Access to health care has been miserable from time immemorial. Access to healthcare in the past varied by time and location, and was influenced by religion, science, and public health measures: In ancient times health was believed to be a result of divine favor, and people would pray and sacrifice to appease the Gods. For example, in ancient Greece, people would make pilgrimages to the temple of Asclepius, the God of healing. During the Roman Empire, the Romans were the first to organize healthcare, provide treatment to soldiers, and establish a public health system. In the Dark Ages Science and medicine were prohibited, and treatment for illness was prayer and divine intervention. In the Middle Ages Monasteries provided medical care and spiritual guidance, and barbers performed surgery and bloodletting.
The Renaissance was a period in European history that marked the transition from the middle -ages to the modern era. The word “Renaissance” is from French for “rebirth”. The Renaissance was characterized by a revival of classical learning and wisdom, and a flowering of the arts and literature. In this period the scientific method advanced, and medical texts were published.
During the 18th century, Voluntary hospitals were established for the physically ill, and public institutions were established for the mentally ill and in the 19th century public health measures included isolation and quarantine to contain the spread of disease were initiated. In 1883, Germany launched the Sickness Insurance Law, which was the first move towards a national health insurance system. In many parts of the world including India healing prayers and treatments by witchcraft are in vogue.
In the healthcare profession, it may be argued that we are responsible for a variety of people and constituencies. We are responsible to our clients primarily in delivering the service that is their due. Our employers presume that the standard of service that is expected will be delivered. Our peers and colleagues expect a code of conduct from us that will enable the profession to grow in harmony. Our family and friends have their own expectations of us, while our government and country expect of us that we will contribute to the general good. A spiritual or religious dimension may also be considered, where we are accountable to the principles of our faith.
In the turbulent times that we live in, unreasonable expectations may be at the bottom of much of the stress, it is time for the profession to recognize that the first step on the way forward is the recognition of the problem and its possible underlying causes. Ethics in healthcare should be a hotly discussed issue, within the profession, rather than outside it. Communication is a key skill to be inculcated among the young professionals who will be the leaders of the profession tomorrow. As leaders in community medicine and public health, we may be the best placed to put this high up in the list of skills to be imparted. A good communicator is better placed to deal with the pressures of relationships with clients, employers, peers, colleagues, family, friends, and government. As we get ready to face a future that is full of possibility and uncertainty in equal measure, let us recognize these and other challenges and prepare to meet them, remembering that the fight against ill health is the fight against all that is harmful to humanity.
As thinkers in the disciplines of community medicine and public health, we must encourage discussion on the determinants of access to healthcare. We should identify and analyze possible barriers to access in the financial, geographic, social, and system-related domains, and do our best to get our students and peers thinking about the problem of access to good quality healthcare. Any discussion on healthcare delivery should include arguably the most central of the characters involved – the human workforce. Do we have adequate numbers of personnel, are they appropriately trained, are they equitably deployed, and is their morale in delivering the service reasonably high?
A 2011 study estimated that India has roughly 20 health workers per 10,000 population, with allopathic doctors comprising 31% of the workforce, nurses and midwives 30%, pharmacists 11%, AYUSH practitioners 9%, and others 9%. This workforce is not distributed optimally, with most preferring to work in areas where infrastructure and facilities for family life and growth are higher. In general, the poorer areas of Northern and Central India have lower densities of health workers compared to the Southern states. This is an ongoing process as per the need as and when arises.
While the private sector accounts for most of the health expenditures in the country, the state-run health sector still is the only option for much of the rural and peri-urban areas of the country. The lack of a qualified person at the point of delivery, when a person has traveled a fair distance to reach, is a big discouragement to the health-seeking behavior of the population. According to the rural health statistics of the Government of India (2015), about 10.4% of the sanctioned posts of auxiliary nurse midwives are vacant, which rises to 40.7% of the posts of male health workers. Twenty-seven percent of doctor posts at PHCs were vacant, which is more than a quarter of the sanctioned posts. Based on the central and state government budget allocation towards health care the standards of health in that particular period in that particular population varies
