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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
The grander ambition
- Aamir Jafarey (24 October 2003)
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Health Eonomy - A Neglected Area in South Asia
- Varatharajan Durairaj (25 October 2003)
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I TOO HAVE A DREAM
- Vadakkuppattu D Ramanathan (26 October 2003)
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Health Care in Nepal
- sonal singh (28 October 2003)
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Stress on Basic education
- Paramoo Sudevan (28 October 2003)
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Influencing governmental think-tanks
- Vikrant Sahasrabuddhe (28 October 2003)
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Calculating Healthcare Expenditure
- Imran Aziz (1 February 2004)
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Welcome to the special theme issue on South Asia
- A J Singh (2 February 2004)
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A stitch in time???
- Kirti M Marya (17 March 2004)
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Where do we begin?
- ROHITH. G RAO (25 March 2004)
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Aamir Jafarey, Ethics Fellow, Harvard School of Public Health Harvard School of Public Health, Bld 1, Rm. 1106B, 665 Huntington Ave, Boston Ma, 02215 USA
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What the authors identify as their ‘grander ambition’ of creating a non political collaboration by bringing together health professionals from across South Asia to bring out this special issue of BMJ can perhaps turn out to be the most important contribution of this effort. Even in the worst of times when armies have stood eyeball to eyeball across borders and fingers have been poised nervously on the so called doomsday nuclear button, sanity has still prevailed at the level of people to people contact. Scientists, researchers and physicians like the lay citizenry of these nations have often proven to represent a more sensible voice than that of the political governments of the region. Bringing together the South Asian health professionals for promoting the health care needs of the region is a good idea. What would be even better however is that if the effort could be sustained to last beyond the publication of one BMJ issue. Does a quarter of the world’s population with its unique burden of health related problems as mentioned in your editorial merit not just a one off special issue but in fact a separate local edition of BMJ? A BMJ South Asia would not only focus attention on regional healthcare issues but also provide a sustained platform for a rational voice from the region to be heard and promote peace and harmony. Competing interests: None declared |
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Varatharajan Durairaj, Associate Professor (Health Economics & Policy) Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695 011 INDIA
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Sir, It is indeed a welcome step to publish a special issue on south Asia (1). South Asia provides ample opportunity to the world to discuss about and learn from its problems and experiences. Researches either do not exist on these issues or if exist, do not get published. As a result, little is known about this region and international estimates such as DALY for this region could be faulty to this extent. Resource allocation, if follows such estimates, could put the region at loss. As indicated by the paper (1), the region contributes a lot to the global disease burden and there is no dearth of studies in this aspect. Besides, there are other issues of public health importance such as government withdrawal from health care financing and provision, lack of insurance cover to the population, inappropriate and ineffective utilisation of existing health care resources (both monetary and non- monetary). The region also throws health equity issues. For instance, Indian health geography comprises of both Europe and Africa within its fold. At the same time, this region need not be looked at as a region full of problems. South Asia also offers models (both established and new) to the rest of the world. For instance, Kerala provided the classical model of 'good health at low cost'. One of the reasons behind the model has been the strong, efficient and equitable government health care system (2). Even rural Kerala has 2.1 hospital beds/1,000 population. This is in comparison to 0.2 at the national level and 0.02 in Uttar Pradesh. More importantly, bed availability is more or less the same (2.2 beds/1,000 population) in urban Kerala. New models of public health care management too are emerging in this region (3). Industrial/NGO adoption of govenment health care institutions (Tamil Nadu & Karnataka), local self-government control of government health care system (Kerala) and new way of managing drug distribution to government health care system (Tamil Nadu) are few examples that can be cited in this context. The special issue, as indicated by the paper, does not seem to cover the health economy of the region. In fact, this has been one of the nelgected areas of research in this region and so, the special issue should overcome this drawback by allocating some space to health economic and policy issues. Reference (1) Zulfiqar Bhutta, Samiran Nundy, and Kamran Abbasi Why a special issue of the BMJ on South Asia? BMJ 2003; 327: 941-942 (2) Kishnan TN. Access and the burden of treatment: An inter-state comparison. Thiruvananthapuram: Centre for Development Studies, UNDP Research Project, Studies on human development in India, Discussion Paper No. 2, 1994 (3) Varatharajan D. Emerging Models of Public Health Care Management in India: An analysis of Three Models in Kerala and Tamil Nadu. International conference on Towards unity in education, training and health care delivery; 11-15th October, Newcastle, Australia: 64-65. Competing interests: None declared |
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Vadakkuppattu D Ramanathan, Dy.Director (Pathology), Tuberculosis Research Centre (ICMR), Chetpet, Chennai - 600 034, India.
