India's Public Health Care Delivery: Policies for Universal Health Care

507 Pages·2021·3.532 MB·English

by  Sanjeev Kelkar

Sanjeev Kelkar
India’s Public Health
Care Delivery
Policies for Universal
Health Care
India’s Public Health Care Delivery
Sanjeev Kelkar
India’s Public Health
Care Delivery
Policies for Universal Health Care
Sanjeev Kelkar
Pune, Maharashtra, India
ISBN 978-981-33-4179-1 ISBN 978-981-33-4180-7 (eBook)
https://doi.org/10.1007/978-981-33-4180-7
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Dedicated to
Prof V R Joshi, my mentor, who blessed me to go to tribal areas for work
and
My wife Dr Sanjeevanee MS, who introduced me to the world of
Community Health
A
cknowledgements
Conventionally, this section acknowledges those who helped shape a book.
In this case it is not just that but a mention of a lifelong gratitude to all
those who shaped me and my thinking to make this work possible. I
entered medicine with great reluctance and had quite a bit of trouble over
sciences. People I got connected with in medicine made me a man and a
medico. My professors, the unparalleled teachers and human beings, were
the first to lay down my fundamentals in clinical medicine, surgery and
neurology.
In postgraduate years, Late Prof V. S. Ajgaonkar was my first teacher.
He was a great humanist. As I approached the last phase of my postgradu-
ate years, Prof V. R. Joshi took me under his wings for all the final refine-
ment I could absorb. He is a noble man. He encouraged me in those
remote 1980s to go to tribal areas after my MD.
Late Mr B. G. Vasanth, an automobile engineer, and Mr B. S. Seshadri,
an income tax officer, stood support of me and my wife rocklike in the
most difficult and yet enviable years of our life in the tribal areas in South
India for over ten years. Those years taught me to go for solutions for the
various difficulties we had, and anyone who works in rural areas in deliver-
ing health care has. We did it by experimenting with many different mod-
els that could solve rural India’s health problems. One of the few persons
who appreciated our work then was Prof R.  D. Bapat, KEM
Hospital Mumbai.
When I came back with my wife and two children to urban settings in
early 1990s, it was Late Dr Manohar Salpekar, Late Dr G. M. Taori with
vii
viii ACKNOWLEDGEMENTS
Late Dr P. S. Bidwai, who helped, taught and settled us to a stable life in
CIIMS, a tertiary care hospital in Nagpur. Coming from the ten-year rural
stint, my rehabilitation and development in high-complex medicine was
done by my colleagues in CIIMS.
The contacts, which accelerated my growth in the technology of educa-
tion and to experiment with it in India, were from the University of Newcastle,
New South Wales, Australia. Drs Jean McPherson, Judith Scott, Kerry
Bowen, John Marley, ex-vice chancellor, Richard Gibson and Kathy Byrne.
Nearly 80 highly qualified Indian doctors from AIIMS and other prestigious
institutes like CMC Vellore and a few non-doctors who worked with me to
carry out these experiments I mention with gratitude. Their contribution
will get reflected in the chapter ‘Medical Education’ and the ‘Problem-Based
Learning’. Cotntributions of Mrs Anandhi Sigh and Mr MV Prasad for the
success of Newcastl university program is greatly appreciated.
Diabetic Foot Society of India, DFSI, was formed with the fortunate
association of many stalwarts like Drs Arun Bal, Sanjay Sane from Pune,
K. R. Suresh from Bengaluru, Ashok Kumar Das, dean Pondicherry and
advisor non-communicable diseases, GOI. Thousands of doctors were
trained by DFSI, which created a revolution in diabetic foot. For the sup-
portive role I played, it was not just huge learning but my identity has got
associated with it now.
My days spent in the headquarters of CARE Hospitals Hyderabad with
Dr N. Krishna Reddy led to a completely novel and successful develop-
ment of outpatient insurance.
Since the time I went to tribal areas for work and after marrying
Sanjeevanee. I have had the pleasure to be associated with many activist
medicos. Many of them wrote daringly on various issues. The activists of
Medico Friends Circle, Voluntary Health Association of India, New Delhi,
Community Health Centre in Bangalore, All India Drug Action Network,
PPST from Kerala, Dr Abaji Thatte, Drs Sujit Dhar, Dhanakar Thakur,
from National Medicos Organization, Bhaskar Kalambi from Vanavasi
Kalyan Ashram, Mumbai, Catholic Hospital Association of India are peo-
ple from whom I have imbibed a lot about health issues. It was a strange
mix of people fired by different ideologies, ready to suffer for the cause of
health. The richness you get from such associations is for you alone to
understand.
Dr Kayathri Perisamy, Colombo, was of great help in contacting Sri
Lankan health policymakers. The discussions helped bolster my thesis. I
am thankful to my friend Dr Jayeeta Bhattacharya for bringing me in
ACKNOWLEDGEMENTS ix
contact with Palgrave Macmillan and its perceptive editor Ms Sandeep
Kaur, who went through the MSS carefully and made many valuable sug-
gestions. I am grateful to Ms Sandeep for that. Lastly, it is my surgeon wife
Sanjeevanee who brought to me such insights in medicine as I had never
imagined. She stood against all odds in our somewhat hazardous life in
tribal rural areas, reared our children and participated in all our adventures
daringly. I am eternally grateful to her.
In all these years I learnt to guard myself from taking a dogmatic posi-
tion, not to express with an air of finality and force any idea or a remedy as
wonderful, but deal with it as an evolution of understanding at that time.
I kept myself free from getting bound by an ideology or an ism. This
allowed me to accept the good works, remedies and opinions and contri-
butions of those, without agreeing with many other things such people
might be doing. Hostility towards other ideas or ideologies is a form of
ghetto that prevents synthesis of commonalities and valid comparisons of
different actions and viewpoints. In addition to this, my widespread and
continuing interest in the humanities fostered by my father gave me a
much wider view than I may have had otherwise.
The five criteria to deliver health care are accessibility, affordability, quality,
equity and justice. Any health infrastructure or policies not able to deliver
these will have to be ruthlessly scrutinized, reoriented or discarded and
new workable ones described in this volume added.
xi
c
ontents
1 Introduction 1
2 Philosophical and Social Basis of Reorganization 31
3 Shortage of Doctors and Government Medical Colleges 59
4 Medical Education 89
5 The De Novo Manpower Deployment Processes 145
6 Primary Care, Government Planning and National
Rural Health Mission 179
7 Structure and Function I: The Primary Health Centres 217
8 Structure and Function II: The Community
Health Centres 259
9 Structure and Function III: Expectations and Realization 301
10 Structure and Function IV: The Final Picture 341
xiii