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Monday, 29 October 2012

Do not step for privatization of health care in West Bengal provinces of India. Health care is the responsibility of a state government. It must be free and must not afford profit at expense of poor’s health

Professor Pranab Kr Bhattacharya MD(Path) Cal, FIC Path (Ind.),  Professor and Head, Dept. of Pathology, School of Tropical Medicine Kolkata[ course Coordinator of Diploma of clinical pathology(DCP) of West Bengal University of Health sciences(WBUHS) Kolkata, Member Board of Studies of WBUHS, In-charge of Diploma of laboratory technology]  108, CR Avenue, Kolkata-700073
 Email= phone no- 91- 9231510435       2)Miss Upasana Bhattacharya, student & Daughter of Prof.P.K.  Bhattacharya  3)Mr. Rupak Bhattacharya Bsc(Cal),Msc( JU)   4) Mr. Ritwik Bhattacharya Bcom (Cal),  5) Miss Rupsa Bhattacharya Resident of 7/51 Purbapalli, Po= Sodepur Dist=24 parganas ( West Bengal)Pin 743178. India.
6) Mrs. Dalihia Mukherjee BA (Hons).Cal. university,7) Mr.Debasis Mukherjee Bsc(cal) both resident of Swamiji Nagar; south Habra 24 parganas(north) West Bengal’ India
 8)  Dr. Jayanta Dasgupta  MD(cal), DM(Gastro) Professor,  Dept. Of Gastroenterology,
Institute of Post Graduate Medical Education& Research (IPGME&R)244A AJC Bose Road, Kolkata-700020, West Bengal , India

 All Correspondances must be  to first Author= Professor. Pranab Kr. Bhattacharya
Corresponding Address= Professor & Head  Dept. Of pathology, 2nd floor, Room No10C,
School of Tropical Medicine,  Kolkata,  108, Chitta Ranjan Avenue Kolkata-700073; West Bengal, India Email= phone no- 91- 9231510435

