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Monday, 12 November 2012

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


Authors are
Professor Pranab Kumar Bhattacharya MD(cal), FIC Path(Ind),  Professor and Head, Dept. of Pathology  [Convener &In charge Diploma in Clinical Pathology  Course West Bengal University of Health Sciences( WBUHS)  DD,36 salt lake city,  Kolkata ,W.B, India; Member of Board of Studies WBUHS]; *Miss Upasana Bhattacharya  Student & daughter of Prof Pranab kumar Bhattacharya ; **Rupak Bhattacharya BSc(calcuttaUniv),MSc(JU);**Ritwik Bhattacharya B.com(calcutta Univ); ** Rupsa Bhattacharya  ;  **Soumyak Bhattacharya BHA(IGNOU) and presently  MSc Student of PUSHA, Govt.of India; New Delhi; all of residence 7/51 Purbapalli, Sodepur, Kol-110;  ***Dalia Mukherjee BA(hons) calcutta. Univ, ***Miss Oindrila Mukherjee BA(hons) Student Calcutta.Univ, ***Debasis Mukherjee BSc(calcutta.Univ) of residence Swamijinagar,  Soth Habra ,Habra 24 parganas(noert) West Bengal , India   Dr. Jayanta Dasgupta  MD(calcutta Univ), DM(Gastro)Professor,  Dept. Of Gastroenterology, Institute of Post Graduate Medical Education& Research (IPGME&R)244A AJC Bose Road, Kolkata-700020, West Bengal , India  Dr Pijush Kanti Roy MS(Calcutta Univ.) ENT Asst Professor ENT, Institute of Post Graduate Medical Education& Research (IPGME&R) 244A AJC Bose Road, Kolkata-700020, West Bengal , India* Dr Indranil Dhar MD(AIIMS) Demonstrator Pathology Calcutta School of Tropical Medicine
Introduction
Health is not merely means to the absence of diseases but it is state of physical mental and social well being. Social determinations of health are conditions, in which people are born, grow, have education, live, get a job to earn and their age including the health system. The concept of Social determinants changed today. While medical care can prolong survival and improve diagnosis after serious diseases, more important is for health of the poor class, labor class population as a whole. Of course the universal access to free medical care is clearly one of the social determinants of health of a state according the authors
.UN Declaration of Health in 2K, development of a state depends on healthier worker, health budget, access to health toward labor &disadvantageous class
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 separate denvironmental 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, fresh water supplies, and ecological support (such as pollination). Infectious diseases cannot be also stabilized in circumstances of climatic instability, refugee flows, and impoverishment. Development of a state or of a country thus depends on how much healthier their worker is and how much budget is
spent for the health of a state or of a country and access of its labor, poor and disadvantageous citizens to free health care.
Economic Growth! GDP per capita related to H DI or NSDPE?
The economic growth of a state or of a country is usually measured by economists n increase of GDP and GDP per ca-pita. GDP per ca pita per year is also a very important key point of human development index (HDI) 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 produc tgrowth rate of India is 9% in 2007-09. But a very big question often strikes the
authors does GDP per ca pita in a real sense reflects the poverty status of any state or of any country? It appears before the authors to imagine or to calculate a decline in poverty unaccompanied by  a simultaneous   improvement in aggregate economic performance- the first author’s 84 years old father late Mr. Bholanath Bhattacharya commented him 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 in 2007], Crude birth rate, Crude death rate, Maternal mortality rate [301 per 1 lack live births in India in 2007] 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 admission1,88,8121 cases Total 1,61,39,528 of 8.5 cores population (19.69%) of the state] &most of them belongs to so poor and bellow poverty line families. But our central government still says economic growth of India is 9% in 2007. 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 un-employment in West Bengal even among 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 to61.7 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!

