needs of
member institutions and health personnel is a difficult and
challenging task. There are many expectations. There could be a
blurring as to which groups or who CHAI should work with.
The
0
.0
£
$
..
—t■
-
JU
9
O'
V
O
O
o
0
53
above ideas and rating by the panelists would help the
making process.
decision
There were some additional comments and new ideas
a. As a national organisation, maintaining linkages with other
agencies, government and members is important and necessary.
However it was felt that CHAI should not disperse itself over
a large number of useful but unrelated issues.
It should
issues.
respect its limitations and not try to do everything and with
everyone !
0
0
•0
b. CHAI should facilitate an active network of non-governmental
organisations committed to health of the people,
It should be
able to resist undesirable tendencies.
O
0
c. There is a need to build a working linkage with Trained Nurses
Association of India (TNAI) as this is the only professional
association for nurses in India to keep them united at the
national level.
o
d. There is also a need for coordination
groups/specific interest areas
0
0
Q
4
4
0
I
with
the
following
- Medical Association - St. Luke's Association;
- Pastoral Care of the Sick;
- Catholic Nurses Guild of India;
- Family Apostolate;
- Community Health;
- Mental Health.
e. It is very important to decide whether CHAI wants to be a
truly professional body dedicated to health and
social
development or whether it just intends to be a spokesman of
the Church, limiting its activities.
f. This was considered to be really a function of resources.
Given limited resources, it was suggested giving priority to
linkages with the immediate health family and with the
government sector and media - to reflect the policy framework.
1
g. Another panelist felt that CHAI should aim to sensitize and
mobilise the whole body of believers (Catholic community) and
through the involvement of the whole community, seek to impact
on society at large. Focus on institutional activities alone
will have highly localised effects, while the whole Indian
society is feeling helpless, cynical and therefore uninvolved.
h. Middle aged women, not gainfully employed constitute an
important segment which should be utilised, because they have
nothing to do and have time and money and wish to be
recognised. Their energies can be properly channelised.
i. The mandate to go and heal comes to the church from the Lord
himself. Therefore the primary role of the congregation is to
be an agent of healing in society, in the world and in
1 *
C
e
54
r
creation. CHAI has to aim at renewal of the Church to make it
a movement of the Spirit to heal.
6.6 REDEFINING ROLES IN THE PRESENT AND FUTURE CONTEXT
Keeping in mind the predicted broader socio-economic-politicalcultural situation in India fifteen years from now (Delphi first
round) and the priority health problems
and issues (Delphi
second round) the Delphi panelists have suggested that the future
roles that CHAI could play are as follows. They have been listed
in descending order of priority and can be sub-divided into three
broad groups.
A. First Order Priority (More than 70%)
6.6.1 Networking role, with like minded groups
(83.78%)
6.6.2 Coordinating role, with/for members
(79.27%)
6.6.3 Inspirational role, with/for members
(78.37%)
e
C
e
e
e
e
c
C
C
6.6.4 Information/Communication role to
members/public
(78.37%)
e
6.6.5 Catalyst role with members/others
(70.27%)
<*
6.6.6 Trainers role with/for members
(70.27%)
A
B. Second Order Priority (50-69%)
6.6.7 Technical support role to members
e
(59.45%)
e
C. Third Order Priority (less than 49%)
6.6.8 Activist role with/supportive of
people's organisations
(44.14%)
6.6.9 Supplementary role to government
through members
(30.63%)
c
r-
Additional comments were :
1. CHAI should network with other health movements and peoples
It should be
movements in the country and act as a catalyst,
alert, flexible, open and competent enough to identify gaps
left unattended by other bodies and to initiate appropriate
action.
6,
A
2. Contributions of NGOs as a coordinated movement can play a
vital role in nation building. Hence CHAI's involvement is
necessary and the role should be to create the strength of a
movement and solidarity with groups/movements become very
important.
c?
e
, I
’xU.'
I
55
-
00
O
o
3. For its own work and the needs of its members all existing
means of training and other available health resources should
be tapped/used.
4 . CHAI needs to be an expression of the catholic communities
concern for health and wholeness in the nation. CHAI should
must
facilitate the involvement of the community in this and
enable member insitutions to become involved with society in
this way
CHAI
o
0
0
0
O
Catholic
Community
Member
Institutions
Society
and
The overwhelming consensus was to focus on the membership
provide a support which would / should include:
★ A discernment,
leadership and direction by CHAI;
0
0
★ A
focus on the country especially the marginalised;
4
a
★
A coordinating and training role to make its members make
more meaningful contribution;
*
Exploration and experimentation with new future strategies;
★ A
development of appropriate technology;
i 0
I
I0
io
★ To provide
a framework and prioritzation of health issues;
★
Not be involved directly with field’ activities
channel new ideas for dissemination to members;
★
Inspire and be a catalyst to its members.