In 2000 the United Nations set out eight development goals to improve the lives of the world’s disadvantaged &poor populations. The goals seek reductions in poverty, illiteracy, sex inequality, malnutrition, child deaths, maternal mortality, and major infections as well creation of job , environmental stability and a global partnership for development. One problem of this itemization of goals was that it separated environmental considerations from health considerations. Poverty still could not be eliminated while political motivations & environmental degradation exacerbated  malnutrition, disease, and injury. Food production & food supplies needed better cultivation system,  more cultivator, more cultivation land &fertile soil   continuing soil fertility, climatic stability, freshwater supplies, and ecological support (such as pollination). Infectious diseases cannot be  also stabilized in circumstances of climatic instability, refugee flows, and impoverishment.
The Economic growth of a state or of a country is usually measured by economists in increase of GDP and GDP per capita. GDP per capita per year is also a very important key point of human development index used by UNDP. Health care expenditure of a country is also measured by percentage of GDP spent for it & GDP spent by Indian government for health care is<3% ,despite gross domestic product growth rate of India is 9% in2007-09. But a very big question often strikes me does GDP per capita in a real sense reflects the poverty status of any state or of any country? It appears before me to imagine or to calculate a decline in poverty unaccompanied by a simultaneous improvement in aggregate economic performance- my 83 years old father Mr. Bholanath Bhattacharya commented me few  years back.  The determinant of economic growth of a state, we people use the denominators like Life expectation at birth, Infant mortality rate [57 per1000 live birth in India in2007], Crude birth rate, Crude death rate, Maternal mortality rate [301 per 1 lack live births in India in2007] etc does really reflect the economic progress of poverty laden families of the state or of a country? I myself don’t belief that now. I see daily so large rushes in public tertiary medical colleges hospitals [in the year-2006 Total OPD 1,42,51,407 cases, Total indoor admissions 1,88,8121 cases Total1,61,39,528 of 8.5 cores population (19.69%) of the state]  & most of them belongs to so poor and bellow poverty line families. But our government still says economic growth of India is 9%. Rather state level growth of real Net state Domestic product (NSDP) may be a good determinant factor. In west Bengal, PCNSDP in 2000-2001 is Rs9778/= per year, per person which means per person capacity to purchase essential goods or calorie for living is Rs 814/= only at poverty level when central govt. definition bellow poverty line is Rs1500/= and people still at BPL level in West Bengal is 27.09% & when poverty line considered Rs 1500/=Pm per person. If PCNSDP criteria is considered to define poverty line then people at poverty level in 2008, at West Bengal will be more then 62%.Over last 3-4 decades , there had been tremendous out break of unemployment in West Bengal  amongst the educated younger generation of age range 21-45 yrs the productive age group. This picture of unemployment is not only in West Bengal but through out India. The number of registered unemployed in India through employment exchange is about 8 cores, whereas in West Bengal the figure is about 1.5 core.  Though LEB during the period of 1970s to 2008 period raised from 49.7 to 61.7 years  & Bihar state which is one of the lowest NSDP  of Rs 4123/= is in better position then MP,UP as per these conventional health indicators. But the fact also says that LEB Per capita GDP & per capita expenditure for health shows better growth. In India Poverty line is decreasing & so in West Bengal!
 Then what should be the denominators of an economic growth of a family of a state of a local society of a country?—can this be an issue of a discussion?
 Growth of physical labor! Stock of physical capacity! Technological labor class advancement! Quality and quantity [skilled and unskilled ratio] of human resources and human capital! Their living standard, their nutrition, their education and their mental health- physical labors are related to economic growth of a province or of a country. As for example, physical labors are related to production in any industry, or in paddy fields, or in agriculture or in roads or other civil sectors, in construction works or in surface, Rails, in water transport works, in home guards industries and in electricity sectors.  The development of a state, in a country is thus dependent on mostly on” lower socioeconomic class and poor class peoplemy old father replied me. My father through out his life led his life in extreme poverty and was a Marxist by his heart and action. He worked directly in fields for economic uplift & fought for settlement of refugees of Bangladesh war-1970s settled at a colony areas of my native village sodepur, 24 parganas(north) W.B, India. How much was he true? If his views are correct then two elements come in questions in my mind. 1) the economic growth of a family and thus of a state in larger sense depends on 1) that how much labor forces are present in a family and how much they are educated at high school level or at university level 2) the health of these labor class forces as a big capital- Both these elementary determinant level has been neglected since freedom, in West Bengal provinces of India. The role of human health in influencing the economic outcome of a state is well understood at macroeconomic level. But health deals with microeconomics at the same time._ healthier workers are likely to able to work for longer period, becomes more productive then their relatively less healthy counterparts and are able to work for longer periods, able to secure higher earnings then the later. Illness and diseases shorter the working level of people. Health has thus a positive significance effect on the rate of growth of GDP per capita. Higher income permits individuals to achieve better nutrition and better health care improvement of them results probably improvement of net domestic products(NSDP) of state , thus increase of national income and can thus decline poverty level. So it is very important to give priority that towards which the health care should be directed! Rich or poor?
