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What’s really holding back healthcare? A new book explores the issues

Former health secretary K Sujatha Rao’s book, Do We Care?, tracks the evolution of India’s health system.

health and fitness Updated: Feb 12, 2017 10:03 IST
Hindustan Times
Hospitals,India,Health secretary
Women who underwent botched sterilisation surgeries at a government mass sterilisation camp receive treatment at a district hospital in Bilaspur, Chhattisgarh.

What ails the health system in India; those interested to know should grab a copy of former health secretary K Sujatha Rao’s book— Do We Care? The book, in a very lucid manner, explains evolution of India’s health system, challenges and constraints it faces, the role governance plays and what lies ahead.

It helps immensely that Rao is an insider, and she does acknowledge that she has a vantage point in the very beginning. Apart from being the health secretary, Rao also worked for two decades in the health sector in various capacities at the central ministry of health and in the state of united Andhra Pradesh.

“This book attempts to highlights my understanding of India’s health system from an insider’s perspective, having been an active participant in the field of policymaking.”

The book is divided into two parts: part 1 has three chapters that talk about the evolution of India’s health system and financing and governance in health. When talking about evolution, not many would know allopathic medical system was introduced in India by the Portuguese.

And in chapter 2, Rao discusses the need to recognise the interface between politics and economics.

While India is often criticised for giving poor share to health in its GDP, Rao painstakingly explains the reasons behind it, and not even once does the reader feel that she is being bombarded with financial jargon.

After the Portuguese, British influence rubbed off on Indian medical system even though health wasn’t a priority of them. She provides a glimpse of initial years after independence when the focus was on immediate health challenges— reducing the toll of infectious diseases and ensuring maternal and child health.

The book touches upon sensitive topics such as ‘insensitive’ implementation of family planning during Emergency in 1976. Then there is impact of economic liberalisation in the 1990s, which among other things ceded space to NGOs.

The lack of resources during that period resulted in India turning to the World Bank for funds for its important though limited set of national programmes.

The language is simple, and you do not have to be public health expert to understand core issues affecting India’s health system.

The common questions about healthcare cross the minds of most Indian such as why hospitals were dirty, why children continued to die of diarrhoea or respiratory infections or were left unimmunised, she admits ‘have no simple answers’. The book takes the reader on a journey to help in understanding reasons behind these ‘legitimate’ but ‘complicated’ questions.

She provides a way forward and divides the solutions into five categories: a) strengthening the process of decentralisation and cooperative federalism, b) revamping the delivery system- both public and private- for achieving the objective of health for all, c) strengthening the people’s sector, d) expanding the use of technology, and e) is acknowledging the value of evidence and knowledge.


Author: K. Sujatha Rao

Publisher: Oxford University Press

Price: Rs 850

First Published: Feb 11, 2017 21:14 IST