Monday, May 6, 2019

India's healthcare system - a story over infographics

There are two kinds of people who work in public health. I think of them as the “Market-Facing Types” and the “System-Lens Types”. The first kind believes that answers to the toughest global health challenges will only be found through market-based solutions. Solutions that include strategic pricing, supply-chain efficiencies, increased access to bottom of pyramid (BoP) markets, economies of scale and profitable private investments. The second lot believes that responsibility for healthcare provision lies squarely with elected governments and public systems, which admittedly are flawed and fragile; building and strengthening these systems is the only long-term, patient-centric and just solution to healthcare challenges. In the long-term, we’ll probably find that the two perspectives need to co-exist, work together and hold each other accountable, but for now, as in other conflicts, each side shakes its head at the other, calling it “na├»ve”, “narrow”, etc. 

Eight years ago, I started my career in public health bang in the middle of the market-facing lot and was, for the longest time, unable to see beyond that particular point of view. I’ve found myself creeping towards the middle recently though. Maybe it comes from spending time with friends who work in places where markets seem like distant realities, places where people live with zero access to formal healthcare, places where an easily treatable illness can easily be the cause of death and debt. 

I began 2019 with a goal to better understand healthcare systems. I have an excellent learning ground too – I live in India, home to the largest pool of healthcare needs, and perhaps the most complex health infrastructure in the world. In this article, I plan to summarise my big picture understanding of India’s healthcare system, under four heads:
  1. What are the major events in India’s healthcare system evolution? 
  2. What does the healthcare infrastructure in the country look like? As in, how is the healthcare delivered?
  3. What are the governance mechanisms? In other words, where will the innovation and change come from?
  4. What are the big healthcare issues to think about? 
Here goes, #1: Evolution and timeline:
Infographic #1: Timeline

These are only the events that interest me the most, so I admit there are some important ones that I’m missing out. My work has been primarily in infectious diseases, specifically TB and HIV, so events relevant to these are what jump out at me. It is absolutely fascinating to me - 
  • that a report submitted in 1946 continues to be the basis of not only current health structures, but also ongoing policy discussions,
  • that we started to talk about the need to engage with the private sector only in 2002,
  • that 19 years after the government launched the pulse polio program, India was officially declared polio-free. This gives me hope for TB eradication. But not too much - the plan was to eliminate kala-azar and filariasis by 2017 and leprosy by 2018 (spoiler alert: we didn't) 
Part 3: What are the governance mechanisms in healthcare? Who does what?
Part 4: What are the biggest issues in healthcare?

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