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Inevitability of Politics in Public Health


Imrana Qadeer

HEALTH PROVIDERS IN INDIA ON THE FRONTLINES OF CHANGE
Edited by Kabir Sheikh & Asha George
Routledge, New Delhi, 2010, pp.281, Rs. 595.00

IMPROVING ACCESS AND EFFICIENCY IN PUBLIC SERVICES: MID-TERM EVALUATION OF INDIA'S NATIONAL RURAL HEALTH MISSION
A Project of Nirupam Bajaj , Jeffrey D. Sachs, Ravindra S Dholakia
The Earth Institute, Columbia University and Sage Publications, New Delhi, 2009, pp. 118, price not stated

VOLUME XXXV NUMBER 3 March 2011

From traditional quantitative estimations and statistical analysis, public health research is now shifting to incorporate the soft belly of its bodyits sociocultural and political dynamics. The books under review belong to this new genre of research, both reaching out to the field to get the pulse of the health service system and both reveal in their own ways the politics in research. A collection of twelve chapters on health providers in India that includes a set of poems and an introduction by the editors, the book covers: primary level workers; doctors; traditional and home care providers; and experiences of adapting to, and transforming relations in, professional spaces. Although why these divisions have been made, why doctors at the district and tertiary level are taken as frontline workers, and why the focus is on providers linked to AIDS control is not clear. The introduction describes a three year project which is concerned with the paucity of, and biased literature on, providers who are seen only, as instruments to be manipulated, with professional motivation reduced to self interest specially of private doctors, and the neglect of traditional practitioners (p. 2). Forty abstracts were invited and the editors worked closely with the selected authors to develop their contributions into chapters for this particular project. While the introduction asks why so little is known about Indias real front line workers considering the importance of the tasks they are entrusted with by society (p. 2), this question does not emerge as a concern for the project, nor does the nature of the society and the process by which it entrusts tasks to providers. Although the transition within the health service sector is recognized, neither the stagnation of professional roles in some categories, nor its rapid change in othersand the social backgrounds of these categorieshas been fully addressed in the project framework. The questions asked are about the individual worlds of providers, their numbers, their drives, perceived roles, relationships with patients and peers, and their personal and professional struggles. The professionalism of the providers is mostly taken as a constantan assumption which is neither desirable nor true and which dissociates it from the policies that transform or distort the health service system. The underlying politics of planning, reflected by chapters by Rama Baru, Vekatesan and Mavalankar et al, sufficiently reveals that the present policies not only have an objective, a direction, and a framework but they restrict, as ...


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