6 . The relationship with Government needs to be
further. This would include:*
s
1'
upon
While initially NGO/Church related health
institutions
pioneered medical services in response to need, there is a
great need to encourage the government who have legitimately
the mandate and responsibility for health care to do this,
especially since they also have the resources
(all NGO
resources put together account for 5% of total expenditure
on development - 95% is by government). CHAI members must
recognise this need and move to new and difficult areas and
be willing to move out and change.
★
Should supplement government in meeting unmet needs.
* Should avoid
>
3
reflected
to
★
I*
3
but
repetitive and unproductive work.
I
cv
. .e
-e
- <
★ While
supplementing government, it should not allow the work
of its members to become an excuse for health policies not
to care about the poor.
C-
it should challenge neo-colonial exploitation in the health
7. It
field. Without this all else will be idle. Ideas and models
of imperialists will be imposed and the poor will have no
choice.
C..
8. While all these roles are important, it should
cautious to be within the limits of its field.
always
C;-
be
6.7 ORGANISATIONAL ASPECTS IMPORTANT FOR EFFECTIVE FUNCTIONING
C
Delphi panelists have identified several organisational aspects
or mechanisms that could be strengthened or introduced by CHAI to
enable effective functioning. This is crucial if strategies of
intervention in key areas are to have an impact. They are listed
below in descending order of priority.
A. First Order Priority (More than 70%)
c.
c.
cA-
6.7.1 To define/redefine objectives (94.59%)
with the concurrence of members.
good start.
It was felt this would
be
a
y
C'
e ■
6.7.2 Formulate clear strategies to achieve objectives (90.99%)
i
It was suggested that initially strategies need not be formulated
too clearly. They should be developed gradually, leaving space
for flexibility and for the introduction of new ideas.
C
6.7.3 Prioritize,
make
choices
vigorously on them (84.68%)
and
work
consistenly
c
and
C
C
i.e., do a few things well
A comment was that this would be scarcely possible
the variety of important goals that have come up.
considering
C. •
6.7.4 Set up a mechanism for reviewing/monitoring/evaluation the
work done and implementation of recommendations (82.08%)
C
C
This should concern its own work and not that of members,
should be carried out only if it does not complicate matters.
It
c?
c: ’
6.7.5 Increase internal cohesiveness between member
(79.27%)
institutions
A f
r
CHAI is too loosely knit, with no clear corporate objectives.
it was felt that this would be necessary to really make an impact
at a larger level.
e
C ■
. 5
e.
57
V
V-
0
•O
CHAI should gradually move towards cohesiveness, ]but should avoid
steam-rolling. The initiatives of a few should not be lost,
-----The
slower moving cannot be pushed too hard.
6.7.6 Decentralise and
planning (74.77%)
promote
regional
units
and
regional
•O
These units can be reference points for
members within the area.
A word of caution was that this should be attempted only
attempted
if
really feasible, otherwise bureaucracy would be
multiplied.
B. Second Order Priority (50-69%)
6.7.7 Work
out a health
institutions (63.96%)
£
policy
for
Catholic
(NB: This has been recently prepard by the CBCI
Health Care Apostolate in 1992)
health
care
Commission
for
It was also felt that this was too preachy.
6.7.8 Encourage lay membership (54.95%)
Q
T
a
It was unclear to a few panelists which
people were being
referred to by the term lay* viz., non-religious
or nonprofessional persons.
In this case a lay person is one who is
not a religious nun or priest.
It
was
f
’‘
felt
’
that lay
membership would be fencouraged
---if they
interested in the health perspectivei that CHAI has.
J
ks
□
It would be a <_good’ idea
’ ’
if they are willing to
collaboration with others.
work
in
are
some
C. Third Order Priority (Less than 49%)
6.7.9 Change of name (29.72%)
viz. , drop hospital from it, caJT it Catholic
Association or something similar.
Wholistic
Health
Comments and ideas were as follows:
Six panelists suggested the name
India*
Catholic Health Association
It will be good to omit the word hospital' in the name of
but not lose the focus on health care.
I
of
CHAI,
Catholic Health Care Association of India was suggested as being
more comprehensive. It would mean adding only another C in CHAI?1
3
3
3
>
%
<2
I
-
•c
c
A change of name requires much reflction. What will be the
perceptions of the member institutions - now largely hospitals ?
