Whither Public Health in India

Investment in a well functioning Public Health system by the State delivers rich dividends in the form of higher productivity from the poor population which is generally not in a position to pay for quality health services. Especially in a country like India where malnutrition is a serious problem and contributes to a higher level of disease proneness among the population. Illness is a double drag on the poor households as it not only leads to higher medical expenditures but also a loss of earnings. Therefore, the right to a well functioning Public Health system is an essential human right. However, in India in rural areas especially the poor have little or no access to functional public health systems. This is very much so in Alirajpur district where there is only one full fledged Government hospital in the district town with a few doctors but there are a lack of good diagnostic and operational facilities without which serious cases cannot be properly treated. The health centres at the sub district levels are in even worse shape with lack of adequate doctors and para medical staff. Here is a heart rending story that will illustrate the desperate situation of the Adivasis much better than statistics ever will.
The village Bada Amba is situated on the banks of the River Narmada and the only way for people there to communicate with the world is either by a two hour travel by boat to the nearest road head or to climb over a series of hills for three hours to reach another road head. One Bhil woman Dahribai began bleeding from her vagina about two years ago. Initially as is the practice with the Bhils she went to a Burwa, the local medicine man who uses both herbs and chants mantras to cure illnesses. When that did not solve her problem she went with her husband to a private hospital in Bodeli town in Gujarat because the Primary Health Centre in Bakhatgarh was dysfunctional. She could have come to Alirajpur but since their village is close to the Gujarat border and they are more familiar with the Gujarati language than Hindi they prefer to go to Gujarat instead. The private hospital in Gujarat said that it could not solve her problem and that she should go to the big Government hospital in Vadodara. Being poor and also unaccustomed to travelling far her husband decided against taking Daheribai to Vadodara as this would involve more expenditure than they could muster. So they came back and for more than a year Daheri's plight worsened as she continually lost blood. This village being remote it is visited from time to time by some male workers of the Dhas Gramin Vikas Kendra who were not told of the condition of Daheribai. Last month a bigger team consisting of some of the female workers visited the village to inaugurate the school that was to be run by the organisation. The school is to be run in one of the huts belonging to Daheri's family. That is how the female workers of DGVK came to interact with Daheri and learnt that she is suffering from this continuous bleeding which has made her severely anaemic. The workers then arranged for a boat and ferried Daheribai to the roadhead in Gujarat as she could barely walk. From there she was brought in a jeep to Alirajpur. The lady doctor in Alirajpur after some preliminary investigation said that Daheribai was most probably suffering from cancer of the uterus and needed to be referred to a higher centre. The doctor said that there were no diagnostic facilities for cancer in Alirajpur and that Daheri would have to be taken to the Government Cancer Hospital in Indore. Even so the doctor did not shy away from prescribing that in the interim Daheri should be taken to Dahod town nearby in Gujarat to get an ultrasonography and CT Scan done at a private imaging centre there!!!
Daheribai was brought to Indore and there the doctors diagnosed her with third stage of cancer which would require intensive chemical and radio therapy. But before they could do this Daheribai would have to be treated with blood transfusions because of her severe anaemia. Moreover, a long stay in Indore would require money in the form of food and regular travel expenditure for another person who would stay with her even if the huge costs of cancer treatment were met by the Government. Since her family did not have the readiness for this expenditure also and for providing the blood required immediately Daheribai has returned to her village till such time as her family can get some money together. This despite the fact that Daheribai requires immediate treatment given the seriousness of her condition. Such is the stark reality of health services for the poor and without a more pro-active and well functioning Government Health system there is no hope for the likes of Daheribai. Thus, even if theoretically there is a right to health and a public health system, like in the case of education, in reality these rights are only on paper for the vast majority of the poor.