Monday, August 2

Economics Nobel shows rural health hope

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The widely acclaimed ground-level work in the state’s villages by economics Nobel winners Abhijit Banerjee and Esther Duflo may bolster the healthcare delivery system in rural Bengal, hope senior public sector healthcare professionals and policy-makers.

The world’s most prestigious honour could spur the government and agencies involved in the sector to commission more field-based research on policies and interventions that can make a positive impact, they feel.

The work of this year’s Nobel laureates has often upturned conventional wisdom. Especially in the field of healthcare, field experiments in the late 1990s and early 2000s by Banerjee, Duflo and Michael Kremer showed subsidies — and not something given away for free — increased the use of preventive healthcare. It prompted WHO and the UN to promote subsidised healthcare for the poor.

Banerjee’s and Duflo’s study on the impact of training imparted to informal medical practitioners (IMP) or quacks in rural Bengal by Liver Foundation West Bengal (LFWB) in 2013-14 revealed that it not only enriched their knowledge but also tightened the shortage of trained doctors in these far-flung areas. Following the publication of the study in Science Journal in 2016, the state health department instituted an IMPtraining programme from 2017.

“Such studies are relevant, and that is the reason why the state government went ahead to implement training of these informal medical practitioners in Bengal,” said state health secretary Sanghamitra Ghosh. “The fact is that they exist and you cannot not whisk them away. Hence, the best way is to include them into the system after up-scaling their knowledge in handling basic health issues and also setting limits on what they are not supposed to be doing. The state government will continue to train more of them.” Ghosh was the mission director with the National Rural Health Mission when the study result was brought to policy. NRHM had also supported the study.

‘Quacks should be brought under institutional discipline’

While economic research on healthcare, education and environmental sustainability had been embraced in many countries after they emerged as key indices in the United Nation’s Millennium Development Goals two decades ago, it is only recently that economists and healthcare professionals have embraced each other here.

“The study on IMP training showed that though there was a lot of criticism on money being spent on quacks, it actually ensured that people in rural Bengal continued to get basic medical care while reducing harm. That is what Banerjee, Duflo and Michael Kremer have repeatedly shown through their randomized experiments,” said Achin Chakraborty, director of Institute of Development Studies, Kolkata.

Public sector health expert Abhijit Chowdhury, who is the haepatology head at SSKM hospital, said healthcare is still perceived of as an ad hoc affair that involves government allocating some money to save some lives. Chowdhury is the secretary of LFWB and had worked closely with Banerjee on the IMP project. “Though health has become a global agenda for human development, it is still perceived as a dole in India. We must look at it as a tool for improving the country,” said Chowdhury, adding that it was time research shaped the country’s healthcare policies.

Malay De, who retired as the state chief secretary a few weeks ago, said: “Instead of pretending that these informal medical practitioners are not there, it is better to bring them under institutional discipline and regulation.” De was the health secretary when Banerjee and Dr Chowdhury approached the health department to upscale the training of these IMPs.


Source: Times of India

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