Will this be perceived as hijacking the organisation and its
agenda ?
Another felt that hospital should be dropped, but was
about wholistic.
not
sure
w-
c._
C:.
c-
Community of Healing and Wholeness' was a possibility.
Q
Another panelist felt that a name change would not help.
If CHAI decides to visualise its role in a wider perspective
on
the lines indicated by some panelists - then, it may not be a bad
idea to change the name.
C.
C'
C
But at the same time, it is worth bearing in mind that by
retaining the present name, CHAI will not be handicapped in any
way in venturing into new areas, to be in tune with the changes
occuring in many spheres of the country.
It was also felt that much depends on the
objectives. A mere change of name will not help.
policies
and
A few further general comments are given below
>
mission
a . A corporate objective or goal could be CHAI’s
statement.
CHAI cannot do this for every hospital
or
religious society involved in health. However it may help
them if requested.
b. Forming objectives, policies and fLdentifying
are important at this stage of CHAI.
priority
areas
c. All these points are more or less necessary and they can occur
side by side, that is they cannot be assigned mutually
exclusive priorities.
d. There is a need for thinking initiatives to be fostered among
members so that they do not look at CHAI as some father
figure.
C*.
*1
’.-sSi
S'
I
c
59
O
7. CONCLUSIONS AND RECOMMENDATIONS
3
3
I
i 0
I
O
7.1 When the Policy Delphi Method was initiated, we outselves as
facilitators were stepping into the unknown.
Most of the
material on the method that we could find was not related to
health.•
We were
also pressed for time as the other
components of the CHAI evaluation study that were being
carried
out simultaneously were even
larger and
more
exhausting.
However now that it is behind us, it has been an
experience of learning and growth.
Some of the panelists too
have mentioned this and incidentally this has also been
documented as one of the spin-offs of the method, which could
even be considered as an additional objective.
k
L
i
o
io
O
□
□
•3
3
The broad scope of what has emerged is valuable and would
perhaps be useful not only to CHAI, but to all those with a
concern for health and health related issues in India.
7.2 CHAI has already undertaken an
important initiative in
organising regional and professional group meetings during
the Jubilee year to discuss findings of the: study and to
evolve plans of action for the national and regional levels,
Members are thus participating in and contributing to the
thinking process regarding the future of CHAI,
During this
process, they will also be responding to the ideas generated
by the Delphi Panelists,
A summary of the findings of the
first round has been made available to them in the report
"Seeking the Signs of the Times",
Findings from the second
round have been circulated to all members as an additional
background
paper.
During the regional meetings, round two
findings are
briefly presented and discussed,
This is
followed by members prioritizing these issues using a rating
scale.
At the end of eleven country-wide regional meetings,
we would have a fairly representative picture of members'
prioritization of these issues,
The important ones can then
be taken up for action.
Thus the most pressing agenda for CHAI after this
elaborate
process would be action based on the findings of the process
of enquiry initiated by thein.
This will be necessary at all
levels, but
particularly by the Centre.
Members
in the
field are health professionals, most often functioning under
difficult circumstances.
They have developed much experience
and skill over time.
However, several of them function with
understandings developed when they were under training often
10-30 years ago.
Several ideas from Delphi represent fresh
or new understandings and approaches.
These will have to be
made
available to members in ways that they may
be
operationalised.
They may even be modified and built upon.
This would require a high level of competence and leadership
from CHAI at the national level.
Appropriate staff selection
and staff development policies would need to be pursued.
4
k
3
3
t
’
3
?
!
60
7.3 While the issues raised in the section on contextualising the
work of CHAI may not be entirely new, and perhaps also not
absolutely true for some regions, it still could form an
important reference point for members to view their work and
their membership in an association like CHAI,
It
is
primarily in the backdrop of the national situation as it
impacts on health, that belonging to a national organisation
makes sense and also has a purpose.
It is apparent from this
section that complex and crucial forces help determine the
health status of people. Provision of curative medical care
by individual CHAI members is important to relieve pain and
suffering and to overcome periods of crises in the lives of
people. However, when it is recognised that several of these
ill health episodes are repetitive and preventible, then
alternative strategies could be adopted.
It does not seem
unrealistic to expect a national level association, with the
strength that CHAI has, to work towards making atleast a
contribution to existing movements in the country that are
addressing these larger issues.
Infact one could go so far
as to say that there is no option for CHAI and its members
considering the 1301101 system that they express allegiance
to.
