Clairvoyance 2009

'We Have to Look at Primary Education as a Long-Term Medication'

The two-day conference embarked upon array of issues like capacity building at the grass root levels, health financing scenario in India, capacity building at the middle-level management and sensitisation of the health workforce towards HIV/AIDS

At the end of my MBBS, I didn't learn anything about medical ethics! When a medical student learns about medicine, he also learns about medical ethics. However, today medical ethics are taught as a law and only in disciplines like forensic medicine. We are training doctors to be good clinicians or technicians, but they do not know the human beings with whom they are interacting. Therefore, we can't just talk about rights, but we also have the responsibility to create a system where these rights will be practiced, said Dr Amar Jesani, Trustee, Anusandhan Trust and Editorial Board, Indian Journal of Medical Ethics. He was talking at the inaugural session of the Clairvoyance 2009 conference, which took place on December 19-20, in the premises of Tata Institute of Social Sciences (TISS) in Mumbai. This year, the theme of the conference revolved around building capacities in healthcare by enhancing abilities and mitigating vulnerabilities.

The two-day conference embarked upon array of issues like capacity building at the grass root levels, health financing scenario in India, capacity building at the middle-level management, sensitisation of the health workforce to HIV/AID, community-based health insurance, sustainable technologies in healthcare and strategic business models for hospitals. Express Healthcare was the media partner for this conference. The conference

started with the welcome address of Dr Lina Kashyap, Deputy Director, TISS. Dr CAK Yesudian, Professor and Dean, School of Health System Studies, TISS congratulated this year's batch for their efforts in coming up with a theme based on building capabilities. "I am glad to note that keeping the tradition of the school, the students are organising the annual conference of which students are also bringing out the souvenir to express their knowledge and skills. I congratulate them for their efforts emphasising on professionalising healthcare management and public health." Professor Julian Le Grande, Professor of Social Policy, London School of Economics in his key note address on how to run a health service, spoke at length about the four different models of healthcare service based on trust, mistrust, voice or choice and its practice in the UK healthcare system. Said Grande, "In the UK, we have highly centralised health service where people have to wait for as long as eight months. In the UK, we tried all the four models, but we have failed." He further said that in Indian healthcare scenario where majority of the population in rural areas is still illiterate, India needs to build a strong primary healthcare service base and the physicians working there can then advice public on further referrals. "Major difference between Indian and the UK health system is that in UK, the public health system is used by all socio economic strata, however in India, public health system is only utilised by poor population. For the initial 40 years, we worked on trust model, however, today we have slowly started introducing choice and competition," opined Dr Yesudian.

The next session was on capacity building at the grass root levels. Professor Susan Rifkin, Professor at London School of Economics who chaired this session said, "We need to look at health not just as an outcome but as a process and we need to look at building the capacity of this process." The first speaker Dr John Oommen Cherian, Head Community Health Department, Christian Hospital, Bisam, Cuttak, Orissa spoke on Madsen's Institute for Tribal and Rural Advancement (MITRA) model of community health management while building capacity at the grass root level. The 'Mitra' project is working with 11,700 people in 50 predominantly Adivasi villages in Bissam, Cuttack, Rayagada districts of Orissa. "When we talk about capacity building at the grass root level, we need to develop an insider perspective by creating a mechanism, as it changes our insight of capacity and system," said Dr Cherian. He further said that as a country, India is very good at building processes but very poor at outcomes. Next speaker, Dr Dhruv Mankad, Lead Consultant, A Project Evaluation Team at Sir Dorabji Tata Trust and Trustee at Anusandhan Trust, Nasik spoke on the issue of training at the grass root level. "Grassroots workers are increasingly becoming primary care providers. Consider them on par with medicare providers for educational methods and technologies," said Dr Mankad. He further said that working population is required to be recognised using innovative education strategies. Dr William A Toscano, Professor and Division Head, Environmental Health Sciences, University of Minnesota School of Public Health, said, "If we see the health workforce gap, then in India 10,000 people are needed in Government sector. Competent workers are a key part of capacity of public health system and to develop competent public health workforce, education and training is necessary."

The next session was on 'Health Financing in India- Are there Capacities?' by Sunil Nandraj, National Professional Officer- Health Systems Development, WHO India, Delhi. "Public health spending is very low in India. As percentage of GDP, it declined from 1.3 percent in 1990 to 0.9 per cent. Seventy per cent of public spending is by the states and major part of it is spent on salary and administration. Eighty per cent of all health spending is private spending (out-of-pocket at the point of service use) and only around two to three per cent of people in India have some form of coverage," said Nandraj. The next session was on 'Middle Level Management Capacity Building'. Dr A Dayalchand, Director, Institute of Health Management, Pune said, "Capacity building for middle-level managers requires a broad definition - beyond training which includes skills development, systems development strategies and processes." Dr Prakash Doke, Director, State Health Systems Resource Centre, Maharashtra while speaking on capacity building at mid-level heath managers, said, "Mid-level managers have a specialised understanding of certain managerial tasks. They are responsible for carrying out the decisions made by top-level management. They can work on small developments unsupervised, larger developments with guidance and be part of a team for large developments. However, they require code reviews and training to get to next level." Mid-level managers in health include traditional (medical, para medical, supporting, administrative) and newer mainly pure managers (District Programme Officer, District Finance Officer, Monitoring and Evaluation Officer, District Community Mobiliser and Hospital Administrator). While talking about significance of middle-level health Managers, Sushama Rath, Public Affair Officer and Tender Adv, National Health State Resource Centre, Delhi, said, "Middle-level managers in healthcare are sandwiched in between policy makers who are not medicos and lower-level managers from whom they need to get work done. Therefore, it is crucial for middle-level managers to know what the exact requirement is and therefore it is important to empower them. Today, NRHM is facilitating this goal by identifying 235 districts all over India and will require a strong force of mid-level managers." The next session was on sensitisation of the health workforce to HIV/AIDS. Said Dr Alaka Deshpande, Professor and Head of Department, JJ Hospital, Mumbai, "Unless the administrators are sensitised about the issue of HIV/ AIDS, they won't be able to understand the needs and won't be able to comply with the needs of the patients and the health work force. At the Government level too, there is a need for sensitisation to tackle this problem." Dr Deshpande also emphasised the need for providing all required bio-safety measures to the doctors and other healthcare workers for their own safety.

Eldred Tellis, Founder-Director, Sankalp Rehabilitation Trust, Mumbai, which works for the rehabilitation of drug users in Mumbai, said, "I don't understand why there is so much fear among doctors about HIV infection. Are we willing to see that HIV- infected person is another human being? What is important is the attitude." Dr Raghuram Rao, Associate Project Director, AVERT Society, Maharashtra said that there is 2.5 million HIV-infected population in India. Illiteracy, poverty and poor awareness of HIV are the main reasons for the prevalence of this epidemic in the country. "The HIV epidemic has been viewed as a strongly gendered health, development and human rights issue," said Dr Rao.

EH News Bureau