DEEDS DETERMINE DESTINY

(UNDO THE BURDEN




INDIAN DEMOCRACY AND AAM AADMI A LINKED DESTINY
THE GENESIS
A Vital Democracy will emerge in India when people at all levels participate fully. This is likely when life and health conditions allow AAM AADMI(common man) to use his right with time and space to think and vote. This will not occur if urban and rural life conditions of Aam Aadmi are under constant threat.
Air water and food are the elements of life and health. Their quality and cost/availability impact our body machine. Poverty and under-nutrition (UNN) are linked, so are UNN and impaired immune response leading to infection requiring medical and surgical treatment.
There is scientific data that the bacterial viral, chemical contaminants and inadequate nutrition are the cause of disease disability and death. The provision of safe water food and air for all is a binding mandate for the government for it is so stated in the Directive Principals of our constitution that sees Nutrients and Public health measures as the means towards these objectives
THE BURDEN
The rise in population has increased the number of AAM AADMI seeking cure of communicable and non-communicable diseases, this burden, the government must share and provide means of treatment and cure. So far no increase in volume and efficiency in facilities are seen in the public sector, where 80% of our population can afford and seek care. Today;
-Half of the new born are underweight with 5.6 million childhood deaths in the first year of life. –
-Maternal mortality is second highest in the world.
-One third of the world’s tuberculosis cases occur in India.
-900,000 die each year from causes related to contaminated water and air.
-New set of life style disorder (Cardiovascular + Diabetes) are on the increase in the affluent.
Indian health scenario in the hands of corporate is increasingly seen as a growing industry currently worth US$ 35 billion and increasing to 135 billion by 2017. These facilities meet the demands of upper class and the insured in urban locations. Today only14% of the population has health cover the rest have to use their own meager resources.
India's wealth is its Human Capital of a billion, only the healthy part of this resource has leaded the economy to a boom through its primal energy and motivation... It would be good economics if more AAM AADMI were in good health and could participate, and earn through their efforts.

NON PERFORMING ASSETS (NPA)
Primary health centers (PHC) are the delivery outlets for rural health care they provide walk in clinics and pharmacies.
The infrastructure for curative care is already in place PHC (22371) District hospitals (4400) Medical colleges (170).
In 1983 national health policy promised health care to all by 2000.
Public expenditure in health has not kept peace with the GDP in fact in absolute terms it has fallen from 3.3% of the first plan period to 1.9% of the seventh plan period.
In this same period private sector spending in health was 1.5 times as much as the government spending.
Low investments in health have led to poor uneven health systems, and care across India.
Inadequacies in this infrastructure need to be met to provide adequate services for AAM AADMI. The Draft health policy has identified PHC as the focus of attention.
I write to highlight the urgent need to provide resource, for the public sector PHC’s so that they are enabled to provide required services to the AAM AADMI in rural and urban India
A significant number of public sector hospital also lack adequate manpower and supplies for cure/care services. This is also true for medical school teaching hospitals.
This resource input will convert these public sector units from low to high performing assets.

Thus the rural and urban poor will not have to seek services of the urban private sector hospitals at great cost (for travel, and hospital charges)
The explanation offered for the lack of success of the Government health system is the pressure of curative care on the system, as a cause of the emphasis on preventive care.
We are aware of these twin motives of health care, but the AAM AADMI has a right to relief of the pain of current disorders.

STIMULUS STRATEGY
In the context of Government administrative functioning, the prevalent approach is top-down. There is no avenue for feedback correction. This has been true for health care administration.
There is a need for change to a modern two way communication between the PHC and District hospital and medical school hospitals.
This will enhance PHC care function and backup supply.
It would also up grade data storage on disease prevalence and the options available.
The urgent need is for an intelligent responsive system. It is entirely possible that this may require a N.G.O. /private/ public partnership.

An alternate strategy is required to meet the needs of AAM AADMI of today and in the future.
All PHC be staffed (doctors) and with a laptop for efficient data recording of disorders in a uniform format this will introduce standardization of data input and outcomes data, will insure accountability of the staff in service.
The 22 thousands PHC will serve as live realtime data source on disease prevalence and morbidity.

The PHC needs to be in contact with district hospital for referral and funds for subsidized travel to district hospitals this will also install a hub and spoke relationship in this part of the health system
District hospital also need to be fully staffed and equipment upgraded to meet the hub function for the district morbidity burden.
One member staff of clinical departments at district hospitals be assigned for consultation with PHC staff.
There are two outcomes. 1) Upgrades clinical services at PHC
2) Patients that need transfer to district hospital are identified.
PC workstations for data recording of patients and their progress should be available in wards, duty room and OPD; this will insure storage and retrieval for review for patient care and assessment by supervision. No data is lost scince workstation are available at all locations.
They will generate authentic health data.
Workstation linked to library services for backup information support and learning when needed by staff.
This staff service will circumvent the knowledge isolation of PHC staff
Software can be evolved for treatment protocols for prevalent disorders.
Both these backups will insure better quality of care service and better job satisfaction.
A strong viable referral system between district hospitals and teaching hospital for general and specialty services needs to be in place. This will improve service for specialty service for complicated cases. The advent of new therapeutic options can be introduced at any times.
All these new interventions may require inputs in excess of the% allocated.
These inputs are well deserved to improve working conditions and quality of patient care. They have first priority,and are possible in the current revenue position
The improved public health care system will impact the quality of private sector health care system through introduction of standard data recording and accountability and the AIM AADMI and the "not so" AAM AADMI will both gain
All these services can be further augmented by the “Rural Health Mission” and other initiatives. The AAM AADMI will then see visible evidence of the success of the economy and democracy.

All these initiatives will convert low performing assets to high performing service units and restore confidence in Aam Aadmi.

In the developed world, and USA in particular stimulus packages for the economy focus on health and education investments as a means of revival of public confidence and return of the retail investor.
In India sixty years have come and gone since independence each day it is becoming more difficult to convince the Aam Aadmi that the actions of governance are working for him and his salvation is round the corner.

Any questions can be can be sent to;drmmkapur@gmail.com you will receive a response
All posts are saved in archives for your access.