Half a pill

Delivery of health care for far too long has been seen to be simply administering to the visibly ill. The launch of the Public Health Foundation of India by the prime minister on Tuesday is therefore a welcome step in ensuring health for all. Its stated objective 8212; to train health care professionals and redefine health as including access to preventive care, inoculation, clean drinking water and sanitation 8212; is hugely important. For public health to be a welfare measure to care for citizens and maximise their economic and social participation, India needs to hasten a shift to a more holistic approach.

However, the problem in the diagnostic side of health care is also formidable. The rural public health system, consisting of primary health centres, has failed to provide even the minimum level of satisfactory health care. Practitioners are paid salaries regardless of whether they see patients or not, creating few incentives and disincentives for providing health care. In developed countries most primary care physicians are paid by the government on the basis of how many patients they attract. The government does not pay for services via salary, as there is too little incentive to take good care of each patient. So, for example, England has 8220;capitation8221; 8212; primary physicians get paid on the basis of how many people sign up with them.

Another problem: the reliance on 8220;barefoot8221; doctors. Registered medical practitioners RMPs were supposed to deliver basic care and refer complicated problems to hospitals. However, studies have found that the less competent a medical practitioner is, the more likely he is to treat, rather than refer, most illnesses. Clean water is better when it comes with clever diagnosis.