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he Clinical Establishments (Registration and Regulation) Act, 2010, enacted by the Central
government prescribing the minimum standards of medical facilities, has not been
adopted by the Delhi Assembly until now. The Act makes it mandatory for both public and
private hospitals to provide emergency health care to critically ill patients. In epidemic
situations, private hospitals make a lot of profit. The almost 20 per cent cut in the Union
health outlay has worsened the situation, Verghese said.
Many private hospitals apparently insist on money being paid in advance for treatment.
This amount varies from tens of thousands of rupees to a couple of lakhs. It is unethical to
place such demands on a patient when the primary duty of the hospital is to provide the
immediate treatment needed.
Indias public health expenditure is currently just 1.26 per cent of

GDP, and continuous budgetary cuts have left the health
infrastructure in a shambles, leaving the door open for private
investment
The Draft National Health Policy (NHP) of 2015, which has formulated the trajectory for
slowly mortgaging public health to the private sector, has defended the lower public health
expenditure target set by it as follows: At current prices, a target of 2.5 per cent of GDP
translates to Rs.3,800 per capita, representing an almost fourfold increase in five years.
Thus a longer time frame may be appropriate to even reach this modest target.
as of March 2014, there is a shortfall (against the IPHS requirement, calculated on the
basis of Census 2011) of about 20 per cent in sub-centres (S.Cs), about 23 per cent in
primary health centres (PHCs) and about 32 per cent in community health centres (CHCs).
Bihar, for example, has a shortfall of 91 per cent in CHCs, 39 per cent in PHCs and 48 per
cent in S.Cs, according to Rural Health Statistics (RHS) 2014.
These are serious infrastructure and human resource issues. While it can be argued that
the infrastructure problem can be addressed with sufficient fundingeven though that
seems difficult to expect given the emerging public health expenditure scenario which is
moving towards increased privatisationthe human resource shortfall arises from a
fundamental problem associated with medical education in the country, which produces
medical graduates who are largely unwilling to serve in rural and remote areas.
As argued in a separate article, a radically different approach, like the proposed Bachelor of
Rural Health Care, is required to produce medical professionals with reasonable skills and
proficiency appropriate to the region, local environment and prevalent situations. This
requires setting up local medical institutions which will draw students from the region and
give them appropriate medical education and social skills. But, such efforts are being
thwarted by vested interests and the large body of medical professionals with skewed
priorities who control medical education in the country through bodies such as the Indian
Medical Association and the Medical Council of India. The government is unwilling to
push any such idea with appropriate investments because, it has largely mortgaged
medical education to the private sector.
What is even more alarming is that the centre has no facility to carry out a blood test of
people suspected of having dengue.--------capacity building
distrust and a general lack of confidence in the public health system.
The village primary health care centres and community health care centres are often not
equipped with pathological facilities.
Dengue strikes when temperatures come down, humidity is above average, and the
monsoon rains are in retreat. These conditions are ideal for the growth of the Aedes
Aegypti mosquito, the vector that spreads dengue. Since A. Aegypti breeds in fresh water,
the World Health Organisation (WHO) holds the practice of storing water in containers for
domestic purposes responsible for the growth of the mosquito. The WHO says: Low
literacy associated with poor economic status leads to constraints in practising personal
protection measures.
The WHO also specifies that there is no treatment available for dengue. All that is
possible are supportive measures once the disease strikes
The current uncoordinated response to the outbreak, as indicated by both the Supreme
Court and the Delhi High Court, may be ascribed to poor governance. It is often pointed
out that there is a tussle going on between the Centre, the State government and the
municipalities, essentially because these institutions are governed by different political
parties.
Kerala was proud to have eradicated killer diseases such as diphtheria, pertussis
(whooping cough), measles and tetanus several years ago because of the high female
literacy rate and the successful implementation of the Universal Immunisation
Programme.
However, the present sprouting of the vaccine-preventable disease has not come as a
surprise. For the past few years, the State has been witnessing a misinformation campaign
against vaccination by naturopaths, homoeopaths and religious fundamentalist groups. A
few doctors who claim to be human rights activists have also joined this bandwagon. The
deaths in Malappuram show that these campaigns are mostly affecting the backward
classes and the weaker sections of society. The objections to vaccinations have intensified
at a time when vaccines have become safer compared with earlier times. Their side effects
have been brought down considerably and recombinant vaccines made with genetic
technology are completely risk free. A few vaccines can now prevent even certain types of
cancer.
pentavalent vaccine intended to prevent tetanus, whooping cough, diphtheria, hepatitis B
and haemophilus influenza type B
WORST HIT MARGENALISED COMUNITIES

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he Clinical Establishments (Registration and Regulation) Act, 2010, enacted by the Central

Indias public health expenditure is currently just 1.26 per cent of

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