What should be then better Health denominators for 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 at all ?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 people and their health which is neglected all through and remains still in question in India by political will, by present health care providers having specialization & super specialty degrees. Here we are to fight against malnutrition, Tuberculosis, Dengue, malaria, diarrhea, RTI,Tobacco related problems Alcoholics, Suicide, Depressions, MDP, Psychotic disorders ,HIV and majority of these population(<65%) are not in position to bear expenses of modern and sophisticated treatment – and it is indeed a challenging
task before modern health care professionals and specialists to make treatment
facilities at their affordable cost “ my old father replied me- a year before his journey to heaven in 2009. My father late Bholanath Bhattacharya through out his life led his life in extreme poverty and was a Marxist by his heart and action at my home town Sodepur, West Bengal , India. 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. He had acquired no doubt vast experience on economic up lift of refugees in fields. 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?
Health care in West Bengal, India now directed towards Upper middle class& richer class population!
In Indian open health market, in health tourism market, in West Bengal provinces improvement of health care delivery is mainly directed towards whom? Obviously here not a pro poor health care delivery system it is now in 2012! – However that 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 a safest and highest quality & cost effective quality health care &cure regardless how much they earn, where they live, how much they are able to pay from pocket and how seek they are!- A patient, a citizen of India’s living must be the first priority and not the up growing of health industry and profitable health financing. Then why to step for privatization of health in west Bengal or in India? Why opening accesses for so many & mushrooming private health care institutions (hospitals) including privaterun Medical colleges? Do they take important roles in the social determinants of health of a state? As a national policy of course West Bengal state needs more qualified MBBS/MD/MS doctors; Patients :Doctors ratio at present in India 1:1700 where as the expected should be at least 1:1000. In west Bengal province of India the scenario is further poor. To meet the demands for more health care providers human resources , more medical colleges opened( O3) by state government in 2011 but these are without proper infrastructure, diagnostic facilities and faculty teachers as per norms of Medical Council of India(MCI). Because of the heavy cost involved, land acquisition problems in opening a new medical college, the state government of West Bengal are not able to start new government run medical colleges with MCI degrees and faculty recognition and thus most of the proposed medical colleges are coming in private medical colleges with two(02) presently existing or in public private partnership(PPP) model. Unfortunately the standard of these two colleges exist in the state declined in quality of teaching and patients numbers- the government medical colleges are also starved of funds and quality human resources in all spheres( doctors, teaching faculties , Nurses, technicians,General Duty Assistants , sweepers, pharmacists etc) and the private sectors has huge un imaginable commercial & business profit interests only in their mind with no commitments towards their admitted MBBS or Diplomat national board examinations(India) students, no commitments to promote good medical education research or ethics or minimum human face towards patient care and cure system.As a result teachers are there today no more role models there and substandard doctors are produced there with MBBS degrees and people are at risk to them.Public health care delivery if directed towards poor,& community contributes more directly to better economy of the state/country-The Improvement of health care through public health care delivery when directed at poor, it contributes more directly to poverty reduction and serves as pro-poor growth strategy. In west Bengal Provinces of India out of 8.5 cores population 27.09% population is still 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 of India! . In India, tuberculosis kills 3,64,000 people and diarrhea 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 nourishment, infectious diseases including T. B, HIV, malaria, 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 from pay out of pocket system , 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 story 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 very negligible and their life style is really most unhealthy one, that they are consuming too much of fat,, eggs, milk or dairy products, cheese, packed dry foods, fast foods , red 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 brisk walking or jogging. 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 cardio vascular diseases, stroke. As a teacher doctor’s state government salary in a reputed public post graduate teaching hospital of kolkata, my unit family also belongs now in upper middle class family and possesses all these ill habitual effects. Are not these people themselves responsible for their own diseases and early death, if it occurs? Why then state health services policies pays priority for these people’s illness, opening marketing accesses for business houses like mushrooming private health institutions/hospitals[ who 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 drinking 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 province of 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, areunavailability of human resources [doctors, nurses], essential medicines, diagnostic
gazates and forcing poor people to get treatment in private chambers and often before quack doctors, on whom villagers depends on much society is facing thus and may be ill afford to be treated by these substandard doctors.The fact is that for last 2, decades, in the state, there was dominance of profit making health insurances industries in cities and towns, -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 anywhere 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(PPP) in Health care system.
Conclusion
Health care is thus a major responsibility of a welfare democratic state government than of central government. It must be subsidized user fee or if possible totally free in a well fare state or country, good quality health care & safety cure and must not afford profit at expense of Poor’s ailments any where in the state ( by the private health care institutions) with enough good quality non private practicing human resources infrastructure , buildings, under one roof diagnosis , free indoor beds,
equipped OT complex, free all categories life saving medicines, vaccines etc in OPD and indoor admitted patients investigations supports in public health care system and effective three tire official referral system from primary health center to tertiary medical colleges that is presently almost non existing and every district should havea government run medical college to produce MBBS doctors at per community based diseases training and what we strongly feel, that economic growth of a
state or a country or wealth is not by GDP only or per capita GDP but is also associated with free or subsidized quality safe health care & cure, greater education better food & diets and healthier labor class workers in various industries and in agriculture fields to avoid soon impending food crisis in West Bengal/ or in India and providing young population job but not by stewardship or setting priority for
30% of upper middle class , rich class and intellectuals class population who produces almost nothing as three dimensional products to consume but controls Indian economy and they are simply consumers in open bazaar economy and are in reality hopeless creatures produced by GOD and not for economic growth of a state or a country,

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By deceleration - Sd/  Professor Pranab Kumar Bhattacharyya
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