Thus CHAI is called to make much more
active,
intelligent, strong hearted and strong willed efforts to gear
up to face these challenges. These would need to be in
alliance with similarly oriented pro-people groups on issues
that could make an impact on the health and lives of people,
if not immediately, atleast some years ahead.
CHAI could adopt creative ways by which an understanding of
contextual issues could be furthered among its members.
A
situation analysis of the State (and possibly district) level
could be undertaken by all regional units in the year
following the Jubilee. This would need adequate preparation
with the use of participatory methods. Health related data
is available from Central and State Government bodies eg. ,
Central Bureau of Health Intelligence, Ministry of Health &
Family
Welfare and also State Directorates of
Health
Services.
UNICEF sponsored studies particularly regarding
health of women and children are also available in several
states.
Similarly there 4*s data available from several
voluntary sector and private health and operation research
groups. The research unit of CHAI in collaboration with the
community health department, the zonal office and
the
regional
units
units could
could facilitate
facilitate this
this process,
Delphi
panelists could be invited as resource persons. The purpose
of such an exercise could be to gain an understanding of the
State level health situation and to identify a few areas on
which members as a group could undertake action at the level
of their institutions, but more importantly at District and
State levels.
e
c
c
A
■
C.
t
<
o
r.
t
c?
*
i
• 4
*4
<i
£
A
ee
>5*
61
o*
J
<5
health issues and problems - emerging problems,
7.4 Major
approaches
0
3
3
5
■ 3
1
p
o
O
O
□
ea
O
3
3
fresh
sour'-os of
'' ' ' ,
s tandard
As mentioned above, utilising available,
nr' jnitude
of
understanding
the
information is an important way
at
regional. and i itional
the
of certain health problems
j
raised
by > ‘el phi
there are seve?al issues
levels.
However
and
problems
panelists that could be termed emerging health
medical
find a
place
in regular
issues.
These may not
easily into
and
they
may
not
fit
literature
professional
However they are recognised to be
earlier classifications.
of
important, based on the experience of a - fairly large number
the
being important for
groups working at .the grassroots, as
specie 1
severa1
and
health
of
people.
There
are
also
lives
data
groups
who
nave
generaceu
a
fair
amount
ol
have generated
interest
them.
Several areas :identified
here are those in
--concerning
which CHAI is not doing much eg.,
active measures to nurture members of the health team.
a
b.. promotion of
of a
a sense
sense of community and belonging as being
critical to well being and wholeness.
related issues.
c. Focus on gender
_
_ I issues
d. Environmental/ecological
though
it is well recognised by all.
e. Population issues,
f. AIDS
9- Disability care
h. Health Education
i. Health care financing etc.
these
and other
areas
to incorporate
need
CHAI will
and
education
continuing
its
training
into
identified
coverage
has been some
in Heal tli
there
Though
modules.
action,
-not
be
able
to
foster
Action, publications alone may
support.
though it may be
L- a
- vital
- these wider
issues,
including a
of
inclusion
Advocating
by
educational
programmes
run
into
situation analysis,
be
training
of
health
personnel
could
members who undertake
attempted.
_r on some of
Similarly, efforts are required regarding.advocacy
with other interested
l
attempted
policy,
for
drug
in the area of lobbying for a rational
community health.
and
in
practice of rational therapeutics.
support to this drug action' and to the
While continuing
health movement,
similar efforts
promotion of a peoples'
CHAI
is
_
areas.
For
instance,
in other
could be made
womens’
working
towards
promotion
of
suited to '
particularly
health
issues,
education f^r health and
ai;
gender
-health and
in
health
care.
awareness and medical ethics and values
philosophical level
these areas are inter-related at a
All
However z
in them.
is already being made
and some imput
and more
skilland competencies
greater efforts, requiring
3
I
62
personnel would help CHAI make a more positive
in these areas, which are its strengths.
contribution
Similarly, there are already initiatives rsupported
'
by CHAI in
the area of holistic health, in the use of herbal medicines
and other systems of medicine and in health work with the
urban
poor.
These need to be further
studied
and
strengthened and promoted among members in a planned manner.
An initial workship has also been held regarding promotion of
positive mental health. This is a crucial area requirinq
follow-up.
Perhaps five or more such areas could be identified and taken
up for intensive and extensive work during the next 3 years.
Use could be made of Consultative
Advisory Committees,
so
that staff can have access to people with experience and
expertise in those particular areas. Staff could also attend
workshops and short courses to further their own growth ‘ in
these areas.