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I am immensely happy to know that the medical fraternities of India and Pakistan have come together to edit a special issue of the BMJ. As a researcher in mycobacterial diseases, I have had the mortification of seeing a minimum of one person dying every minute due to tuberculosis in the Indian subcontinent. From time to time I have this dream: There should be a treaty of non- aggression amongst the nations of the subcontinent for the next five years where no borders will exist. The soldiers of India, Pakistan and Bangladesh will be shuffled in such a way that people from India – its southern region will go to Pakistan, Western and Northern regions to Bangladesh while Pakistani soldiers will go to the Southern and Eastern parts of India and Bangladeshi soldiers will go to North India. After this redeployment, they can be trained as DOTS providers and they can go for active case finding and treatment of all patients with pulmonary tuberculosis. This certainly will help in cutting the chain of transmission; the money saved from purchasing military hardware can be used for providing diagnosing and treating tuberculosis. Who knows, as a spin off, even the political problems of the last half a century amongst these countries may also get solved! Is anybody listening? V.D.RAMANATHAN MB, PhD (London), vdrnathan@yahoo.com Competing interests: I earn my livelihood working in the field of tuberculosis. All the same, it will give me immense pleasure if tuberculosis were to be eradicated and I am out of a job. |
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sonal singh, Resident-Physician Unity health System,Rochester,NY14626
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We believe that participating in global health is an extension of our responsibility as physicians to serve humanity. Nepal’s total health expenditure per capita is 66$ 1. It lacks adequately trained health-care personnel; infrastructure and planning that can support the healthcare needs of a fundamentally unique and geographically distinct group of people, especially women and children. At the crux of the problem lies illiteracy and ignorance combined with a lack of vision from the top. We welcome the initiative of the BMJ to focus on South Asia, which should act as an eye-opener for healthcare professionals, policy makers and the people at large. Reference: 1.http://www.who.int/country/npl/en/ Competing interests: None declared |
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Paramoo Sudevan, Senior Consultan in Pediatrics & Vice Principal Universal Empire Institute of Medical Sciences, Vyttila, Kochi 682019, India
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I am happy to read about the proposed issue of BMJ on South Asia. If some articles stressing the need for basic education for the citizens appear in the issue of the journal it will be an eye opener for the political leadership. Most of the illnesses in this area can be linked to some extent to ignorance. Kerala experience is good example. Female literacy goes a long way in reducing the infant mortality and under five mortality Competing interests: None declared |
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Vikrant Sahasrabuddhe, Fogarty Doctoral Fellow in International Health University of Alabama at Birmingham, Birmingham, AL 35205, USA
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While a special issue on South Asia in BMJ might be a harbinger of the times when the medical and public health community will rise up to the compelling demands of ill health and underdevelopment in the region transcending borders, one cannot forget that much of the intended change will come through an urgent and sustained response from the governments of the region. Well-designed and impeccably planned government-run primary health care systems have failed in bringing about a visible change due to a lack of commitment and non-realization of the potential impact of preventive health care towards the health and development of the community. Apart from sensitizing the dormant scientific community to the harsh realities and astounding challenges of the region, the special issue on South Asia will be immensely successful if it manages to influence the health policy think-tanks of the governments of the region and helps in unleashing collective knowledge and wisdom for solving some of the most complex tasks on the face of the planet. Competing interests: None declared |
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Imran Aziz, Consultant Respiratory Medicine West Suffolk Hospital, Bury St Edmunds, IP33 2QZ, UK
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I am very happy that BMJ will have a special issue on South Asia. In the begining of your article (1) you have quoted from Dr Mahbubul Haq, who was the finance minister of Pakistan but more importantly he was the former vice president of the World Bank and this should have been mentioned. I am also hoping that in the issue you could shed light on how healthcare expenditure is calculated. In 31 January issue of BMJ Dr Singh (2) in her letter mentions that Nepal spends $66 per capita on health based on the data from World Health Organisation (WHO) website (3). The annual budget of Nepal from the Nepalese ministry of finance website (4) gives the budget for ministry of Health to be Rupees 2.1 billion. As Nepal has a population of 24 million and 1 US Dollar is equivalent to 75 Nepalese Rupees, this equates to approximately $3 per person. As there is a very big difference between the government and WHO figures, it is important the readers should have an understanding of how the figures are collected. References 1. Bhutta Z, Nundy S, Abbasi K. Why a special issue of the BMJ on South Asia? BMJ 2003;327: 941-2. (25 October.) 2. Singh S. Focus will be an eye opener. BMJ 2004;328:288 3. World Health Organisation. www.who.int/country/npl/en/ (accessed 31 January 2004) 4. Ministry of Finance, His Majesty's Government of Nepal. www.mof.gov.np/publication/budget/2003/pdf/anneng/bmis_e_66_annex6.htm (accessed 31 January 2004) Competing interests: I am a Pakistani |
