Epidemic Diseases: 'Whose baby is it?'
Item
- Title
- Epidemic Diseases: 'Whose baby is it?'
- Creator
- Sunil Nandraj
- Date
- 1998
- extracted text
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Epidemic Diseases : 'Whose baby is if ?
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Sunil Nandraj
In the recent past there has been arc jence of various epidemic diseases such as Malaria, Gaslro-entitis.
Tuberculosis. Kala Azar, Filarisis, Gcilc among others in different parts of the country. The morbidity and
mortality is increasing at a rapid pa
'iih new areas being declared endemic The resurgence is due to
various factors chief among them being environmental factors, lack of basic health services, poor nutritional
status of the people, lack of basic necessities, inadequate supply of drugs among others The government
on its part is shirking its responsibilities of providing adequate funds for public health care programs from its
own resources and instead approaching bilateral and multilateral agencies for loans. The most recent being
a loan of Rs 8910 million from the World Bank to combat malaria. This loan is to cover the 100 most
affected malaria districts in the states of Andhra Pradesh. Gujrat, Maharashtra, Bihar. Rajasthan Orissa. &
Madhya Pradesh where it is most rampant. The loan is to be utilised in training technicians at the district
level in the early detection of the malaria who will be known as link workers and providing basic equipment
such as microscopes for malaria detection in the public health care delivery system ,
The mam focus of the policy makers, planners, administrators, politicians, media, international agencies,
voluntary agencies and others in the control of. epidemic diseases has been on the public health care
system The role of the private health sector has never been critically examined and the government has not
made sufficient efforts to involve them in control of the diseases affecting majority of the population. Recent
studies conducted have brought out that the private health sector is the dominant sector in health and is
utilised by nearly 60% to 70% of the people for their illness. These providers are mainly in the form'of
practitioners practicing various systems of medicine, local healers, hospitals & nursing homes, laboratories,
medical colleges, corporate hospitals, blood banks among a host of other providers.
The government has not been able to involve the private health services in combating the various diseases
which should have been done on a priority as they are the major providers of care. It is quite shocking to
note that the official figures provided by the government regarding the number of cases treated and deaths
due to various diseases are available only from the public health care services. Furthermore the government
right from the central government to the municipal / panchayat level do not have reliable & sufficient
information in terms of their number - ' .cticing, functioning, type of care provided, number of cases treated,
nature of practice, standards mainta ./ .1 to mention a few indicators. There is inadequate information from
the private health services. This is '■
sally due to the fact that the private health services in our country
function in a most unregulated and unaccountable manner. Even 50 years after independence there are no
legislation's, rules, acts etc. for monitoring private hospitals & nursing homes in India, except in the states of
Maharashtra & Delhi. Where attempts are being made especially in the states of Tamil Nadu and Bihar to
enact legislation there is opposition from the medical fraternity. In the states where there is legislation the
implementation is found to wanting forcing consumer organisations to approach the judiciary for proper
implementation. The same problem is with regard to the diagnostic laboratories, health clinics, nature cures,
slimming centres, etc. etc. They do not come under any authority and operate freely without any
accountability. Qualified practitioners practicing different systems of medicine are supposed to register
themselves with their respective state medical councils, but the state of affairs in most of the medical
council is utterly diseased , with registers not updated, elections not held, action against erring doctors being
not taken, recognising sub-standard private medical colleges among a host of other problems. The problem
with quacks practicing is more alarming with the concerned government departments such as police &
health passing the buck to each other. The above clearly shows that the government does not have
sufficient information on the private health services operating in the country and has not paid enough
attention to monitoring them. Many developed economies which have a large private health sector such as
USA have strong regulatory mechanism for the functioning of the health care services. In the absence of any
such strong stringent regulations it has been totally left to the whims and fancies of the providers
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Uue to its unregulated nature it has led to various kinds of unethical and irrational practices being carried out
especially in times and areas of epidemics. Profiting from human misery especially when large sections of
population are affected due to disease it becomes a healthy business for the private providers. There are no
restrictions or guidelines for the fees charged by private providers. The charging practices are more often
exorbitant and irrational and without any basis. The treatment provided is based mainly on economic factors
than medical reasons Some of the irrational & ethical practices quite well known and many of the patients
have faced are diagnosis not done properly, patients made to come back for more consultations, over
prescribing, over investigations, unnecessary surgeries, making patients stay for longer period than
necessary, administering saline drips routinely, pushing critical patients in the last stages to public hospitals
among a whole lot of other practices Many families have been pauperized due to the high cost in private
health sector
The private health care providers have never shared responsibility of involving themselves in the task of
combatting various diseases afflicting the people other than for their own financial goals. More important,
has the government envisaged a role and involvement of the private health sector in its diseases control
program. The policies and programs formulated become applicable to the public health services without
viewing health sector in its totality. Presently the government has resorted to taking loans for tinkering in the
public health care services by 'retraining' a few workers, buying more jeeps, holding international seminars
etc. The government should give up its ostrich like attitude and involve the private health care sector by
making it more accountable and monitoring its functioning and activities. Firstly the government should carry
out a census of the all private health providers operating in an epidemic area It is not difficult for the
government to make private practitioners/hospitals/nursing homes/laboratories register with the local
authority and insist on receiving periodic reports of diseases such as Malaria, TB, AIDS etc. All notifiable
diseases should be reported to the local authority on a periodic basis. A random medical audit of the
prescription prescribed by the doctors at the chemists shop would go a long way in making the private
providers recommending the correct line of treatment There is an compelling need to educate and create
awareness among private health care providers (includes qualified doctors) on providing the correct line of
treatment for various diseases. Periodic medical audit of treatment provided for inpatient care and
investigations reports from the laboratories should be. insisted upon. A platform should be provided for
regular meetings and exchanges between the private health sector and public providers. There is a urgent
need to draw up standards for clinics, hospitals, nursing homes, diagnostic laboratories in terms of
qualification of human power, equipment used, infrastructure facilities, sanitary conditions among others. It is
possible for the local authority to give recognition based on standards being met, records received, medical
audit reports to give a certificate which should be prominently displayed and create awareness among
people regarding the same. Those not following the directives punitive action should be taken as health is a
issue that deals with life and death. This measures would make the private health sector more involved in
diseases control program and make it more accountable. Until the basic issue of involving the private health
sector in combating the various epidemic diseases are addressed any amount of money pumped either as
aid or loan from bilateral or multi lateral international agencies will not solve the problem. In the overall
context there is an urgent need to have a comprehensive health care which involves close inter-linkages
between the public and private health sectors that provides care to people which is accessible to the
majority, of reasonable quality and affordable.
(This paper has been sent for publication to the Times of India)
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