 In Indian open health market, in health tourism market, in West Bengal provinces improvement of health care delivery is mainly directed towards whom? Obviously not a pro poor health care delivery system it is now in 2K! –existed in 1970s! What should be focus in health care in 21st century? It must be patients cure and care both. Every patients must have sufficient accesses to safest and highest quality of health care regardless how much they earn, where they live and how seek they are!- A patient, a citizen must be the first priority and not the health industry and profitable health financing. Then why to step for privatization of health in west Bengal? Why opening accesses for so many & mushrooming Private health care institutions including private Medical colleges?
 Improvement of health care through public health care delivery when directed at poor, it contributes more directly to poverty reduction and serve as pro-poor growth strategy. In west Bengal Provinces of India out of 8.5 cores population 27.09% population is bellow poverty line( Rs 1500/= pm I.e. < $1-1.5 per day per person) and 62% population is at poverty line (Rs 1500/=)even after 61 years of Independence! . In India, tuberculosis kills 364,000 people and diarrheal disease and other infections kills 3 million people every years .700-800 million people in India lives with daily income<us$1-1.5. These poor bears disproportionate burdens of illness, psychiatric illness, Suicides and various under nourishments, infectious diseases including T. B, HIV,  sanitation & sewage disposal problems, water borne infections, mosquito borne diseases then upper middle class, middle class and rich people[300 millions in India]. The poor suffers from ill heath due to mainly of causes of poor nutrition that reduces their ability to perform works due to weakness, due to threaten Tuberculosis, their defective immunity and resistance for diseases, frequent treatment expenditure, frequent doctors fee, nursing home charges and loss of economic forces. Poor families thus exhaust their earnings, their savings, their assets and take re curse of borrowing leading to more poverty, poor health status & drop in school & colleges.
There always remained inequalities between rich and poor population within a state within a country or between rich and poor countries.  In case of state of West Bengal, in India, the same is also true. No doubt there happened a systemic (in hands of few percentage -<20% population) economic growth and number of middle class economic families or people increased in the state. In India, now< 300 millions people may be classed in middle class economy. Their physical or labor contribution for economic growth of the state is negligible and their life style is really most unhealthy one, that they are eating too much of fat, eggs, milk products, cheese, packed dry foods, meat, consume much  cooking oil & carbohydrates, drinks alcohol, consume cigarette and tobacco products, but they are reluctant to burn their calorie by physical labor. They lost all their physical activities including daily one hour walking. City middle class and upper middle class population mostly drive their cars every where they go. As a result, I think, they suffer from obesity, high BMI, metabolic syndrome, diabetes mellitus type-2, high blood pressure, renal failure, atherosclerosis and cardiovascular diseases. As a teacher doctor’s   state government salary in a reputed public post graduate teaching hospital of kolkata, my unit family belongs now in upper middle class family and possesses all these ill effects.  Are not these people themselves responsible for their diseases and early death if occurs? Why the state health services policies pays priority for these people’s illness, opening marketing  accesses for business houses like mushrooming private  health institutions/hospitals[ never show any human face] in healthcare system, neglecting the real needs of poor?. we need a renaissaue in health care driving force towards an effective and strong primary health care in state of west Bengal particularly targeting poor people in regard immunization, proper food care, nutrition, safe water, sanitation, maternal and child care, prevention and quality treatment of local diseases, provision of essential drugs, laboratories diagnostic facilities extending from secondary health care tire to primary health center level. In 1983 the India’s national health policy adopted the alma- atta definition of primary health care to mean the provision of curative, preventive and rehabilitative health services and accesses of health services to rural areas. A large three tire health care system developed in all provinces including in state west Bengal. Primary health centers are units that provide integrated health care in rural villages [30,000 populations] and provide referral to secondary and tertiary care in an almost non effective referral system. But problem of PHCs remained, are unavailability of human resources [doctors, nurses], essential medicines,gazates and forcing poor people to get treatment in private chambers and often before quack doctors, on whom villagers depends on much
  The fact is that for last 2, decades, in the state, there was dominance of profit making health insurances industries, a new wave of investor-owned specialty or super specialty hospitals, and profit-maximizing behavior in west Bengal provinces including in India .The involvement of private companies any where always generates some controversy. Some health policy maker people believe that only commercial interests can bring health innovation and efficiency and can modernize the health system. –the idea is not a default . I rather assume that the profit motive is incompatible with the pursuit of excellence in health care system. The government of west Bengal so planned to  establishing at least 60 primary health centers, diagnostic laboratories services in secondary and tertiary level health care including in medical colleges of the state  to be run by private companies in the name of public Private Partnership in Health care system. Health care is the responsibility of a state government. It must be free and must not afford profit at expense of poor and what I feel

 Copy Right-  This article is the Intellectual Property of Authors and Copy Right of this letter belongs to Professor Pranab kumar Bhattacharya and his first degree relatives only as per copy right act & rules of Intellectual Property Right Rules 3D/107/1201a,b/ RDF Copy Right rules/ SPARC copy Right rules-2006/ and Protect intellectual Property Right(PIP) copy right rules of USA-2012. No Person, No NGos, No Researchers , No Health planner who ever he/she may be from India or  Provinces like West Bengal provinces, except the first degree relatives of Prof PKB & authors, is entitled to implement any things any syllable even any Idea out of contents  present in this article. Please do not Infringe, restrict yourself  and be enough carefull for your own safety if you are not direct Blood relation to prof Pranab Kumar Bhattacharya