BEST MOVEMENT IN MY LIFE

Best movement in my life when I got the maximum trophies for

CCA in my previous school (NAVY CHILDREN SCHOOL
,KARWAR). I won six trophies. There were three 3
rd
prize trophies, one
2
nd
prize trophy and two 1
st
prize trophies. The school was newly
established and fourth class was the highest class in the school. I was
studying in fourth standard. It was my birthday when the CCA prizes
were distributed. It was already a special day as it was my birthday and
it was more special when I got to know that I am the maximum prize
winner in the school. Getting so many prizes was an awesome feeling; it
was the best movement in my life. The same could be said of india's health system. Sixty
years after independence, India remains one of the unhealthiest places on earth. Millions of people still
suffer from diseases and ailments that simply no longer exist almost anywhere else on the planet. Four
out of five children are anemic. Almost one in four women who give birth receives no antenatal care.
What makes the picture even bleaker is the fact that India's economic boom has had, so far at least, little
impact on health standards. Think of it this way: in the five years between 2001 and 2006 India's
economy grew almost 50%, the country's biggest expansion in decades. Meantime, its child-malnutrition
rate, a number that measures the percentage of children under 3 who are moderately or severely
underweight, dropped just a single percentage point, to 46%. That's worse than in most African countries,
and means almost half India's children remain at risk of "health problems such as stunted growth, mental
retardation, and increased susceptibility to infectious diseases," according to the most recent National
Family Health Survey, a study of more than 230,000 people, from which the figures are taken.
Perversely, the incredible economic growth is having an impact in other ways, driving up rates of rich-
world diseases such as obesity and diabetes and encouraging high-end health services, some of which
offer world-class care but remain far beyond the reach of the vast majority of Indians. It's these services
think of last year's surgery to save an Indian girl born with four arms and four legs and the skill of
India's world-class doctors that the country brags about when its marketers sell India as a medical-
tourism destination and an emerging health-services giant. The truth behind the glossy advertising is less
incredible: India remains the sick man of Asia, malnourished and obese at the same time, beset by
epidemics of AIDS and diabetes, and with spending levels on public health that even Prime Minister
Manmohan Singh has conceded "are seriously lagging behind other developing countries in Asia."
The sorry state of India's medical services might not matter so much if tens of millions of Indians weren't
already so sick. Part of the problem is the lack of infrastructure not fancy hospitals or equipment but
basic services such as clean water, a functioning sewage system, power. The World Health Organization
estimates that more than 900,000 Indians die every year from drinking bad water and breathing bad air.
The Indian government says that 55% of households have no toilet facilities. Many cities lack sewers. The
missing infrastructure is not unique to India. Parts of Africa face similar underdevelopment. But some
public-health experts believe that India's massive population adds to the burden, overloading systems
where they do exist and aiding the spread of disease in the many places they don't.
There are other reasons for India's ill health. Over the past decade or so, funding for public-health
initiatives such as immunization drives and programs to control the spread of communicable diseases has
BEST MOVEMENT IN MY LIFE

been cut; some critics blame shifting government priorities. One of the best ways a country can improve
its health, for instance, is by making sure its children are immunized against measles, polio and other life-
threatening illnesses. But immunization rates in India are significantly lower than in other developing
nations such as Bangladesh, China and Indonesia. Just 43.5% of very young children are fully
immunized. "It's shameful," says A.K. Shiva Kumar, an economist and public-health expert who consults
to the United Nations Children Fund in India and was a member of the government's recently disbanded
National Advisory Council. "All this high income, this growth of the past few years is well and good, but
numbers like this show you can't get complacent about health or you'll go nowhere."
Cycle of Illness
In the past few years, diseases such as dengue fever, viral hepatitis, tuberculosis, malaria and
pneumonia "have returned in force or have developed a stubborn resistance to drugs," according to a
report on health care in India by consultancy PricewaterhouseCoopers. "This troubling trend can be
attributed in part to substandard housing, inadequate water, sewage and waste management systems, a
crumbling public health infrastructure, and increased air travel." Pylore Krishnaier Rajagopalan, who was
head of the government Vector Control Research Centre in the southern city of Pondicherry between
1975 and 1990, blames policies that concentrate on the latest scientific techniques and not enough on
basic controls. "Field work is almost dead," Rajagopalan says. "These mosquitoes are sun loving. How
can a shade-loving, lab-bound, white-coated scientist control the mosquitoes through research? It may be
the future but millions of people in India are suffering and dying now because we're not doing the basics."
If all that explains why Indians are so sick, look to public hospitals and medical services to understand
why they are not getting better. In many parts of the country, but especially in rural India, where two-thirds
of the population lives, health services are poor to nonexistent. Clinics are badly maintained and
equipped. India needs hundreds of thousands more doctors and more than a million more nurses.
Current staff often don't turn up for work. "It is a well-recognized fact that the system of public delivery of
health services in India today is in crisis," begins the paper "Understanding Government Failure in Public
Health Services" published in the influential Economic and Political Weekly last October. "Recent
analyses show that high absenteeism, low quality in clinical care, low satisfaction with care and rampant
corruption plague the system."
Such dire conditions force millions of people to head to the better public hospitals in India's cities. The Dr.
Ram Manohar Lohia Hospital (RML) in New Delhi is well maintained, relatively clean and is probably one
of the best. Unlike most hospitals, which get their funding from state governments, the RML is financed
directly by the central government and caters to the thousands of public servants and senior government
officers, including members of Parliament, who are lucky enough to have state-funded medical insurance.
But its high standards are also a magnet for sick people for hundreds of miles around. About 60% of the
4,500 patients the hospital sees every day travel not from the New Delhi area but from neighboring
states. Some of them are complicated cases that have rightly been referred to a tertiary-care hospital, but
many are simple cases of malaria or dengue fever that other hospitals should treat easily. "The challenge
is that our facilities are totally at saturation point," says Dr. Nishith K. Chaturvedi, the hospital's medical
superintendent. "If states were doing a better job it would cut our case load by 35%."
The crush of numbers means that the RML is sometimes forced to have patients share beds. "For a short
period only," Dr. Chaturvedi says, looking slightly sheepish. "But it happens." A tour of the emergency and
outpatient departments brings the problem into stark relief: the crowds of patients and visiting relatives
BEST MOVEMENT IN MY LIFE

