Remember ME - You Me and Dementia

Sunday, August 16, 2009

Swine Flu Tests Privatised Health Care in India

While the swine flu pandemic has not hit India too hard, it has sorely tested the country’s ailing health delivery system and its plans to remedy the situation through ‘private-public partnerships.’

Much of the drama is playing out in the western Indian city of Pune where the death of a 14-year-old schoolgirl, on Aug. 3, following misdiagnosis at a private hospital where she was being treated, has led to charges in the media that the government was not doing enough contain the spread of the A(H1N1) virus.

Health authorities reacted to the death of the schoolgirl, Reeda Shaikh, by asking people who develop flu-like symptoms to report to designated government facilities for testing. That quickly resulted in panic and chaos with public facilities being swamped by people with flu-like symptoms.

In Pune, which now accounts for 12 of the 21 deaths reported since the first case surfaced on May 13, there was frenzied buying of face masks and antivirals, with large numbers of people seen queuing up to catch flights out of the city.

Confusion continued to reign in Pune regarding testing and treatment at private facilities, with the government reversing its initial order and several private hospitals defensively refusing to attend to patients suspected to be suffering from swine flu.

What happened in Pune tended to be replicated across several of India’s cities - the sense of panic and confusion as well as shortages of antivirals like ‘Tamiflu,’ spread by terse reportage on India’s numerous television channels.

It was not long before the government began to be accused of creating artificial shortages of antivirals by restricting the sales of Tamiflu and playing into the hands of the manufacturers of generic drugs and testing kits.

"It should have been obvious to the government that a few designated facilities would not be able to cope with the demand for tests and treatment," said Amit Das Gupta at the Delhi Science Forum, a non-profit public interest organisation that is engaged in issues related to science and technology. "Even in the U.S. those sick with the virus are being asked to stay at home unless they need special care."

"To put the number of deaths and infected patients being reported in perspective, it would be well to remember that some 36,000 people die in the U.S. alone every year due to ordinary influenza and related complications. As far as India is concerned it is well established that 42 percent of all deaths in this country are caused by communicable diseases," Das Gupta said.

Das Gupta also dismissed the government’s claim to have contained the spread of the disease through surveillance. "Effective surveillance depends on the existence of well-developed public health delivery systems, and in India these are in disarray as a result of shrinking budgets for public health spending," Das Gupta told IPS.

India currently spends less than one percent of its GDP on public sector healthcare, forcing the majority of people to take recourse in private medical care. Leading public health experts have for years been warning that the allocation is woefully inadequate, and Jeffrey Sachs, chair of the international advisory panel of India’s National Rural Health Mission, has suggested that the figure should be raised to around five percent of GDP.

In such a scenario the capacity of the government to intervene effectively when faced with a rapidly spreading virus like the A(H1N1) is severely limited. Experts believe that more than the precautions the government has taken - such as screening airport arrivals - India’s sub-tropical conditions may have put the brakes on the virus.

"It would have been best to let the epidemic run its natural course. Of course, extra precautions may need to be taken as winter approaches when the northern temperate areas of the country could become more vulnerable," Das Gupta said.

On Jun. 11, the World Health Organisation (WHO) raised the pandemic alert level for swine flu to ‘Phase 6,’ indicating that community level outbreaks were occurring in different parts of the world. Margaret Chan, Director General of the WHO, then admitted that it was not possible to contain or reverse the spread of the virus.

However, it was not until this week that authorities in India admitted that it was more important to contain the panic rather than the virus, which, in any case, has manifested itself as being not too different in symptoms and virulence from ordinary seasonal flu viruses.

"As the virus spreads it will slowly create immunity among people and the number of new cases will start to drop," R.K. Srivastava, India’s director general of health services, said Thursday.

But the government’s failings were exposed by a group of independent public health specialists at the Centre of Social Medicine and Community Health at the Jawaharlal Nehru University through a note, calling for "greater clarity in the management of and treatment of A(H1N1) so that the public is informed regarding the aetiology, treatment and management of swine flu."

"The hysteria created by the media and the knee-jerk reaction from the ministry of health and family welfare are not conducive to rational and well- informed management of the situation," said the note signed by Dr. Mohan Rao, Prof. Rama Baru, Dr. Rajib Dasgupta, Prof. Sanghmitra Acharya, Prof. K.R. Nayar, Prof. Ramila Bisht and Dr. Ritu Priya.

The JNU experts said that treatment should continue to be limited to designated public hospitals and that the government needs to set out guidelines regarding the stage at which presumptive cases, and not just laboratory confirmed cases, will be treated with specific antivirals.

Equally, they said, there was no need for the government to open up testing and treatment in the private sector, especially when the situation was ripe for unnecessary - and expensive - testing for swine flu and unnecessary over- diagnosis and treatment. "This will not only lead to resistance to the only drugs we have but widespread exploitation of people wrongly diagnosed to have swine flu," the experts said.

As for the government’s plans to seek partnerships with the private sector, India’s biggest private facility - the multi-billion dollar Apollo Hospital in the national capital - simply refused to obey a government directive for private hospitals to help out on the grounds that treating swine flu cases could put other patients at risk of cross-infections.

In a press release Apollo Hospital said: "We cannot put our patients, many of whom are immune-compromised, at risk by exposing them to the infections. We are therefore not in a position to provide facilities for H1N1 flu screening, sample collection and inpatient treatment in our campus for fear of cross- infection."


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