Health care system has changed a lot throughout the world. We Indians are either ignorant or indifferent towards these changes. Nowadays the diseases are complicated, the drugs used are complicated and consequently the treatment given to patients are more complicated. We have to adapt to this changed situation. But Indian health care system has not changed a bit. It is the same old system introduced by our British rulers in the last century.
An individual has changed, his environment, habits, morality and values of life, all has changed. Then how come the old system is suitable to present day scenario? Obviously there is genuine need for reforms. These reforms are important for the following reasons:
Science has made tremendous growth in the last 100 years and added lot of new subjects to it. An individual cannot master all these subjects; In order to use these new developments fully, we must have specialist in each branch of science; It is not only foolishness but also suicidal to ignore this new knowledge; and It is all the more important in health care science which deals with human life.
Question may be asked, are we not have specialists in new branches of medical science and are they not provide service to humanity in big hospitals? Yes, it is true, now we have “one specialist sitting in front of each hole of human body” But can we say the same with allied or Para medical sciences? Para medical peoples are produced to help the doctor in his diagnosis and treatment of patients without error or mistake. Thus we have pharmacists, nurses, physiotherapists and lab technologists employed in a hospital. These Para medical sciences also developed enormously in the last one century. Now we have graduates and postgraduates in all these disciplines. As though a postgraduate M.Pharm pharmacy practice cadre is not sufficient, Pharmacy Council of India has recently introduced a six-year Pharm.D course after +2. Thus we have, B.Pharm, M.Pharm, B.Sc and M.Sc nursing graduates as well as BPT and MPT physiotherapists and BSc and MSc lab technologists.
But the million dollar question is why these people are not appointed in Indian hospitals? Who or what prevent it? Why then these courses are conducted in our colleges? Who is the stumbling block in giving the benefits of new scientific developments to our people? The reasons for not updating or reforming our health care system are many; the important among them are the huge cost involved and the influence of the people with vested interest.
Huge cost
No doubt if we attempt to modernize something, we should consider the cost involved. Here the expenses for health care reform are not only big but also recurring. But for a government which presents lakhs of crores of rupees budget every year, it may not be prohibitive. What is required is the will power and the vision - the way one look at this expenses.
Most of the government officials in finance ministry are of the opinion that expenditure in health and hospital sector is unproductive. They consider the health department as white elephant eating too much and producing nothing. That is why the budget allotment for health care sector is less than 2% of GDP. Who will make them to realize, the expenditure in public health sector is investment for future, healthy and productive India? Do we need to remind them the age old proverb ‘Health is Wealth’? If we calculate the production loss due to mentally and physically weak Indians, it is many time that of these expenses. One epidemic of disease in one area of the country wipes out all the gains made in many years. Hence Indian govt should come forward to be a true welfare state. This is especially required when you have a dream of achieving super power status by the year 2020. Nobody, including higher officials and their families, can escape an epidemic of disease or antibiotic resistant micro organism, if it sweeps the country. A healthy and peaceful personal life is guaranteed only under a healthy society we live in.
Influence of people with vested interests
For few group of people in India, reforms are allergic and unwanted, as they are making lot of many in the existing old system. Take for example, the PCI has proposed to abolish D.Pharm and make degree in pharmacy as minimum qualification to practice the profession of pharmacy way back in its Education Regulation 2001. What happened to that proposal made to Govt of India? It asked the PCI to apply brake and go slow on reforms. The reason cited was under development of some north and north eastern states. Weather there is logic in this dictate [of forerunners to slow down until the last man catches you] apart, there is a strong doubt that vested interests who are currently benefited by low wages and unemployment among pharmacists are behind this backward decision of govt.
Well, the next question is how long to slow down? Usually D.Pharm syllabus is updated every 10 years, now 2011 has gone, 10 long years we have wasted, what the PCI should do? Instead of getting the earlier [ER 2001] proposal cleared by Central govt, PCI has announced it is going for the revision of D.Pharm syllabus [after 20 years of current syllabus framed in 1991]. That means they are going to continue D.Pharm. What is wrong if one guess the influence of those backward elements in this decision?
It is the same case with hospital reforms also. For most of us including politicians and bureaucracy, doctors are Gods or next to Gods! So we have blind belief in them [which they misuse] and hence we are not able to see through the game they play. They don’t want to lose their domination of Para medical departments, which are many way advantageous to them both personally and professionally. That may be the reason why they want to continue with existing set up with diploma holders in all the Para medical departments. Graduates and postgraduates may not be as obliging as these sub ordinate diploma holders.
Compare this scenario with that of developed countries including Gulf countries, where even the prescription writing is in the hands of clinical pharmacists, not with doctors, who are restricted to diagnosis of diseases. Only MSc nursing graduates are appointed as nurses there. A postgraduate in pharmacy or nursing can detect the errors of doctors and help him in his successful practice and also the patient. Instead of looking at this as a help to them doctors look at it, as described above. Why they are not worried about their possible mistakes? It is because of us - the innocent Indian citizens. We think a God can never commit mistake. Whatever goes wrong with treatment, they hide, and we are ready to accept it as disease process or fate and ready to sacrifice our near and dear. Hence he has escaped, is escaping and will escape from his responsibilities! Fight for health care reform for your own safety. When we are going to question everything as the great philosopher Socrates told us to?
(Author is ex.president, Indian Pharmacy Graduates Association, Madurai, Tamil Nadu)