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Neel Sharma: Does the cost of using technology in medical education unfairly disadvantage developing countries?

14 Apr, 15 | by BMJ

Medical education reform has seen significant changes since the days of the Flexner report. What remains true are the rigorous entrance requirements, the scientific method of thinking, learning by doing, and the need to undertake original research (1). The advent of technology over the past decade and more has meant that learning by doing has taken on a whole new meaning. more…

Gender inequality given short shrift by India’s draft National Health Policy 2015

24 Mar, 15 | by BMJ

The Indian government’s draft National Health Policy 2015 is radical in terms of its analysis of the failures of the past. It fails, however, to translate this admission to policy prescriptions that will be gender transformative. In so far as addressing gender inequality in healthcare, the policy frames gender as an area for action under “Nirbhaya nari” (translated as fear-free woman), a program that covers sex determination and sexual violence, and which calls for these issues to be tackled through legal measures, timely health sector responses, and by working with young men. more…

A public health commentary on India’s draft National Health Policy 2015

19 Mar, 15 | by BMJ

The Indian government’s draft National Health Policy 2015 clearly articulates its goals and principles going forward, which is a laudable departure from previous policy pronouncements. It is very candid in its acceptance of the failures of past health initiatives, but does not identify the reasons for such failure. By failing to do so, the solutions pro-offered for existing problems seem to be an effort to patch over past oversights, rather than policy actions that can achieve future progress.

The policy explicitly talks of the difficulties in enhancing public expenditure on healthcare, and prefers to limit its expectations to a modest 2.5% of the GDP. But no country in the world has achieved universal health coverage with such low levels of investment in health and the policy overlooks that. No policy actions can work without appropriate fiscal allocation and this is where the policy does not meet the identified gaps in healthcare provision. more…

“Anything you get for free is not of good quality:” perceptions of generic medicines

6 Mar, 15 | by BMJ

Bhanu_prakashThe number of people with non-communicable diseases (NCDs) in India is increasing with each passing year. The World Health Organization estimates that NCDs could account for nearly 60% of total deaths in India.

Yet, despite an increased allocation of spending on healthcare by the government in the past few years, out of pocket expenditure by patients at the point of service delivery has shown little respite. In this context, India’s role as a leading manufacturer of generic drugs could offer great potential for decreasing healthcare expenditure—by both the people and the government. more…

Praveenkumar Aivalli on the status of AYUSH doctors in the government healthcare delivery system in India

26 Feb, 15 | by BMJ

praveen_aivalliAYUSH—an acronym for Ayurveda, Yoga, Unani, Siddha, and Homeopathy—is a system of medicine that has been integrated into the Indian national healthcare delivery system to strengthen public health in rural India. In 2005, when the Indian government launched the national rural health mission (NRHM) to improve healthcare delivery especially for the rural population, integration of AYUSH was an important strategy that was adopted. This was done with the objective of offering treatment choice to people as well as a strategy to overcome the human resource shortage in the government health facilities. The planning and implementation of AYUSH differs across various states, depending upon the existing level of development of AYUSH services in the state and the development emphasis of the state. more…

Richard Smith: A global university for healthcare workers

24 Feb, 15 | by BMJ

richard_smith_2014WHO estimates that the world is short of 12.9 million healthcare workers, and Devi Shetty, the cardiac surgeon and chairman and founder of Narayana Hrudayalaya Hospitals, thinks that radical steps are needed to provide these workers. Money for healthcare for all will come, he believes, but it cannot be achieved unless healthcare workers are available to provide the care.

India, for example, needs three million doctors and six million nurses in addition to millions of community health workers. The country needs 500 new medical colleges, and Shetty is keen that the very poorest who have “magic in their fingers and passion in the hearts” should be able to train as doctors. more…

Richard Smith: Surgeons spend their time putting a price tag on human life

24 Feb, 15 | by BMJ

richard_smith_2014Physicians and surgeons across Asia, Africa, and Latin America spend their time putting a price tag on human life, said Devi Shetty, cardiac surgeon and chairman and founder of Narayana Hrudayalaya Hospitals, at the World Summit on Innovation in Heath in Doha last week. His mission is to reduce the costs of health to make healthcare available to as many people as possible. more…

Tushar Garg: India needs to teach its doctors more about the care in healthcare

16 Feb, 15 | by BMJ

Tushar_Garg.2kbI was taking a patient’s blood pressure in a clinic when I heard one woman—who was poor, uneducated, and a first time attendee there—being asked a question by a resident doctor. When the patient kept murmuring something inaudible, perhaps trying to remember, the resident told her to return when she knew the answer to the question.

After a few internship postings, I realised that such encounters were not uncommon and certainly not limited to a specialty. more…

Aditya J Nanavati: How do surgeons reflect on surgical complications?

11 Feb, 15 | by BMJ

Aditya J NanavatiLosing a patient in the operating room is probably every surgeon’s worst nightmare. I recently happened to experience such an event. Not my first and probably not my last. Yet every time it happens it is accompanied by a troubling few hours or days afterwards. I know the operating surgeon of the case that day to be a very good and compassionate man. Even after years of experience he was visibly moved. How good a person he is, probably was evident by the fact that he discussed his feelings honestly with all the team members. What happened in the operating room that day made me think quite a bit. How does a death or a bad outcome in or after surgery affect a surgeon? What philosophy guides the surgeon’s response to a complication? A part of me was sad for the patient and his family. Of course it had to be, part of being human and having a good value system meant that I was wired to feel bad. But another part of me wondered, if I were the operating surgeon, would that be all it made me feel? It brought in a flood of thoughts. I reflected on all the surgeons I have worked with as well as I tried to recollect my personal experiences. In terms of reacting to complications arising from surgery I believe different surgeons react differently. In my personal opinion I believe I would be able to classify them into four types. more…

Jocalyn Clark: Are slums creating equality?

30 Jan, 15 | by BMJ

Jocalyn_Clark1When you fly into Mumbai from the east, there is an extraordinary descent passing over mounds of lush green foothills reminiscent of Hawaii. It’s quite mesmerising. And then even more so is what lays at the foot of these foothills: a vast sprawl of tin roofed shanties, which I later learn is a slum of over 300 acres housing nearly 100 000 people. The slum literally encroaches upon the airfield, creating the illusion of a patchwork carpet leading on to the runway.

Inside the international airport are all the flashy trappings of a modern, bustling air and shopping terminal. Perhaps, I wonder, this is how the pace of development in South Asia is to be measured—not by absolute economic measures, but instead by how wide the gap is between the slum and the slick. more…

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