29/12/2015 8:15 AM IST | Updated 15/07/2016 8:25 AM IST

Here's Something We All Need To Be Intolerant About

In this Monday, Feb. 3, 2014 photo, a tuberculosis patient Manjeet Mishra, 18, sits outside a ward at Lal Bahadur Shastri Government Hospital at Ram Nagar in Varanasi, India. India has the highest incidence of TB in the world, according to the World Health Organization's Global Tuberculosis Report 2013, with as many as 2.4 million cases. India saw the greatest increase in multidrug-resistant TB between 2011 and 2012. The disease kills about 300,000 people every year in the country. (AP Photo/Rajesh Kumar Singh)


Amir Khan and I are as different as chalk and cheese. He is a superstar while I am just another doctor. He is among the elite (read rich!) while I am starting out heavily in debt after finishing school. His one comment brings a nation to a standstill, while all that my comments do is lead my brother to unfollow me on Facebook. In spite of our differences, however, I do agree with Mr Khan in that we are an intolerant bunch.

We get upset when we think someone eats beef, we get upset when someone does not; we get upset when people are fully clothed, we get upset when someone wears too little; we get upset when people show affection, and then we get equally (but rightfully) upset about the rise in hate crimes. Every such event starts with an uproar and ends with statements of apologies. But while all this ruthna and manana is going on, we have slowly become tolerant of issues that should actually bother us.

A country cannot progress if affordable and quality care is out of reach for its citizens.

Take healthcare for example. India is a home to 17.5% of the world's population. Unfortunately, we also account for a whopping 20% of all the global burden of disease. In spite of a continuing health crisis, in the 2015-16 budget the government allocated just Rs 33,150 crore -- about 4.2% of GDP -- for healthcare, of which only 1.2% is for public health spending. The National Health Policy 2015 has outlined many projects for the country. But the policy is ambitious to say the least given the financial constraints this budget has imposed on it. This can only translate to two major effects -- the common man and woman will rely more on private hospitals and providers, leading to instances of catastrophic healthcare expenditure for many; and for those 25% of the country living below poverty, sub-optimal and low standard care will become a norm, provided they receive healthcare at all. That will be disastrous for a rising economy like India because a country cannot progress if affordable and quality care is out of reach for its citizens.

Richard Horton, the editor of the highly prestigious journal The Lancet, has brought attention to this state of crisis through an interview in which he severely criticised India's health policies. His comments attested to an article that The Lancet published recently in which seven main problems of the Indian healthcare system have been outlined. These included a weak primary healthcare sector that is unable to provide affordable care when needed; unequally distributed skilled human resources; increasing reliance on an unregulated private sector; low public spending on health; broken and unreliable health information systems leading to poor monitoring and evaluation; arbitrary drug prescriptions; the rising cost of technology adding to the unaffordability of healthcare; and a weak leadership and governance with little to no accountability that leads to a chaotic system.

Their [rural surgeons'] daily work is an uphill battle that ultimately affects the patients they work for -- which happens to be 70% of the country.

For people working in the health sector, there is no new information in this article. Every health organisation in the country is aware of these issues and is working towards fixing it. In November this year I was in Karad, a small town about 300km from Mumbai, for the annual conference of the Association of Rural Surgeons of India (ARSI), where these issues were brought up. The members of this association are a group of dedicated surgeons providing care, under circumstances unimaginable, to those living in rural India.

These individuals, who know the system inside out, brought to attention the dysfunctional primary care setups with limited workforce, broken hand-me-down equipment, lack of blood during emergencies, professional and social isolation of the few brave doctors who do decide to stay behind. They lamented that because of a lack of conversation between the state and central government, as well as private and government setups, there is a mismatch between health programs and guidelines, causing the current health policies to not support primary healthcare. Coupled with ever-dwindling resources and lack of political will, these rural surgeons acknowledged that their daily work is an uphill battle that ultimately affects the patients they work for -- which incidentally happens to be 70% of the country.

That is why we urgently need high-impact cost-effective solutions for strengthening the primary health system. Improving access to surgery is one such solution. The World Health Organization acknowledged this when it passed the resolution "Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage" earlier this year.

We urgently need high-impact cost-effective solutions for strengthening the primary health system.

The Lancet Commission on Global Surgery is hosting a National Surgical Forum early next year. Experts from around the country, including surgeons from ARSI will gather to discuss a National Surgical Plan for India -- a plan that will lead not just to an improved access to these services, but will also lead to an overall improvement in the country's primary health systems. The larger society must pay attention to and endorse such activities instead of raising a hue and cry about non-issues.

Dr Horton said in his interview:

"At the moment, India is on the edge and it can take two routes. It can take a route of investing in health and investing in its people and creating a thriving and flourishing future for India which has a part to play in world affairs or it can do what it is doing now and ignore health it which case it will see epidemics sweep across the country creating an unsustainable future and destroying national security..."

It is high time we focused on being intolerant enough to say we won't let that happen.

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