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A matter of life and death

By Sandhya Srinivasan

The majority of illnesses Indians suffer are linked to poverty and poor living conditions. Children fall ill because they are not vaccinated. Patients die because the health centre is too far away or because life-saving drugs are not available. Surely it's an injustice that people must accept illness and death because they cannot get even basic treatment?

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Public health infrastructure: What we need and what we have

By Sandhya Srinivasan

We need 7,415 community health centres per 100,000 population. We have less than half the number. Worse, at the healthcare facilities we do have, the basic staff is not in place. Only 38% of our primary health centres have all the required medical personnel. With the public health infrastructure in such a shambles, how can the poor count on government health centres

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Healthcare denied: Voices of the people

Children dying of snakebite for want of anti-venom vaccine at the public hospital; patients dying for want of a respirator; women in labour turned away from a community health centre; life-threatening illnesses misdiagnosed.... These horrifying case studies and experiences recorded at public hearings in different states in 2004 by the Jan Swasthya Abhiyan, and by InfoChange Agenda correspondents illustrate the extent to which citizens are denied the basic human right to timely and effective healthcare

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Safdarjung Hospital, New Delhi

By Naren Karunakaran

Nanhe Singh of Sheikhpura village near Bulandshahr in Uttar Pradesh has cancer of the pharynx. He has been undergoing radiation therapy at Safdarjung Hospital. A marginal farmer with just four bighas of land, Nanhe visits the hospital for sessions of radiation therapy. There is no facility for cancer treatment anywhere near his town.

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Calcutta Medical College and Hospital

By Rajashri Dasgupta

The Kolkata newspapers regularly carry stories of babies being found in garbage bins, of seriously ill patients dying because the electricity went off in the intensive care unit for hours on end. While there have been arguments that such stories are motivated and based on careless research, to visit a public hospital in this city is to witness despair.

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Waiting for a lifeline

By Shabnam Minwalla

At Mumbai's JJ Hospital, 1,000 HIV-positive people are amongst the 4,000 nationwide who are accessing the government's free anti-retroviral therapy (ART) programme. Sixty children in the hospital's paediatric ward are waiting for a lifeline. There are around 250,000 other patients in India urgently in need of ARVs, who can neither access the programme nor afford to buy the medicines for themselves

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Nagaland has 500 doctors for 2 million people

By Rahul Goswami

Patients from Nagaland often travel to Assam for medical attention. Meghalaya has set up permanent accommodation in Vellore, Tamil Nadu, for patients travelling there for treatment. A severe shortage of medical personnel and facilities is the major problem in the northeast

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Ill and impoverished: The medical poverty trap

By Aditi Iyer

Sickness in households that do not have the capacity to pay for medical expenses can have catastrophic consequences. A survey of households dragged into poverty showed that 85% of 134 households in two districts of Gujarat and 74% of 335 households in three districts of Andhra Pradesh said that health expenses were the main reason for their economic decline

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Anatomy of a health disaster

By P Sainath

Janreddy's family survived crop failure. But debts of Rs 300,000 to cover health costs have nearly destroyed them. Loans taken to cover health costs have been a major contributor to the debt-suicide cycle in Andhra Pradesh

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The out-of-pocket burden of healthcare

By Ravi Duggal

There is clear evidence that public financing is critical for good healthcare and health outcomes in any country. Yet in India, only 15% of the Rs 1,500 billion healthcare sector is publicly financed. Investment and expenditure in the public health sector is shrinking. As a result, the public health system is on the brink of collapse, and there's been a 30% decline in the use of public healthcare facilities

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The big squeeze

By Amit Sen Gupta

What does a liberalised economic policy have to do with public health? Everything. With the World Bank and IMF calling for market-based pricing of welfare services, including healthcare, the introduction of user fees and greater private sector participation, health expenditure in India has declined from an already low 1.3% of GDP in 1990 to 0.9% in 1999

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User fees: The cost of cost recovery

By Sandhya Srinivasan

Since 1991, user fees have been introduced in government hospitals despite evidence that user fees do not really help cost recovery and only end up placing a further burden on the poor

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Less than 1% of our health budget is spent on mental health

By Soumitra Pathare

Mental health disorders account for nearly a sixth of all health-related disorders. Yet we have just 0.4 psychiatrists and 0.02 psychologists per 100,000 people, and 0.25 mental health beds per 10,000 population. If access to mental healthcare is to be improved, mental healthcare must be provided at the community and primary level

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If Costa Rica can, why can't we?

By Shabnam Minwalla

Britain's model National Health Service is today impoverished and short-staffed. Canada is inching towards privatisation. Healthcare in the US yields handsome profits for a few corporations but indifferent care for most patients. And yet Costa Rica, which spends just $ 562 per capita on health, obtains results that rival the US, and the public sector in Sri Lanka manages to cater to 60% of all health needs. A quick look at healthcare systems globally

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Women suffer more, get treated less

By Neha Madhiwalla

Morbidity amongst women is higher than amongst men. But women are less likely to access healthcare for several reasons: they cannot afford treatment, they can't get time off work, they have little status within the family, and they're intimidated by a public healthcare system that does not cater to the needs of the illiterate

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Work two years and maybe you can afford to get treated for TB

By S Srinivasan

There is a gross under-supply of drugs at public health facilities, forcing patients to buy overpriced drugs from the profit-driven private sector. For many poor Indians, getting sick and buying medicines is a sure route to further impoverishment. A labourer earning Rs 60 a day will have to work more than two months to purchase medicines, at retail market prices, that can cure him of anaemia, and more than two years for multi-drug-resistant tuberculosis

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The advent of patent raj

By Ammu Joseph

The third amendment to the Indian Patents Act, recently passed by Parliament, is likely to adversely affect the availability, accessibility and affordability of medicines -- three important components of people's right to health

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75% prefer the private sector

By G Ananthakrishnan

In the absence of a robust state-funded health infrastructure providing free care, citizens have no option but to seek out private facilities. As a result, we have a burgeoning private healthcare sector, unregulated and often exploitative

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NRHM: New hope for the rural poor

By Abhijit Das

The mission provides for a health activist in each village, a village health plan prepared by a local team headed by a panchayat representative, strengthening of rural hospitals for effective curative care and accountability to the community

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'You can't blame liberalisation for all our woes'

By Archna Devraj

It's convenient to externalise the enemy, says national convenor of the Jan Swasthya Abhiyan, B Ekbal, but it's the lack of political commitment and glaring deficiencies in the system that are really responsible for the mess the public health sector is in. In this interview, Dr Ekbal discusses the JSA campaign and the decline in Kerala's model healthcare system

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