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s a speaker invited to talk 

on the trends in health-

care sector in an event in

Chennai recently, I was

pleasantly surprised to hear Dr Mahesh

Vakamudi echoing noted uturist Jim

Carroll’s orecasts or year 2020. Mahesh is

head o Anesthesiology and Critical Care

at Chennai’s Sri Ramchandra Hospital.

Quoting Carroll, my ellow speaker

put orth the proposition that India

needs to transorm the present healthcare

system, which “xes people aer they are

sick,” into a more proactive preventative

care and diagnostics system.

Unortunately, or India, a decade may 

not be sufcient to achieve this paradigm

shi. And there are too many odds

stacked against it.

Today, the biggest challenge that the

country aces is not that o ‘availability’ o 

quality healthcare; the country has suf-

cient number o best-in-breed healthcare

acilities to meet needs o urban popula-

tion segments. Instead, India is grappling

with a huge challenge o ensuring ‘acces-

sibility’ o quality healthcare acilities to

all, particularly or the rural populace.

A

According to the data made avail-

able by the Union Ministry o Health,

curative services avour the non-poor in

India—or every  ` 1 spent on the poorest

20 percent population,  ` 3 is spent on the

richest quintile.

All this, despite the National Rural

Health Mission (NRHM), which has not

been able to achieve anything remarkable

in improving the state o health acilities

in rural hinterlands.

Yes, NRHM can claim to have made

some impact in neo-natal care and im-

munisation, but ill health continues to be

a major risk actor or the rural poor in

the country. And the reasons are clear or

anyone to see: lack o adequate healthcare

services in rural and remote areas and

 very high direct and indirect costs o ac-

cessing them elsewhere.

Non availability o a ‘neighbourhood’

healthcare acility adds to the loss o ill

person’s contribution to the household

economy and leads to a diversion o 

time–particularly o women in poor rural

households–rom productive activities to

caring or the ill.

And the impact is severe. Over 40 per-

‘Fixin h ick’ pproch hould iv wy o

prvniv cr nd dinoic ym, pcilly

for h rurl popl

cent o hospitalised Indians are believed

to borrow heavily or sell assets to cover

their healthcare bills, while 25 percent o 

hospitalised Indians all below poverty 

line because o hospital expenses.

To transorm rom a not-so-efcient

curative care nation to Carroll’s vision

o treating citizens “or the conditions

we know they are likely to develop, and

re-architecting the system around that

reality,” India needs to quickly set up

a nationwide disease surveillance grid,

something that had been piloted in bits

and pieces but never quite rolled out.

While the NRHM mission document

does talk about strengthening capacities

or data collection, assessment and review

o evidence based planning and village-

level disease surveillance system, the gov-

ernment now needs to drive the agenda as

part o its integrated Mission Mode Project

under the National eGovernance Plan.

It should also create a mechanism to

und the initiative as part o the state’s

overall budget allocations, and link the

disbursal to a time-bound, milestones-

based implementation plan with a xed

project deadline and und expiry date.