Ushering good governance in public health

The third day of Healthcare Sabha had three interesting panel discussions on topics of great relevance to creating a healthy India. One of them was a discussion on ‘Ushering good governance in public health’ wherein Dr Atul Kharate, State TB Officer, Madhya Pradesh, GoI; Dr Suleiman Merchant, Dean, Lokmanya Tilak Medical College and Hospital, Mumbai and Dr Deepak Agrawal, IT Head, AIIMS, Delhi, highlighted the need for development thinking, spending and action to ensure good governance in public health. Dr Prateek Rathi, Special Executive Officer, ESI Scheme, Department of Public Health, Maharashtra moderated the discussion.

Dr Rathi began the session by setting the context with a brief snapshot on the current scenario as far as public health parameters are concerned. Referring to reduced IMR and MMR rates and eradication of diseases like polio, he said that the current healthcare system has had some amount of success but also admitted that we have not done so well in many other crucial areas. He cited   examples of Thailand, Bangladesh and Pakistan to point out that these developing nations have seen more success than India in certain areas of healthcare delivery. He spoke on the rising burden of diseases and accented the need for better policies and strategies to tackle them. He drew attention to huge health iniquities faced by the country and reflected that these are due to failures in governance. He rooted for the adoption of a more holistic approach towards healthcare delivery which can be possible only through good governance. In the course of his session, he raised several pertinent questions to the panelists on issues faced by the public health system in India. Some of them were dealing with dilemmas like choosing between equity and efficiency in healthcare delivery, setting the priorities and deciding on resource allocation; means to tackle information asymmetry and empower patients; charting a plan of action for the future, etc.

The panelists were unanimous in their opinion that technology is the answer to deal with a lot of problems in the public health sector. Dr Merchant recommended the use of telemedicine, community medicine, big data analysis, and others as a measure to eliminate the quandary of choosing between accessibility and quality. He informed that BMC hospitals have tie-ups with Centres of Excellence to increase telereporting. He also gave examples of apps created by NGOs like Armaan to track maternal and child health. He strongly advocated the use of simple, basic, preventive measures to tackle issue in governance.

Dr Kharate highlighted how TB management has improved by leaps and bounds in his state with the implementation of new advancement in diagnosis and better reporting of the disease. He also explained how technologies like GeneXpert have played a significant role in bettering TB management. Dr Kharate is also a strong proponent of absolute commitment and adherence to the healthcare policies in the country. He feels that failure in governance are the result of incorrect practices and lack of commitment towards implementing the right measures, to a great extent. He said that concerted efforts and allegiance are the means to usher good governance.

Dr Agrawal gave instances of how AIIMS Delhi has effectively used technology to get more data and improve treatment outcomes. He went on to describe various ways in which IT has improved processes and thereby outcomes in his organisation. He explains that IT implementation has streamlined their processes and encouraged efficiency which, in turn, gets passed on to the patients. Thus, technology brings in evidence in healthcare delivery, a key aspect of good governance. Dr Agrawal also said that data, if disseminated appropriately, can also empower the patients to make empowered decisions and educated choices with regards to their own health.

Thus the experts recommended IT adoption, right resource allocation, innovative solutions and best practices to create an efficient framework for public health.

Key recommendations

• Technology is the answer to deal with a lot of problems in the public health sector
• Failure in governance are the result of incorrect practices and lack of commitment towards implementing the right measures
• There is a need for a more holistic approach towards healthcare delivery which can be possible only through good governance