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A J Singh, Health professional Gujarat
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A special issue on health in South Asia is overdue and most welcome. It will help to focus world attention on the avoidable morbidity and mortality in the region. To an extent the BMJ also owes it to the region, which provides a substantial chunk of the Doctors and allied paramedical staff to the UK as well as the other western countries. While the region has to go a long way, there have been a number of positive developments that show the way and need to be highlighted. The control of blindness has been a major success story. As against 1.2 million, (mostly ICCE/ECCE) cataract surgeries just about a decade ago more than 4 million cataract (IOL) surgeries are carried out annually, now. The work done by Aravind Eye Institute in Madurai in South India provides a new model of low cost eye care in the developing world. A major dent has been made on leprosy. In my own state of Gujarat the prevalence has been brought down from about 30 to 1.2 /10,000, through a close collaboration between the state government and the NGOs. Reconstructive surgery and training has helped the cured patients to take up fruitful occupations. While the southern States have brought down their IMR to a more respectable 13-17/1000, it continues to hover around 60-70 in most states of the country. Most of the mortality is peri natal; poor nutrition, malaria, pneumonia, diarrhoea accounting for the rest. There is an acute shortage of gynecologists and pediatricians in the remote areas, as a majority of the doctors leave the shores tempted by higher returns in the west. While rural areas are underserved a number of state of the art services have come up in the metro areas. They are going to be the major attractions for medical tourism. Already a number of non resident Indians visit India for high quality, low cost medical care. Of late a number of patients from the UK have been coming to circumvent the long NHS queues back home. There is an immense possibility of collaboration between the public health institutions in the west such as the Schools of Tropical Medicine at London and Liverpool, Centre for Health Economics at York, with the selected schools in South Asia. For the cost of training one south Asian health professional in Liverpool or London more than ten could be trained within the region. Hope the special issues focuses on the possibilities of these synergies. Competing interests: None declared |
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Kirti M Marya, Assistant Professor Department of Orthopaedics, SSR Medical College, Belle Rive, Mauritius
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Dear Editor, Lot has been said about the Indian subcontinent and its set of problems. Lot has also been said about poverty, nuclear proliferation, population, religion etc. Lot has also been done by many organisations under the umbrella of UN, WHO, and other non-governmental organisations. Lot also remains to be done. As I have mentioned above, the needs of these areas are in lots. BMJ is on the verge of expanding its wings into under priviledged territories if not unknown ones. The problems associated with these countries is not only lack of education, lack of funds, lack of facilities but also lack of public awareness, lack of political will as well as lack of imagination. The population at large does not understand the basic health concepts and frankly they just are not concerned with that; once they are sure of their survival (food / shelter is the main concern), only then can they think of these concepts. Political will is the foremost requirement for improvement of health standards. One way of doing this is to enforce it on these countries to compulsorily dedicate a part of every loan they get from world bank or other international agencies, on health care. This will ensure atleast mobilisation of funds and then these funding agencies can always counter-check how this fund has been utilized. Imaginative ideas survive in the fertile brains. It is an excellent concept by BMJ to promote health world-wide for a better and healthy world. One world; one culture -healthy living. May this issue prove to be a stitch in time..... Competing interests: None declared |
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ROHITH. G RAO, Clinical Attachment Middlesbrough. TS4 3BW
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Sir, Its a great and novel idea to bring out a BMJ edition on south east Asia, contributed by the regional health care professionals. Agreed that these countries share cultures, practices, social lifestyles and mainly the diseases and health problems too. Inter-reaction between health care professionals may bring out new ideas and solution to existing problems and maybe regional harmony too. But what good these solutions can bring when the governing authorities and political figures do not co-operate. Do we go about changing the political bigwigs who run the circus and convince them that they have to work for humanity? Or the authorities and bureaucrats majority if not all who are corrupt and interested in enriching their pockets, and tell them that their honesty will feed and save many a impoverished lot. Or the illiterate and economically impoverished public that their ignorance and indifference is the cause of their present situation? Most of the south east Asian countries have no dearth for resources, talent or professionals. Its the bad management that has brought health care delivery system to this pitiable condition. Clinical governance and accountability are unheard terms in many centers while research and audit, well who has the time for it. Corruption and bad management has made the government health care deplorable hile the select few(corrupt and rich) to afford private health-care. Its only awareness among the masses that can bring some changes and it cannot happen overnight. This falls on the shoulders of the present and future generations of youngsters to raise to the occasion come to the rescue. Competing interests: None declared |
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