A VIEW ON HEALTH CARE
“Health is a state of complete physical, mental and social well
being and not merely an absence of disease or infirmity” is the most famous
definition of health given by the World Health Organization way back in 1948.
One may find it difficult to take in this definition with so many changes in
views; on nature, growth, disease in the last few decades. Nevertheless, this
definition has stood the test of time so far with no major improvisation in
definition coming up in the recent past. Health can be viewed as existing in a
dynamic state with forces acting upon it to deflect it from an optimum balance,
which it has to hold for functioning effectively. Health care is a broad field.
It encompasses so many disciplines including medicine, social sciences like part
of economics, management, sociology, behavioural sciences, food and
agriculture, housing, education, etc.
Having taken up a medical career I deem it is
fair play from my part to discuss about the above topic. Living in a society
which is rife with politics, driven mainly by domineering corporate money
power, communal and fanatic ideologies, with hard to digest consequences, what
is a snapshot view of care or treatment of individuals? It is difficult to define
care. More because it is not an act (relates to thought, attitudes and
traditions). Definition of Health care can be restricted to “practices which
lead to improved well being physically, mentally and socially”. Medical care is just one aspect of health
care. Medical care refers chiefly to those personal services that are provided
by the physicians. Health care is a public right1 and it is the
responsibility of the government to provide this care to all people in equal
measure.
I have a view of a society where there is enough care that no
creation gets squashed or trampled by well meaning “experts”. Giving your
creation a chance, an opportunity to take it’s stand and appear is what enough
care can do. Care in layman’s terms means being responsive. This indicates the
accessibility of the individual to others. From the field of social sciences
the definition given for quality of care 1suggests two dimensions
for individuals –access and
effectiveness. In essence, do the individuals get the care they need and is the
care they get effective. I am sure many of us are still under the impression
that medicine is a biological science since one went through biology to make it
to medicine. But that is a fallacy; medicine is more of social sciences than
biology. The art of medicine draws so much from the social sciences that to be
an effective doctor one’s mastery over the art matters to the same degree as
the science. The word doctor is from latin and means to teach or to educate. So
the art and science of medicine is about shedding light on physical and mental
illnesses with umpteen ways to go about doing it.
Politics is medicine on a
large scale said Virchow. That was about 3 centuries ago. Yet, it still is a
well rounded way of looking at politics. Medicine is about good treatment and
care of individuals. So, if our politics included this aspect as the pivot then
it would make a wonderful world. But in reality the field of medicine has been
haunted as much by the corporate as much as in the state politics. The natural
way of a circle in a society is interactions within a group which has
commonality among themselves either in terms of social or economic characteristics.
An altruistic approach where there are equal interactions between a
sophisticated society and a disorganized lesser privileged one, goes against
the natural law, so says science – second law of thermodynamics. An amount of
work or effort has to be provided to direct the just mentioned interaction.
Amid the scramble for power there is a beacon of light and a
shimmer of hope. To make primary health care universally accessible and
affordable, a mandate was put forward by the World Health Organization several
decades ago. It put forward the concept of health for all by 2000 A.D and the
strategies to arrive at it. The poor and marginalized would get primary health
care which shall be the responsibility of the state. Nonetheless, it stated in
the same tone that “people’s health are in people’s hands”. The strategies to
arrive at a state where there is health for all are through community
participation, inter- sectoral coordination, equitable distribution and appropriate
technology. The concept of people’s health in people’s hands means the
responsibility is upon the community to demand for it’s health and involve in
participation to achieve it. An example of community participation for better
health is forming of “kudumbashree” units in kerala where they serve as self
help groups involved in income generation programmes. They are units of
empowerment which is an important initiative towards health and development. Socio
economic empowerment makes a good ground for
health care and other development activities.
The public{Govt.) sector health care system in india has three
levels of health care – Primary, Seconday and Tertiary. The primary level of
health care is the first point of contact between the patient and the health
care system at the grass root level. This is the primary health care level
where people from the villages go to the nearest Health sub center(in rural
areas) or health post (in urban areas) which are usually manned by an ANM
(Auxiliary nurse midwife) or VHN (Village health nurse). The ANM/VHN or the
link worker (a health volunteer who is the link between the community and the
health system) form the first point of contact. From there, the continuity of
care begins, with it’s referral to the Primary health care center level.
Patients who cannot be managed at the PHC level are further referred to the secondary health care level. This
includes the taluk hospital or district hospital. Very severe patients who need
sophisticated care are referred to the medical college hospital, which makes
the tertiary health care center.
In India the health care system consists of the government
sector which provides for about 20 percent of health care and the remaining 80
percent is by the private sector and voluntary agencies. The government sector
includes the insurance schemes like ESI, CGHS and other agencies like railways
,defense services. We have a parallel system with allopathic and AYUSH
(Ayurveda, Yoga, Unani, Siddha and homeopathy)running side by side. Around half
of registered medical practitioners belong to AYUSH. This is in line with the
pulse of the people. AYUSH is more acceptable and frequently first approached
by the masses especially in the lower socio economic groups.
As a result of the failure of realization of it’s mandate of
health for all by 2000A.D, WHO identified five key elements3 for
achieving the ultimate goal of better health for all. They have been taken up
as major reforms in the health care sector. They are reducing exclusion and social disparities in health (universal
coverage reforms);organizing health services around people's needs and
expectations (service delivery reforms);integrating health into all sectors
(public policy reforms);pursuing collaborative models of policy dialogue
(leadership reforms); and increasing stakeholder participation.
The health care system in
Malawi also has the three levels of care with the public sector mainly
consisting of 640 health centers and 3500 village health clinics spread all
over Malawi which includes many public private partnership facilities with
Christian health association of Malawi(CHAM) . There are 4 major public
hospitals in Zomba, Mzuzu, Blantyre and Lilongwe. With Poverty being a major
determinant of health, Malawi has big challenges in the health care arena. The
Social factors like literacy aren’t that bad (when compared to south east asian
giants) as compared to the economic factors. Malawi has a Women’s literacy rate
of 60%4 and access to skilled personnel delivery to 70% of women.
I hope this article has
shed light on the elements of health care , key concerns and the available
solutions for it.
REFERENCES
1.
Park’s Textbook of Social and Preventive
Medicine, 17thedition.2007
2 Campbell
SM, Roland
MO, Buetow
SA. Defining quality of
care. Soc Sci Med. 2000 Dec;51(11):1611-25
3. World Health Report, 2008
4.website accessed- http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_mwi_en.pdf
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