Forcing the present healthcare system to deliver services is like flogging a starved mule to work
The precarious HIV situation in Nagaland has been in the news. It is a harsh reality that with the resources invested; the situation is still far from satisfactory. But HIV/AIDS situation is not an isolated case. Good healthcare is so difficult to achieve. People visiting healthcare centers across the State know that all is not well. The standard reaction is the pointing of fingers at the government machinery which is responsible for running the services. But things get more complicated when we explore the factors which determine the type of healthcare we receive.
HIV/AIDS happens in the society. When a patient reports at a clinic, it is only the tip of the iceberg which manages to pop out of the water surface so that it becomes visible. So, tackling a medical condition which is mostly hidden in the society is not an easy thing. Many of the health issues, likewise, lie beyond the health sector. For example, non communicable diseases risks like tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol, all are behavioral risks. These unhealthy behaviors lead to Cancers, Diabetes, Cardiovascular Diseases, etc called as non communicable diseases which are the leading cause of death in the world. And we know that to change behavior is extremely difficult. Health is related to all areas of life and so is the medical department related to a lot of others like Education, Agriculture, Roads, Transport, IT, etc. So, the state of health depends on the performance of other areas as well. This is not an excuse for the poor healthcare delivery but an explanation to understand the interconnectedness of factors determining the wellbeing of a population and the collective responsibility for good health. When a society progresses, level of health improves proportionately.
One specific and primary factor which determines the quality of health care is health financing. Forcing the present healthcare system to deliver services is like flogging a starved mule to work. There is not enough money to provide any decent level of healthcare. India spends only about 1% of GDP in health which is among the least in the world. To make matters worse, the central government under Modi has cut the budget on health. The impact is felt more by poorer States like Nagaland which is dependent on central funding. Another pressing issue for the State is the new pattern of funding for all the central schemes. Funds of all centrally sponsored programs now being routed through the State finance department has resulted in delays in fund releases risking the health of thousands and lakhs of people. Some States have come to the rescue of low central allocation but the Nagaland State budget allocation to healthcare always shows that health is not high in the priority list.
In Nagaland, the challenge of geography is a factor which cannot be ignored. Though small and sparsely populated, the difficult terrain makes it difficult to reach all people with good healthcare. The population and financial norms calculated in Microsoft Excel does not hold any water when one actually moves out of the boardroom and travel. A village located on a hill is connected to another one on the next mountain by a road which leads down to the river in between. So, even if two villages appear to be near, the road leading down and up the next mountain makes it a harrowing experience in terms of physical connectivity. Placing of health institution and manpower, referral of patients and transportation of supplies, and IT connectivity are affected because of the terrain. The irony is that health care cost escalates for the poor people in the rural areas.
After the resources and external factors are discussed, the uneasy human factor remains. The cancer in the human self (corruption, greed, selfishness, or however we call it) grows out from inside and invades all the structures and systems that we have built. Neither can we wish it away nor can we build a structure or system which bypasses it.
Morung Express Editorial (June 2015)
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