G’nY. What three primary positives do you see in India’s health scenario?
Alok Mukhopadhyay : Well, there has been a sizeable development in health infrastructure across the country in post-independence India. I also see reasonable success in immunisation, combating of HIV/AIDS and near eradication of leprosy. And, the improvement in life-expectancy and gradual slowing down of population growth, particularly in the
non-northern states is commendable.
G’nY. Would institution building help fill the demand-supply gap of doctors, or would it assist further brain drain?
Alok Mukhopadhyay : There is alarming shortage of human resources in healthcare and many deliberations have addressed them. Setting up of many new AIIMS may not be the answer, but upgradation and upscalability of credible existing training facilities is a must. To prevent brain drain, it is essential to have statutory requirement for doctors, paramedics and other support staff to provide mandatory service for three to five years before they can migrate. The critical gap in the human resources of health sector can also be addressed by ensuring that we have an appropriate referral system in place, so that everybody does not queue up before a doctor. There is considerable scope of treating minor ailments by paramedics and accredited social health activists (ASHA) workers at the grassroot level.
G’nY. Why do you think India’s ailing populace prefer private healthcare?
Alok Mukhopadhyay : It is true that a large proportion of Indias ailing population go to private healthcare providers as the public sector is not functioning adequately in many parts of the country. There is shortage of drugs and diagnostic facilities and of course, often human resources. But, we also need to remember that a fairly large part of the private sector are untrained quacks, who provide quick-fix treatments with serious health consequences at times. You see, the private sector is also failing to provide quality care at a reasonable cost, but are accessed by patients due to lack of alternatives.
G’nY. What is the current trend of healthcare expenditure?
Alok Mukhopadhyay : Healthcare expenditures have continued to rise both in urban and rural areas because of an increase in diagnostic costs, sometimes due to over prescription. The general public who are not part of Central Government Health Scheme (CGHS) or similar coverage find it extremely difficult to cope. There needs to be more stress on prevention so that episodes of ill-health can be arrested before they become complex.
G’nY. Is multi-drug resistant TB a reality or a myth?
Alok Mukhopadhyay : Unfortunately it is a stark reality, and we have just begun to address the issue in selected urban settings. With Prime Ministers personal interest on eradication of tuberculosis and increased budget and facilities, a good beginning has been made to arrest the situation.
G’nY. The 2018-19 declares a 5 per cent increase in health budget. Do you think it is adequate?
Alok Mukhopadhyay : No. It is but a notional increase given the increased cost of human resources, supplies, vaccines and more. The allocation is extremely inadequate.
G’nY. Do you think the Health Protection Scheme deserves the spotlight?
Alok Mukhopadhyay : Well, the Health Protection Scheme is an important initiative. But, given the fact that the states have to implement it, a more serious consultation with the states was necessaryfirst to review the existing state-level programmes, and second to get their inputs. Such schemes need to keep in mind that many parts of India where the people are to benefit, do not have an appropriate private sector. Therefore, the scheme needs to be implemented in the public sector with the private sector filling the gaps so that in the process public sector can be strengthened and peoples confidence in them can be restored.
G’nY. What are your views on the National Medical Commission Bill 2017?
Alok Mukhopadhyay : The Bill could be a substantial instrument for significant reform, but it needed more participatory discussion between stakeholders while formulating. It is needless to say that there is no scope of mixing various systems of medicine in taking healthcare forward. Each system has their strengths and weaknesses and have to grow on their own with certain amount of inter-disciplinary dialogue.