However involving them in several issues
simultaneously will hamper their work at the present stage
and also result in fatigue, frustration and burnout.
7.5 While involvement in the promotion of specific areas of
health care and health action are important,
important, a
major
contribution of CHAI to its members and others could be in
providing a pro-people perspective of health work and health
action.
This has been an area that CHAI has developed,
particularly during the past 10 years.
This should be
upon. The basic premises of health work
continued and built upon.
that have emerged from the Delphi panelists offer certain
fresh ideas and formulations. These could be internalised
and
CHAI’s
statement of understanding
or
philosophy
articulated.
These perspectives of health and health work
could form a core part of all the training modules and other
activities of CHAI.
7.6 Regarding constituencies and groups on which CHAI should
focus on, the Delphi panelists have given a high rating to
strengthening working links with national level
health
associations and to influencing government policy making.
The above links that CHAI has already developed with CMAI,
VHAI, AIDAN etc.,
could be further strengthened at the
regional level.
CMAI
members could form an :important
resource for continuing education for the small health centre
members of CHAI in different parts of the (country
-. CMAI also
has many training programmes for nurses andI allied health
professionals.
Modalities could be worked out as to how
these can be linked to CHAI members, utlised by them etc.
Similarly in the area of publications, production of health
education materials in different Indian languages, advocacy
on health issues, and in training, useful linkages couldI be
built with VHAI. There are several other training,
research
and special interest groups in the country
with whom
networking could be pursued more actively by CHAI both at
national and at regional levels.
G
C
C
c
c
c
G-
c
c
c
e
c*
c
*
4
4 .
■a
r
1
e
C?
J
o'
63
0
o
3
0
i o
■o
!O
0
,□
iO
r?
rb
fo
>o
•>
Ia
r
I
n
->
There is much further scope for CHAI, alongwith others in the
voluntary sector, to interact with, to influence and be
influenced by the government sector. Except for the period
during the seventies,
seventies, there has been minimal work done in
this area. This ofcourse presupposes a certain professional
capability to be able to function at this level.
Efforts
could be made to build this up, which could be acquired by
actually getting involved.
Focus on CHAI membership and their needs could also be
strengthened, in all its activities.
A planned approach
could be utilised, with focus on members who are in greatest
Involving members in networking and CHAI policy
need.
formulation at the national and regional levels, could be
done more vigorously. This will straightaway result in
multiplying
of CHAI’s hands and
capabilities
several
hundredfold.
Through the study, we are convinced that the
members have immense strengths and potentials that have not
been tapped adequately by CHAI.
7.7 Another key area that has been raised by the
Delphi
panelists, is the importance of organisational mechanisms for
effective functioning. Functional mechanisms and structures
are crucial if action on the large number of important areas
of health that need to be addressed, has to be undertaken or
else the many suggestions may remain good ideas that cannot
be operationalised.
This development of mechanisms and of skills and capabilities
and competencies may be time consuming, difficult and even
frustrating.
However there are perhaps no short cuts.
Enough resources in terms of personnel and time would need to
be allotted towards this. Keeping in mind that CHAI is a
membership association and not an 'institution’, utilising
democratic methods would be important. Members too should
have a sense of responsibility for CHAI and participate
actively in and contribute to its growth in policy making and
implementation.
I
e
64
<•
’t. ■
8. BIBLIOGRAPHY
f
I
1. Colligan, 0., 1982,
Your Gift of Prophecy,
Readers Digest, pp 223-232.
G.
C.
2. Delbeeq, A.K. Van de Ven, A.H. and Gustafson, D.H., 1975,
Group techniques for Program Planning - A guide to Nominal
Group and Delphi Processes,
Scott, Foreman and Company.
G
c
3. Technological Forecasting,
Encyclopaedia of Management.
<•> «
4. Linstone, H.A., and Turoff, M, (Eds), 1975,
The Delphi Method - Techniques and Applications,
Addison - Wesley Publishing Company, Reading, Massachusetts.
5. Sackman, H., 1974,
Delphi Assessment : Expert Opinion,
Process,
Rand Corporation, USA.
Forecasting
and
MH.
Group
An
Xu,
AiS,
^'■4
(/<$’/' LIBRARY
LIBRARY
j
(
AND
AND
DOCUMENTATION
DOCUMENTATION
<
UNIT
o\
> in
y ~ II
A
s^'Vgalob^
j
{
I
I
J
>*• K'
■
Jal
- Media
5041.pdf
Export
Position: 612 (5 views)