Saturday, May 16, 2009

Providing health care in India's villages - An administrative problem that needs managerial solutions

I couldn't agree more with Shoba Narayan's analysis of the problem of providing health care to the over 600,000 villages across India. It's a massive logistical and administrative problem that is crying out for common sense solutions. Meeting the people who are responsible for the provision of health care services in rural India (ANM's, ASHA's and Anganwadi workers), as we often have the opportunity to in the course of our work at Barometer, is a uniformly humbling experience. For the most part these are incredibly hard working, passionate women, who think nothing of being spread thin across large popluations with minimal infrastructure and support. Maybe the newly re-elected UPA/Congress Government, which has reaped the dividends of concentrating on the rural economy, will make this a priority. Here's an extract from the article I was referring to:

The healthcare administrator’s job, I would argue, is more important than the doctor’s. Except, in most villages, such a job doesn’t exist. The PHCs are manned by doctors and the panchayat leader squeezes in the sanitation and nutrition work amid her other duties. The ASHAs (accredited social health activists) do a decent job and are one of the most innovative schemes that the Indian government has come up with. But they are stretched. Just as the government recruited local women into becoming ASHAs, they can perhaps climb the ladder to becoming rural health supervisors. This supervisor’s job would be part PR, part brute-force execution and part infrastructure. She needs to convince the people who live on the banks of the Krishna that streaming their wastewater into the river will cause water-borne diseases downstream. She needs to cajole and coerce the village panchayat into installing toilets rather than having people defecate under the great blue yonder.

Part of the problem is that doctors, let alone administrators, don’t want rural postings. In late February, then Union health minister Anbumani Ramadoss announced that he was going to make rural postings compulsory even though, as many Indian medical blogs noted, they have “failed miserably” in the past. One medical education blog written by a Dr Anshu said that after being trained in medical colleges with sophisticated equipment and colleagues, doctors found the “learned helplessness” of rural postings frustrating.

This is one instance where I believe throwing money at the problem will help. Rural postings can only become attractive when they afford job satisfaction. Private charitable hospitals are doing a great job with this. Teresa is now taking her son to the Sathya Sai Baba hospital in Whitefield, Bangalore. We got her son an appointment via email and the neurologist is treating Gerald without taking a penny. The Mata Amritanandamayi Hospital has a waiting list of doctors wanting to serve, I am told. I am not a follower of “Amma”, or Sathya Sai Baba for that matter, but I would urge them to set up their institutions in remote rural spaces. The global manpower and funds they can draw will ensure a facility that will serve as a draw for not just patients but doctors and therefore, a thriving medical community that gives job satisfaction in rural postings.

Wouldn’t it stand to reason that the jobs that were the least satisfying ought to be paid the most? Of course, by that logic, a street sweeper ought to be paid more than a CEO. By that same logic, a rural medical posting ought to get more than the measly Rs10,000 that it commands. Double their wages, I say, to compensate for the intellectual isolation that doctors complain about. In this recessionary economy, that would make doctors flock to villages in droves.

You can read the entire article here.

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