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Year : 2017  |  Volume : 42  |  Issue : 3  |  Page : 186

Do We Care? India's Health System

Department of Community Medicine, GMERS Medical College, Ahmedabad, Gujarat, India

Date of Submission01-Jun-2017
Date of Acceptance03-Jul-2017
Date of Web Publication3-Aug-2017

Correspondence Address:
Pradeep Kumar
Department of Community Medicine, GMERS Medical College, Ahmedabad, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-0218.212072

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How to cite this article:
Kumar P. Do We Care? India's Health System. Indian J Community Med 2017;42:186

How to cite this URL:
Kumar P. Do We Care? India's Health System. Indian J Community Med [serial online] 2017 [cited 2022 Jun 25];42:186. Available from: https://www.ijcm.org.in/text.asp?2017/42/3/186/212072

Publisher Name: Oxford University Press

Location: New Delhi, India

Price: INR 850/-

Year of Publication: 2017

Editors Name: K. Sujatha Rao

Pages: 446

ISBN: 9780199469543

The author, Ms. K Sujatha Rao, does not need any introduction among the public health professionals of this country. Having spent 20 of the 60 years of her service in health sector, she has an unparalleled in-depth understanding of public health system in India and the ills it is facing. I have had the honor of working under her when she was the Director General, National AIDS Control Organization (NACO) and I was looking after the National AIDS Control Program for Gujarat state as Additional Project Director of the State AIDS Control Society. I still recall thoroughly preparing for the review meetings to be chaired by her as she would like to review in-depth about progress and challenges.

The book presents an insider's perspective, a personal view (as emphasized by author herself) regarding our health system which is adequately backed up with facts, figures, and references. It is divided into two parts such as (1) India's Health System: challenges and constraints and (2) implementing policy: success, failures, and road ahead. The first part traces the evolution of modern time public health system in India since British Raj. It follows the health financing and the role of governance in influencing the health system. Author mentions that India is among bottom 15 countries of the world with a public spending on health <1% of its gross domestic product. This low public spending puts burden on individual households resulting their impoverishment and denial of care due to the unaffordability. She stresses that poor financing coupled with poor governance and indifferent leadership makes our health policies “good on paper but weak in implementation.” The chapter of health financing will be very informative to the readers.

The second part deals with two success stories of recent times, namely the HIV/AIDS control program under NACO and National Rural Health Mission. Author cites various innovations tried successfully at NACO. She has beautifully described the changing status of various stakeholders in the system, namely, politicians, bureaucracy, technocrats, and other emerging ones such as media, judiciary, and even the extra constitutional partners such as party functionaries, lobbyists, and personal secretaries of ministers – last three with no accountability. She advocates the creation of Department of Public Health. Thanks to her efforts and that of many others, such a creation, long overdue due to the reluctance of policy makers, is finally showing some promise as there has been some movement, at the highest level, toward creation of an All India Medical Services cadre. Its creation shall make it possible to utilize services of large pool of public health professionals and experts (MD – PSM and DPH) which will not only benefit the system but also those not getting jobs or languishing at contractual fixed salary appointments at various central/state departments where job continuation, at times, depends on funding from outsider agency.

In general, in such books, we expect interesting titbits of that time (now it can be told type), but such things are largely missing except for a few such as the story of NEET, killing of a proposal of community doctors or assistants by Indian Medical Association, and about events at Medical Council of India. When such a capable and strong officer pleads helplessness in implementing the ideas due to the reluctance of policymakers, people like me would wonder who are these policymakers and if you could not, then who can?

Looking at the cost factor, I will call this book very affordable as, forget the textbooks, even the copied guides, made easy type books, and MCQ collections of the subject are priced over INR 500. Purchase from an online portal (which I did) can further reduce the cost of procurement. While the book may not benefit directly the examination going under or postgraduate students of Community Medicine, it is of immense value to a mature public health professional or a teacher of Community Medicine. In my opinion, the book is a must read for every health professional and will strongly recommend including this book in departmental and college libraries.


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