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Health Care in a Globalized World

Rajib Dasgupta

Edited by K.V. Ramani, Dileep Mavlankar and Dipti Govil
Sage Publications, New Delhi, 2008, pp. 227, Rs. 495.00


That India’s health service system poses critical health management challenges and demands bold initiatives is no exaggeration. The title is sure to be an invitation for public health scholars and health management professionals. The issues on which the volume is foregrounded include complexities and uniqueness of India’s healthcare system, fast-evolving technology and mechanisms of health financing in a globalizing world. Cross-cutting issues include equity, access and cost-effectiveness to name a few. The unfinished agenda of communicable diseases, and, maternal and child health issues have been compounded by newer problems of non-communicable diseases and urban health.   There are nineteen chapters grouped under ten themes. The introductory chapter by the editors is largely a summary of the chapters that follow. The ‘agenda setting’ would have emerged stronger had the philosophical moorings been explicit. Two points made by the editors are important:   • That, we need to ‘develop a uniquely Indian set of health sector reforms to enable the health system in meeting the increasing expectation of its users.   • That, ‘community-based volunteers for health are effective in changing community perspectives and improving health’.   While the former is the raison d’etre for all reforms, the latter position implies that community perspectives are obstacles to improvements in the health sector. Put differently, is the demand side part of the problem of the solution? A more sensitive exposition of the epidemiological needs vs. felt needs debate could have dealt with the complexity more meaningfully.   Analyses of data from the 52nd Round of the National Sample Survey has revealed that vulnerable sections, particularly Scheduled Castes, Scheduled Tribes and labourers strongly preferred to access government facilities as private facilities imposed a severe burden on them and the quality of care was extremely variable. Jeffrey Sachs makes a strong case for investing in public health systems as it is considerable in size but often lacklustre in performance. Many of his prescriptions are being addressed within the National Rural Health Mission (NRHM) and several positive changes have been documented in reviews of the NRHM. The chapter by Andrew Green provides a balanced view on Health Sector Reforms (HSR); the influence of the ‘new right’ and the emergence of ‘minimum care’ models when epidemiological rationale often gave way to tenets of economics and health management. HSR has thus lost out on contextual sensitivity and has been reduced to an elaborate set of standard operating procedures. A detailed framework for ...

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