Another budget goes by without anything substantial for the healthcare sector. While our cover story in this issue, ‘(Was the budget anti-climactic?; page 9) analyses the few high notes and the many missed opportunities in this year’s budget, the recent uproar over babies with congenital heart defects dying while waiting for open heart surgeries at Mumbai’s King Edward Memorial (KEM) Hospital only underlines the deepening malaise of India’s healthcare system. To add insult to injury, KEM is being run by reportedly the country’s richest municipal body, the Brihanmumbai Municipal Corporation (BMC). They have funds to buy the heart-lung machine vital for such surgeries, but a 2009 proposal to buy a new one remains mired in red tape.
It was left to the private sector to step in. Dr Devi Shetty, who has 30-odd heart-lung machines across Narayana Hrudayalaya, offered to conduct 100 surgeries per month and clear the wait-listed cases at KEM. Jolted into action, the BMC authorities went into a huddle with four corporate hospitals, asking them to operate on 200-odd cases on the list in a month. The BMC has promised to not only foot the bill for the surgeries but the post operative care as well. In fact, this could very well be the way forward: a coupling of the complimentary strengths of the private and public sectors.
Policy experts are wondering how to apply this logic to multi drug resistant tuberculosis (MDR TB). India is one of four nations (the other three are China, Russia and South Africa), with the highest burden of MDR TB. Inspite of the government’s Revised National Tuberculosis Control Programme (RNTCP) covering the whole nation and providing free medication to patients, incidence of MDR TB is rising. Thus there is no doubt that every part of the healthcare sector will have to take long term responsibility to tackle this threat.
Perhaps the easy availability of medication is the reason why India has fallen into the MDR TB trap. Troubled by a cough, a patient in India would put off visiting a doctor because of the long queues. Either he will self-medicate or ask the friendly neighbourhood chemist for something for his persistent cough.
When that fails to give him relief, he visits a private doctor, who prescribes more antibiotics. At each step, no one checks if the patient is completing his course of antibiotics and the TB could be developing into a more resistant strain so that by the time the patient is finally hospitalised, doctors have very few choices left.
Policy makers are today appealing to private practitioners to follow RNTCP guidelines and notify them of suspected TB cases but doctors are torn between protecting the confidentiality of their patient and the greater public good. Of course, they also see this as government interference and do not want to be part of a system perceived as inefficient and cumbersome. Corporate hospitals too are wary of acknowledging that they treat TB patients because other patients might fear infection.
Clearly, healing India’s healthcare system will need us to apply both mind and heart to solve this riddle.
Viveka Roychowdhury
Editor
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