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Shubhendu Parth
Managing Editor, eHealth
Healthcare needs
surveillance grid
‘Fixing the sick’ approach should give way to a
preventive care and diagnostics system, especially
for the rural people
A s a speaker invited to talk
on the trends in health-
care sector in an event in
Chennai recently, I was
pleasantly surprised to hear Dr Mahesh
Vakamudi echoing noted futurist Jim
Carroll’s forecasts for year 2020. Mahesh is
head of Anesthesiology and Critical Care
at Chennai’s Sri Ramchandra Hospital.
Quoting Carroll, my fellow speaker
put forth the proposition that India
needs to transform the present healthcare
system, which “fixes people after they are
sick,” into a more proactive preventative
care and diagnostics system.
Unfortunately, for India, a decade may
not be sufficient to achieve this paradigm
shift. And there are too many odds
stacked against it.
Today, the biggest challenge that the
country faces is not that of ‘availability’ of
quality healthcare; the country has suffi-
cient number of best-in-breed healthcare
facilities to meet needs of urban popula-
tion segments. Instead, India is grappling
with a huge challenge of ensuring ‘acces-
sibility’ of quality healthcare facilities to
all, particularly for the rural populace.
50 > www.ehealthonline.org > December 2010
According to the data made avail-
able by the Union Ministry of Health,
curative services favour the non-poor in
India—for every `1 spent on the poorest
20 percent population, `3 is spent on the
richest quintile.
All this, despite the National Rural
Health Mission (NRHM), which has not
been able to achieve anything remarkable
in improving the state of health facilities
in rural hinterlands.
Yes, NRHM can claim to have made
some impact in neo-natal care and im-
munisation, but ill health continues to be
a major risk factor for the rural poor in
the country. And the reasons are clear for
anyone to see: lack of adequate healthcare
services in rural and remote areas and
very high direct and indirect costs of ac-
cessing them elsewhere.
Non availability of a ‘neighbourhood’
healthcare facility adds to the loss of ill
person’s contribution to the household
economy and leads to a diversion of
time–particularly of women in poor rural
households–from productive activities to
caring for the ill.
And the impact is severe. Over 40 per-
cent of hospitalised Indians are believed
to borrow heavily or sell assets to cover
their healthcare bills, while 25 percent of
hospitalised Indians fall below poverty
line because of hospital expenses.
To transform from a not-so-efficient
curative care nation to Carroll’s vision
of treating citizens “for the conditions
we know they are likely to develop, and
re-architecting the system around that
reality,” India needs to quickly set up
a nationwide disease surveillance grid,
something that had been piloted in bits
and pieces but never quite rolled out.
While the NRHM mission document
does talk about strengthening capacities
for data collection, assessment and review
of evidence based planning and village-
level disease surveillance system, the gov-
ernment now needs to drive the agenda as
part of its integrated Mission Mode Project
under the National eGovernance Plan.
It should also create a mechanism to
fund the initiative as part of the state’s
overall budget allocations, and link the
disbursal to a time-bound, milestones-
based implementation plan with a fixed
project deadline and fund expiry date.