Cultural Psychology of Health in India by Dalal Ajit K

Author:Dalal, Ajit K.
Language: eng
Format: epub
Publisher: Sage Publications India Pvt, Ltd -- eBooks

The Present Scenario

Many commentaries and critics are of the opinion that India's health care system itself is critically sick and in intensive care unit (ICU). An Independent Commission on Health in India, which submitted its report to the former Prime Minister Mr Vajpayee, pointed out that the health services are in an ‘advanced stage of decay’. Documents from the Planning Commission paint an equally dismal picture (Planning Commission of India, 2004). This scenario has worsened in the last one decade.

In most of the rural sector, PHCs are barely surviving or are non-existent, in spite of all pronounced policies, programmes and financial support of the government. The quality of health care services provided by the public health system is extremely low along all the criteria on which quality can be judged—infrastructure, availability of drugs and equipment, regular presence of qualified medical personnel and treatment facilities for the patients. Instead of being supportive and palliative of people's health, it will not be wrong to say that the health care system itself poses a hazard to its intended beneficiaries, especially the poor, who are often as reluctant to use public health services as the rich people are.

One notable failure of most of the rural health programmes is low community participation. Imposed from outside by the government functionaries and NGOs, these programmes could not garner community support. Western and westernized NGOs are incompatible with local culture, needs and aspirations of people. Local health practices and resources were not taken cognizance of, nor were services of traditional practitioners acknowledged.

One of the major lacunae in India's health system in India is that there is no effective monitoring system. There is no proper public readdressal mechanism to ensure appropriate standards of care in clinical practices. This is equally true of the public as well as private sectors which are largely unregulated. The Medical Council of India, the apex body overseeing standards of care, has no process in place whereby doctors are assessed for their competence to deliver quality services according to set norms. The renewal of doctors’ registration is mostly a routine procedure. Given the lack of effective monitoring, there is little information to go by in terms of competence of medical personnel and actual practice in a clinical setting; though there is substantial evidence of overuse of antibiotics and tranquilizers in public health care centres (Harihar, 2012).

Delivery of public health care services in India is marked by pervasive absenteeism. According to a study, absenteeism among doctors was as high as 43 per cent and among other health workers, 39 per cent in government health care facilities across Indian states (Chaudhury et al., 2006). A survey conducted by Banerjee (2000) in Udaipur in Rajasthan found greater absenteeism in PHCs and CHCs than in sub-centres. This meant that for people seeking health care services, there was considerable uncertainty attached to a visit that is costly in terms of time and travel expenses. On arrival at a PHC, there is no guarantee that it will be open on working days; if open, will there be a doctor and other staff around.

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