Rebuilding India’s Public Health

Abstract

Assuming impervious boundaries of public health service systems when searching for answers to its problems can be misleading as historically, economic and welfare planning to improve the quality of life of all has been considered critical. Despite years of planning, the health sector in India has acquired a tumultuous trajectory with chaos prevailing at different levels – conceptualization, policy, financing, organization and community participation. Using the concept of order in Chaos, this paper attempts to trace four basic underlying elementary patterns in the developmental process rooted in the larger socio-political structures that led to this chaos. Its second section explores the roots from where these patterns explaining the links between health, poverty and inequality in health emanate - the zone of conflict of interests among those who hold power and those whom they represent. It explores how they altered the public health service system and settled in favour of a small but powerful elite (the corporates, the upper-middle class and the professionals) seeking international standards irrespective of the local context. Structural Adjustment and the Health Sector Reforms benefited them by shifting subsidies to the private/ corporate sector, transforming services into a costly commodity, fragmented and marginalized primary health care and public hospitals while ushering in hi-tech medicine. What happens to a dream deferred? Does it dry up Like a raisin in the sun? Or fester like a sore- And then run? Does it stink like rotten meat? Or crust and sugar over- Like a syrupy sweet? May be it just sags Like a heavy load Or does it explode?