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Perspective


The Medico Friend Circle (mfc) is a nation-wide platform of secular, pluralist, and pro–people, pro-poor health practitioners, scientists and social activists interested in the health problems of the people of India. Since its inception in 1974, mfc has critically analyzed the existing health care system and has tried to evolve an appropriate approach towards health care which is humane and which can meet the needs of the vast majority of the people in our country.

The existing system of health care is not geared towards the needs of the majority of the people, the poor and the rural segments of our society. Thus, it requires fundamental changes. Since the health care system is only a part of the total system, these would occur as part of a total social transformation in the country. We believe that, to achieve this goal, measures however small have to begin here and today, in all spheres of human social life. mfc is trying to build a nation-wide current committed to this philosophy. Briefly outlined here is mfc's position on the existing health-care system in India.

After independence there has been a rapid growth in health care services organised by the government. Yet, the private sector has increasingly become the major provider of medical care in India. However, like any other commodity in the market it is accessible only to those who have the money to pay. Medical care now resembles any other commercial sector and therefore, medical professionals are increasingly becoming driven by profit rather than by concern for wellbeing of people. Commercial competition and personal interests of doctors lead to several kinds of malpractice.

This behaviour is encouraged and promoted by profit-oriented drug companies, which dump many useless or even harmful drugs on to the consumer through the doctors. All the above tendencies will be exacerbated with further privatization of medical services and medical education.

We believe that medical and health care must be available to everyone irrespective of her/his ability to pay. This requires strengthening of public services. Also that medical intervention and health care be strictly guided by the needs of our people and not by commercial interests.

Medical practitioners are concentrated in cities and towns, because of the greater purchasing power of the people in urban areas as compared to the rural, the professionals' own upper class and caste background, and their need for infrastructure which is often lacking in rural areas. This overcrowding of doctors in urban areas is also partly responsible for the overgrowth of specialists. This has resulted in the denigration of the role of basic doctor to just a 'cough and cold' doctor.

The training of doctors is also responsible for this situation. Hospital based training by westernised and urban-oriented specialists produces a graduate conditioned to urban and hospital practice. Therefore, even after prolonged expensive training in a medical college, such a graduate is still not capable of dealing with the situation in rural areas.

We, therefore, attempt to work towards a pattern of medical and health care adequately geared to the predominantly rural health concerns of our country and a medical curriculum and training tailored to the needs of the vast majority of the people in our country.

Though there has been an explosion in medical knowledge on the one hand, a number of innovative field-experiments have shown that many common health problems in India can be taken care of by community-based health workers if they receive limited yet good quality training. A system of health care based on such health–workers and supported by referral services of doctors is more appropriate, more so far a developing country like India. This would also demystify medical knowledge. In India however, health care remains doctor-based and doctor-dominated.

We, therefore, work towards popularisation and demystification of medical science and the establishment of an appropriate health care system in which different categories of health professional are regarded as equal members of a democratically functioning team.

Commercial interests demand a growing market for drugs and medical therapies and this is partly responsible for medical practice being reduced to curative services. This denigrates the primary role of preventive and social measures. Drugs, surgery and even vaccines have so far contributed only marginally to the improvement in people's health in different countries. In spite of the primary role of socioeconomic development in improving the health of our people, a wrong belief is promoted that medical interventions – use of drugs, surgery, etc are primarily responsible for maintaining people's health.

We believe in giving due importance to curative technology in saving a person's life, alleviating suffering or preventing disability, even while we stress the primary role of preventive and social measures to solve health problems on a societal level.

The government health sector is not commercial and PHC doctors are supposed to emphasise preventive medicine. However, this sector has not changed the basic pattern outlined above. The doctor working in a PHC is inclined and trained to do mainly curative work. Preventive and promotive measures, when undertaken, are therefore reduced to pure technological and administrative measures without any social content, and are then thrust on the people.

A large part of the resources of the PHC is spent on family planning programmes (read population control), which targets women and pushes invasive female contraceptives in a hazardous manner. Women are seen only as child bearers and health-programmes for women are geared only towards maternity and contraception. It is no wonder that people look upon PHCs mainly as centers for immunization or family planning. For their ailments, most people approach the private sector, whatever its quality and price, and at the cost of their present and future wellbeing.

We therefore demand a sensitive and comprehensive public health system which caters to all health-needs of the people, and for mechanisms of active participation by the community in planning and carrying out preventive and promotive measures.

Medical practice in its existing form reflects and reinforces some of the negative, unhealthy cultural values and attitudes in our society, for example, glorification of money and power, division of health-workers into intellectuals and manual workers, domination of men over women, of urban over rural, and of foreign over Indian.

We, therefore, work towards health care services based upon human values, concern for human needs, equality and democratic functioning.

In the present health care system, non-allopathic therapies are given an inferior treatment. Allopathic doctors call non-allopathic practitioners quacks, without knowing anything about their system of medical care. Equally unscientific are the claims of success made by some non-allopathic practitioners and drug companies. Prejudice, ignorance and self-interest have prevailed over open-minded scientificity in this important area of medical care.

We insist that research on non-allopathic therapies be encouraged by allotting more funds and other resources and that such therapies get their proper place in our health-care system.

MFC thus tries to foster among health workers a current that upholds human values and aims at restructuring the health care system. It believes in deep and inclusive debate and discussion and offers a forum for dialogue/debate and sharing of experiences with the aim of realizing the goals outlined above and for taking up issues of common concern for action.