Health: accessible to all in India?
When thinking about health care, I think of the idea of a “full sequence of services” for the sick person, until he recovers his health and begins to lead a normal life again. It must be, as is already the case in many countries, a right, like the right to education, the right to credit, etc., mainly for the poor sections of society.
There must be progressive access to the necessary services, which are increasingly complex, in an orderly and rapid manner, from diagnosis to cure.
Access to primary services
These services should be at hand and solve small problems, such as getting rid of fever, pain or diarrhea, to get back to normal, as quickly as possible. Generally, they are provided in health centers, distributed throughout the country, or otherwise; and they must be accessible to the citizen, in each village or group of villages. The children are the most vulnerable and one can imagine what it is like to take them to the Centre, in case it is far away.
I was very impressed to know the model of Mohalla Clinics (MC), in Delhi. They are like neighborhood centres, some open from 8 a.m. to 2 p.m., and others in 2×8, from 7 a.m. to 7 p.m., with a doctor, a nurse, a pharmacist and an assistant available. At the MC, the patient has access to 212 types of free diagnostic tests, carried out by recognized laboratories; one can receive up to 109 free medicines from the essential medicine list of the Delhi government, when prescribed by the doctor.
It seems to be a tested and well adapted model for India and hence it is already working in more than 8 other states of India with Maharashtra trying to adopt it.
Many patients may experience pain and feelings of discomfort that are only symptoms of deeper causes. Other times with the occurrence of a more delicate problem, such as a vascular accident, still when it seems overcome, it is important that a specialist follow it up by doing what is necessary.
Therefore, it is important to have a good connection between the primary care center and a regional hospital, with which it relates. In this way, cases needing to be clarified or accompanied by a specialist doctor can be sent to the hospital, for subsequent actions such as tests, analyzes of various kinds, in particular imagology, and consultation with the specialist. .
Secondary care hospital
The primary health center must coordinate – in cases where the citizen cannot do it directly – the trip to the hospital, the booking of the consultation and the additional tests required by the specialist doctor.
It seems important that the Village Health Center has an ambulance or a convenient means of transport on certain days of the week, or every day, to pick up and bring back the group of people who have to go to the hospital. . This easy access to the hospital will greatly improve the efficiency of travel and the additional specialist service needed. Most likely, this type of coordination is already underway in some health centers; but it could be standardized and generalized to the whole country.
The health center can deal much more effectively with the hospital in all matters relating to admission logistics and other bureaucratic procedures, based on programs for the poor to receive hospital services free of charge.
A poor person, generally still illiterate, must be guided and taken to different departments of the Hospital for the analysis requested. It would be recommended that a social worker from the health center accompany the group, to give support to each patient, by going to the test site and to the specialist doctor, then “translating” all the recommendations of the doctor.
When the Hospital is notified in advance of the type of consultations and analyzes required, it can better organize the flow of patients so that each one receives the attention and the results transmitted to the specialist doctor, as quickly as possible, with the effectiveness of a good PRIVATE hospital. The logic of efficiency must prevail in the examinations and consultations required, without delay and, if possible, on the same day as the patient goes to the Hospital.
It is also important to explain how to take the medicine and how to obtain it for future doses: if the Health Center provides it or if it can be purchased from a pharmacy. It is better for the poor patient to receive all the drugs free of charge, so that the expense does not deter him from taking them.
My feeling is that the coordination of primary and secondary assistance only exists in a very small number of cases. That’s the point: much more is needed to make people aware of their rights, to use them when needed.
Ways to encourage hospital efficiency should be studied and practiced, so that patients are cared for as soon as possible. With all the contacts in the hospital and the services rendered with kindness and friendliness, as it happens, for example, in the Aravind Eye Care System hospitals, do not scare off those who come from rural areas.
In hospitals, when a patient arrives, a system for issuing a ticket with the approximate time of consultation could be very useful: it gives an efficient organizational trait and not where one is called when the health personnel want it, or the first are the rich and then the poor.
It happens in many European countries that the public hospital, by attracting good, hardworking and well-prepared doctors and nurses, earns them great prestige. If there are enough staff to respond to the influx of patients, then prestige and efficiency make the State Hospital v/s Private dichotomy disappear. It is very motivating for all those who work in public hospitals.
(The author is Professor
at AESE-Ecole Supérieure de Commerce
(Lisbon) and author of “The rise of India”)