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Saturday, December 28, 2013

Clairvoyance 2013… a vision within and beyond

The two-day annual health event of the School of Health Systems Studies (SHSS) at TISS last week, renewed its commitment towards health care in India. With a theme of Re-imagining health and health care in India, the event brought together the who’s who of the field under one roof. Although the event was an amalgamation of both the private and public health aspects, as a public health professional I will present some of the public health issues that were highlighted in the weekend.
Clairvoyance was inaugurated by the country coordinator of UNAIDS, Mr. Ousamma Tawil. His inaugural speech addressed the audience with a question: was HIV (Human Immunodeficiency Virus) a problem in India? Yes. Was it being addressed? Yes, too. Were all people living with HIV being reached? Was money spent well? Umm… As he mildly put in the known fact that India may soon be the country with the largest population in the world, he emphasized that number (of HIV patients) was big. With 2.1 million people living with HIV, India has an annual incidence of 130,000. The key population is 8 percent trans-genders and 7 percent intravenous drug users among others. The way forward in primary health had to be based on AIDS prevention. So what seems to be an obstacle for India? With Men Seeking Men and Female Sex Workers being criminalized prevention in the key population and then in the general population is restricted. As though his address was some sort of prediction, last week’s High Court judgment on the criminalization of gay sex pins down the cultural behavior of the society of India towards this section. This attitude, Mr. Tawil said, will prevent the bridges that are required to bring people out of the dark and into the functionalities of social programs. Plans of inclusion and scaling up must be made.
With the number of people treated for HIV as 700,000 in 1700 centers across the country focusing on HIV treatment, India is the second largest nation after South Africa in the treatment of HIV/AIDS. Another milestone for India is its position as the generic pharmaceutical capital where it produces more than eighty percent of the anti-retro virals (ARVs) supplied to the world. With a reduction in external funding, the National Aids Control Organization (NACO) continues to support the momentum required to sustain the activities and has shown a drop of 57 percent in the incidence of HIV infection in the country. So why do issues like discrimination, stock outs and protests regarding these have to be in the way?
In continuum with a focus on the role of social determinants of health, Dr. Anurag Bhargav, Associate Professor at Himalayan Institute of Medical Sciences, brought to light a rather neglected aspect in the management of Tuberculosis (TB). Taking us back into the past when India was still ‘virgin’ soil for TB, Dr. Bhargav showed us the pathway in which TB soon had not only invaded the country but had become one of the top reasons of morbidity and mortality. The British who then occupied India and also suffered from TB, soon recovered while Indians continued to succumb to the disease and the only difference in management was pointed out to be Nutrition – the British were well nourished. He reminded us that it was Rene J. Dubos who in the early twentieth century had stated that, “TB is a social disease” (The White Plague). This condition of under-nutrition is still ignored and the Anti-tubercular pills, whether for six or twenty-four months, will be of little use if not supplemented with nutritious food for all patients who struggle to fight the disease. The only vaccine, Dr. Bhargav remarked, to fight TB is FOOD.
In the session on innovations in public health, various kinds of innovations especially those involving the community were presented. These included training and community health clinics where the community themselves were involved in the services provided, community auto rickshaws being used as emergency transport to health care and means of social marketing of condoms. Dr. Sapna Surendran, a Research Associate from Models Districts Health Project, Columbia Global Centers, gave the audience an idea of what it takes for an innovation to be expected on national level. Initial steps range from baseline studies and analysis of existing national surveys to triangulating this information with government officials and local stakeholders. Designed interventions are implemented and soon presented to the state and central level government that then considers whether this innovation can be applied at the local level. While all is not rosy during the process of approval, the implementation of the approved innovations at large scale also poses challenges.
As thought provoking topics were discussed extensively and ideas challenged, Ms. Leena Menghaney, India Coordinator, Campaign for Access to Essential Medicines, Medecins sans Frontieres (MSF) introduced to the audience the need for advocating for cheaper drugs. With extensive efforts MSF has been able to bring down the market price of a HIV drug from US$ 10,000 per patient per year (ppy) to just under US$100 ppy. The crunch of the issue lies in the fact that if pharmaceutical companies continue to have their way, applying for patency in every incremental change in the drug molecule, causing a monopolization in the market with the ever-greening of the drug. In that scenario, even large organisations like MSF will not be able to afford drugs for all those who require it in their projects around the world. This simply stands in no comparison then to the plight of the individual who will have no choice but to give up. While we may say HIV will not affect me, this concept is true for drugs used for management of cancers, hepatitis and many other common diseases that challenge public health today.
From an appeal of change in behavior towards those marginalized in HIV, to a call to simply feed those with TB. From the need of bringing creativity into community health programs to advocating for affordable drugs worldwide. Such were the issues that stirred up the group of budding health professionals at TISS last weekend.

By- Dr. Carolyn Kavita Tauro
MPH-Social Epidemiology
2012-2014 Batch
TISS, Mumbai