http://www.thehindu.com/opinion/columns/healthcareneedsskillindiatoo/article8780381.

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HealthcareneedsSkillIndiatoo
RAJMOHANPANDA

Photo:ThulasiKakkat

Deficienciesinqualityofcareresultfromknowledgegapsortheinabilityto
change.
Bengaldoctorbeatenup,Hospitalransackedbyangryrelatives,AIIMSdoctorassaultedby
patientsrelative,FIRfiledoverthelastmanyyearssucheventscontinuetomakefrequent
headlines.Thequalityofcareinhealthremainsamongthepromisesyettobeachieved.
TheoverwhelmingfocusonquantityofhealthcareinIndiahaslongignoredamassive
problemwiththequalityofhealthcarethatisdeliveredboththroughpublicaswellasprivate
institutions.However,itisinthelastthreeyearsthattherehasbeenalotofinterestinthe
qualityofhealthservicesinthecountry.Thisisaninterestingdevelopmentandlongdue,
howeverthereasonsbehindthishavenotbeenwellunderstood.Whyhasqualitysuddenly
startedoccupyingcentrestageinthedeliveryofhealthcareservicestoday?Onereasonisthat
privatehealthcarehassuddenlyexplodedinthecountryinmanyforms,includingtheentryof

corporateentities.Theotherreasonscouldbeheightenedexpectationsfromnewgovernments
andeasyaccesstohealthinformation.
Moreregulationnosolution

Ifqualitywassuchasimplethingtomeasureandaccountfor,whyhasitnotbecomean
importantelementdrivinghealthcareservicesinthecountry?Whatmeasureshavebeen
takentoensurequalityinpublicaswellasprivatehealthcare?Byandlarge,most
policymakersfeelthatmorestringentregulationscanhelpensurequality.Thisiscounteredby
organisationsliketheIndianMedicalAssociationwhichfeelsthatoverzealousregulationsuch
astheClinicalEstablishments(RegistrationandRegulation)Actwillonlycomplicatematters,
increasecostandcanbedetrimentaltoaffordablehealthcareinacountrysuchasIndia.Itis
withoutdoubtthatweakenforcementofregulationisamajorimpedimentinensuringquality
ofcare.However,itistobenotedthattheexperienceofdevelopedcountriesintheWesthas
proventhatregulation,whileaprerequisite,doesnotalwaysensurehighqualityhealthcare.
Theotherimportantquestiontoaddressis:aredoctorsandhealthcareworkersalwaysto
blameforthelackofqualityorisitasystemicproblemthatrequiresmoreresources?
Thesedeficienciesinqualityofcarerepresentneitherthefailureofprofessionalcompassion
nornecessarilyalackofresources.Infact,theyresultfromgapsinknowledge,inappropriate
applicationsofavailabletechnologyortheinabilityoforganisationstochange.Healthcare
systems,publicorprivate,havefailedtoalignpractitionerincentivesandobjectivesto
measureclinicalpractice,ortolinkqualityimprovementtobetterhealthoutcomes.ThePrime
MinistersambitiousSkillIndiaMissionisagreatinitiativewhichneedstobeappliedwith
rigourtothehealthsector.Withoutimprovingskills,expandingaccessthroughinsurance
mechanismswillnotyieldresults.
Investinginquality

TheInstituteofMedicine,U.S.,definesqualityasthedegreetowhichhealthservicesfor
individualsandpopulationsincreasethelikelihoodofdesiredhealthoutcomesandare
consistentwithcurrentprofessionalknowledge.Giventheproliferationofprivatemedical
collegesinIndiaandpoorqualityofprofessionaleducation,itisntdifficulttounderstandwhy
suchviolentepisodesrecurfrequently.Outcomesalsoincludepatientsatisfactionorpatient
responsivenesstothehealthcaresystem.Interestinglyitisthisanglewhichhasbeen

highlightedinrecenttimesbythemedia.Althoughgoodoutcomesaretheobjectiveofall
healthactions,outcomesalonearenotanefficientwaytomeasurequalityfortworeasons.
Thefirstisthequalityconundrum.Apatientmayreceivepoorqualitycarebutmayrecover
fully,orapatientmayreceivehighqualitycareforacomplicatedillness(suchascerebral
malariaortuberculosis)andstillnotrecover.Second,adversehealthoutcomesarerelatively
rareandobviouslydonotoccurwitheveryencounter.Efficiencyisalsoanotherbuzzword
confusedwithqualitymeasuringandcomparinghospitalefficienciesrequireskillsetswhich
arenoteasytofindandreplicatealloverthecountry.
Measuringqualityhastomovefromawayfromasimplepublicversusprivatedebateanda
blamegamementalitysoastobeaninclusivestrategythattakesintoaccountmanyofthese
themes.Measuringqualityandnotjustoutcomesinhealthcareandmakingthosedatawidely
availabletothepublicwillhelpmakebetterjudgments.Itwillalsoholdpolicymakers
accountabletothebottomline:improvingthehealthandwellbeingofthepopulation.
Whencountriesinvestinquality,aninvestmentcanbebeneficialbutcancomeatacost.This
isimportanttonote.Indiahasthepotentialtobeagamechangerinqualitywithuseof
lowcosttechnologytomeasureandimprovequalityofcareinthehealthsector.
ThePrimeMinistersclarioncallforzerodefectinMakeinIndiashouldntberestrictedto
manufacturingalonethequalityofhealthcareserviceswhichaffectcitizensonadaytoday
basisisequallyimportantasqualityofproductsmanufactured,andwillhelpinbranding
India.

RajmohanPandaisaseniorpublichealthspecialistatthe
PublicHealthFoundationofIndia.Hiscurrentinterestliesinimprovingprimarycareand
governancemechanismsinhealthsystemsforbetterhealthoutcomes.