Lecture Critique
This critique is based on the lecture I found to be the most interesting so far: an introduction to India’s healthcare system. This lecture was presented by Dr. Praveen Kulkarni—a professor at Jagadguru Sri Shivarathreeshwara (JSS) Medical College who teaches preventive medicine. He started the presentation by explaining that there are three main health issues India faces: communicable diseases, non-communicable diseases, and maternal and child health problems.
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Communicable diseases refer to diseases that can be transmitted from person to person, while non-communicable diseases, on the other hand, are not transferred this way, they include mental health disorders, chronic illnesses, or could even be based on lifestyle choices.
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The foundation of maternal and child health problems is malnutrition. Malnourishment can have severe consequences on a pregnant woman, such as anemia, hemorrhage, and even death. Consequently, the child is also affected, they could present developmental delays in the future, or even early death in some cases (UNICEF, 2023). However, it doesn’t stop there because the cycle continues. As Dr. Praveen Kulkarni explained, if an undernourished mother gives birth to an undernourished child and that child grows up and gives birth to a child of their own, their child will also be undernourished, hence the cycle continues.
These three health issues are what is most seen in cases presented at healthcare facilities. Dr. Praveen Kulkarni proceeded to elaborate on these healthcare systems and how there are different levels of healthcare provided to certain groups.
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India is mostly divided into four healthcare systems: public health sector, private sector, indigenous systems of medicine, and voluntary health agencies [such as the Public Health Research Institute of India (PHRII)]. However, another issue that arises from this topic, as quoted by Dr. Indira—a member of PHRII—is that "70 % of healthcare in India is private”, meaning that it is difficult for marginalized groups to seek accessible healthcare.
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Returning to Dr. Praveen Kulkarni’s presentation, he continued to discuss the multiple healthcare systems in India and how it serves the corresponding populations’ needs. He visually showed this concept in the form of a pyramid, with the village being at the bottom of the pyramid and working his way up to the top of the pyramid where the district lies. The pyramid was divided into three levels: primary, secondary, and tertiary. The way it works is if a case cannot be solved at the primary level, the patient is transferred to the secondary level, and if the patient’s issue persists then they are moved up to the tertiary level.
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Beginning with the primary level, a village’s population consists of about 1,000 people. For every thousand people, an Accredited Social Health Activist (ASHA) is present to attend to their basic health-related needs, questions, and/or concerns. The people of the village have a lot of trust in the ASHAs since they are seen as the doctors of the villages and are always ready to help their village. Also, the people of the village do not have to pay the ASHA hence another reason they trust their ASHAs is because they do not receive financial incentives directly from the village. The responsibilities of ASHAs include attending to basic health-related needs, questions, and concerns, and educating the village on up-to-date health-related issues—such as vaccines. Right above the village, the health and wellness center comes up next, which can attend up to a population of 5,000. This center consists of two groups of community health officers who attend to patients’ needs: Junior Heath Assistant Male (JHAM) and Junior Health Assistant Female (JHAF). These officers’ roles consist of assisting in childbirth, pre-natal and post-natal checkups, cleaning wounds, taking blood pressure and blood sugar levels, and counseling women. Then the last facility at the primary level is the primary health center, which can attend up to 30,000 patients. In this facility, there are more medical staff present, such as nursing staff, lab technicians, clerical, community health officers, and medical officers. They can prescribe medicine and the prescriptions over the counter are free of cost. However, primary healthcare centers do have limits, for example, they cannot perform surgery. So, if a patient needs surgery urgently, then they would be transferred to a medical facility at the secondary level.
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The main facility located in the secondary level is called the community health center, which can attend to approximately 80,000-120,000 patients. Here, they have all the medical staff mentioned in the primary health care center, additionally at least 4 specialists: a general physician, a general surgeon, a general gynecologist, and a general pediatrician. Some of their duties include attending the sick newborn care units, blood centers, and so on.
Lastly, at the tertiary level, the district hospital can hold up to 500,000 patients. This is the most advanced healthcare facility on the pyramid. Here they have all the most advanced possible equipment to attend to a patient with even the most complicated case.
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This lecture was taught by a preventive medicine professor, and overall, the presentation seemed informative, unbiased, and very thorough. But it would be insightful to hear the perspectives of members of these different healthcare facilities and how they view their system in comparison to the other systems available and if they prefer one over another. For example, if an ASHA would favor their treatment or diagnosis methods over a doctor’s methods at a district hospital, and vice versa. It would have been interesting to see each healthcare staff further explain the roles and responsibilities each holds and how important it is in the pyramid overall.
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Lastly, Dr. Praveen Kulkarni also discussed the topic of abortion in India. I found this very interesting as India views abortion as a healthcare issue rather than a political issue like in the United States. According to Dr. Praveen Kulkarni abortion is referred to as Medical Termination of Pregnancy (MTP) and can be justified/permitted under the following circumstances: rape, a threat to the mother, failure of contraception, deformation, or a problem with the child. There are even clinics for women that perform these procedures. I think this topic would be surprising or even shocking for some people in the United States since abortion is not as normalized in the U.S. and is even illegal in some states.
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However, India still faces some challenges when it comes to accessing healthcare, some of which include the following: no control over private sectors, underutilization quality of healthcare is always questioned, deficiency of health personnel, lack of community participation, medical compliance, inadequate funding, efficiency of paramedical staff, lack of political and administrative commitment, and lack of health insurance coverage.
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Overall, this lecture was one of my favorites as it provided a general idea of the healthcare issues, systems, and delivery in India. Dr. Praveen Kulkarni gave a very thorough and informative presentation on this topic and even included this pyramid to better visualize the topic.
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References
Kulkarni, P. (2023, May). Introduction to India’s Healthcare Systems. Lecture, Mysore; Jagadguru Sri Shivarathreeshwara (JSS) Medical College.
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UNICEF. (2023). Maternal nutrition. UNICEF. https://www.unicef.org/nutrition/maternal#:~:text=During%20pregnancy%2C%20poor%20diets%20lacking,and%20developmental%20delays%20for%20children.