are as thick and suffocating as the heady fug of chloroform and the sounds of children screaming. A few
cases on trolley beds wait outside under a small awning. Though generally well kept, "it's very hard to
maintain cleanliness even if you clean every half an hour," says the head of the outpatient department,
Dr. P.K. Misra, waving his hand at a heap of bloodied sheets in a corner. "I have visited a few hospitals in
the U.S. They are like five-star hotels for us. But we can never match that. It's the population load."
Progress Report
Later, taking a break in an unoccupied office, a tired Misra laments the state of public health. "This place
is one of the good ones," he says. "I have seen hospitals with dogs below the beds." After graduating,
Misra spent a few years in India's northeast, one of the poorest parts of the country. "I went to the rural
area to serve the people but the government doesn't recognize that," he says, explaining that classmates
who went to big cities "are now professors and earning big bucks." The system, he says, is set up so that
rural areas will never have good doctors or other medical staff, tens of thousands of whom leave to work
in cities or abroad. "It's better to start a practice in the city than go to the country and ruin your life."
With such problems in the public system, it's little wonder that private operators have boomed. Some 80%
of all spending on health care in India is now private, some of it by large companies insuring their staff,
some by nongovernmental groups running health programs, and a bit by rich Indians using the best
private facilities. But the overwhelming majority of the spending is by poor citizens. Money is so tight that
many rural Indians skip doctors and rely on advice from local pharmacists, who too often prescribe cough
syrup or tablets that do nothing to help. Because only one in 10 Indians has any form of health insurance,
out-of-pocket payments for medical care amount to 98.4% of total health expenditures by households,
according to the PricewaterhouseCoopers study, which estimates that 20 million people in India fall below
the poverty line each year because of indebtedness due to health-care needs. In Brazil and China, both
countries India often compares itself with, the public share of health-care spending is around 40%, while
the average for G7 countries is 70%. In India it is just 17%.
The good news is that the current Indian government seems to get it. "Health is slowly becoming an
important focus," says Krishna Rao, who heads health economics and funding for the Public Health
Foundation of India. The organization was set up in 2006 by the government, NGOs like the Bill and
Melinda Gates Foundation and private health providers to influence policy and research, and to set up
world-class public-health schools around the country. The government has also promised more money for
rural health through its ambitious National Rural Health Mission. The Congress Party, which leads India's
coalition government, says it will increase public-health spending from the current 1% of India's GDP to
up to 3% by 2010, but that's still just half the rate at which countries with comparable per capita incomes
such as Senegal and Mongolia fund their health sectors. "What has been a fatal flaw in our approach is
that we have gradually abandoned comprehensive health care and a public-health perspective for
focused attention on selective diseases," Prime Minister Singh said at the April 2005 launch of the
National Rural Health Mission. "We have grievously erred in the design of many of our health programs.
We have created a delivery model that fragments resources and dissipates energies. Most importantly we
have paid inadequate attention to the public-health issues and the possibilities of social and preventive
medicine."
If that is to change, one of the first myths that need to go is the idea that economic growth alone will lead
to better health. Though health indicators vary widely across India, the link between wealth and good
health isn't clear cut. Poor states such as Orissa and Chhattisgarh that have made efforts in child
BEST MOVEMENT IN MY LIFE

immunization over the past few years now have better coverage than richer states, where immunization
has actually slipped.
Other sacred cows will need to be challenged. India's old socialist system may have had its problems,
says Imrana Qadeer, one of India's foremost public-health experts, but the belief that private enterprise
can cure all of India's woes is dangerously misguided. "The private sector doesn't want to do basic things
like treating diarrhea, improving nutrition, immunizing babies because that's not where the money is,"
says Qadeer. "In India we cannot live without a strong public sector."
In the end that will mean spending hundreds of billions of dollars more on public health, perhaps even
creating a