Dr. Alex Vadakumthala
Executive Secretary
CBCI Commission for Health

The presence of various diseases in our country in such a high ratio covering a large population, even when the scientific and medical world has progressed so much, and prevention strategies have considerably advanced, calls special focus and attention.

India has more tuberculosis patients than any other country in the world. “About 14 million population is estimated to be suffering from active TB of whom 3 to 3.5 million are highly infectious. India accounts for nearly one third of Global T.B. burden and every year has more than 2 million new cases of tuberculosis. Approximately 2.9 million people die from tuberculosis each year World wide; about one fifth of them in India alone. Nearly 500,000 die from the diseases – more than 1,00 per day – one every minute. The spread of HIV/AIDS would increase number of TB cases as well as deaths” (Ministry of Health, Govt. of India, Annual Report, 2000-01, p. 53). Twenty percent of the total 14 million population suffering from active disease in India is positive for sputum and the rest is radiologically active but sputum negative.

Malaria took away many lives in the past two or three years, especially from 8 states, like Orissa, Bihar, M.P. and so on. According to official statistics malaria deaths were below 500 annually till 1993, but it was more than double by the year 1995, and it is on the increase. Kala-azar (visceral leishmaniasis) is one of the major problems in sates like Bihar, West Bengal and U.P. “In India it is estimated that there are 2 to 2.5 million cancer patients at any given point of time with about 0.7 million new cases coming every year and nearly half die every year” (J. Kishore, National Health Programmes of India, p. 98).

Every region in India is experiencing a snowballing increase in the transmission of HIV. The infection is spilling over from high-risk groups, earlier considered as the reservoir of HIV, to low risk groups and from urban to rural areas, particularly through migrant workers and truck drivers. The National Aids Control Organization has estimated 3.86 million adults infected with HIV (Cf. www.naco.nic.in). The Seropositivity rate is 23.64% in those tested by HIV. Most of the cases reported are in the age group of 15 to 49. The male – female ratio is 3:1. Unless proper precautions are taken, it is predicted that by the year 2020, India may become the `AIDS-capital of the world’! India also has the largest number of STD cases in the world. Forty million new cases are reported annually.

India carries 61% of the world’s recorded leprosy patients. That amounts to 5,09,000 people. (This does not include the unrecorded patients!) About 14-20 percent of the patients are children. “Distribution of the disease is uneven, although it is present throughout the country. High number of patients are now present mainly in the State of Uttar Pradesh, Bihar, Orissa, West Bengal and Madhya Pradesh. At present these five States contribute 71% of the country’s case load”. (Ministry of Health, Report, 2000-01, p. 50).

The alarming situation of these diseases, the emerging and re-emerging numerous cases of the illnesses would give us an inkling of gravity of the issue. We need to consider also the vastness of the Indian subcontinent and the large population that require health care.

Healthcare Structures and Service Facility

There has been a remarkable increase in the number of hospitals, dispensaries and healthcare personnel in the country in the last fifty years. According to the Government statistics in 1951, the number of hospitals in the country was 2695, that by 1997 has grown into 13692. During the same period 23015 new dispensaries have come up. The total number of hospital beds now is estimated to be 596203, which would be 70 beds per 100,000 people. The number of doctors enrolled is 489189. However, the health care facility, is still very much inadequate in our country.

The Catholic Church has 787 hospitals and 2807 dispensaries and 3 medical colleges in India. The number of healthcare institutions would be much more when we consider other health related service sectors like leprosy relief and rehabilitation units, centers for disabled persons, hospices and care units for the HIV infected and so on. The Church has now a major share of the nation’s healthcare responsibility. Yet, the need of the people is only partially met.

When we consider the healthcare systems in India, we have to consider also the different types of traditional and indigenous methods of cure and alternate systems of medicine. The Ayurvedic system has 134 colleges all over the country, with 454684 registered practitioners. The Unani system has 29 colleges, with 39550 doctors and Siddha has 2 colleges with 11895 practitioners and Homeopathy has 146 colleges with 167097 doctors. The alternative systems of medicines could be more affordable and easily accessible for the poor. Yet, these systems, unfortunately, are neither properly utilized, nor their usefulness and effectiveness are adequately examined and weighed.

The healthcare facility available is supposed to be for a population of one billion people (as on May 11, 2000 as per the assessment of the Government), spread out in a total geographical area of 3,287,263 sq.kms. The task, indeed, is enormous. And, the challenge is too big.

Need of an Evaluation and a New Vision

We need to make a serious evaluation on the healthcare ministry of the Church in India today. Are we truly fulfilling our mission? Are the poor sick of our country receiving proper healthcare and attention? How can we make our policies and implementation strategies really effective? Implementation of the following seven steps could be a response towards this.

1. A shift in our attention: A major and immediate shift should be made in favour of the poor, especially towards rural areas and backward and vulnerable groups. Each human person, created in the image and likeness of God’ is a masterpiece. Everyone is precious. Especially in the socio-economic-political context of India, the Church’s healthcare has to be diverted to the poor (Cf. John Desrochers et al, Health Care in India, p 22).

2. A revision in our definition: health is to be seen in a wider perspective. “Health is at the core of all human development and needs to be understood in a broader sense to include all aspects: physical, social, mental and spiritual. Therefore, health would mean adequate food, housing, clean water, clean air, good social milieu, and strong interpersonal relationships. In short, it means the satisfaction of one’s basic needs: harmonious relationships with one another, nature and God” (Cf. Health Sunday Message, 2000)

3. A change in our approach: We need to go beyond the curative and preventive aspects of health care. We have to concentrate on the community health care. It is enabling people to exercise collectively their rights and responsibilities to attain and maintain their health. We need to work towards increasing people’s consciousness and awareness building and health education. We focus on Community Needs Assessment Approach (CNAA): it promotes decentralized, need-based and participatory planning and a monitoring system that emphasizes quality of care and community participation (Cf. Ministry of Health, Annual Report, 2000, p. 5).

4. A transformation in our strategy: Collaboration, networking, tie up and advocacy in health issues are the need of the hour. This is important especially since the Christians are minority in this land. This collaboration has to be carried out in different levels: within the Church institutions, Government Structures, Non-Governmental Organizations, participation with people’s movements, etc. Right implementation of Government’s programmes for water, sanitation, etc. can be done more effectively if this strategy is strong.

5. Active promotion of alternative systems of health care: We have a wealth of traditional systems of medicine in Homeopathy, Ayurveda, Unani, Siddha, etc. Other systems include naturopathy, acupressure, and acupuncture. There are many effective herbal medicines. The value of systems like Yoga should never be forgotten.

6. Health insurance for the poor: Though different Insurance Companies propose various Health Insurance Schemes, they are mostly targeted to the medical needs of the affluent. The poor are not able to cope up with the terms and conditions of these schemes. The Health Insurance Scheme for the poor is a need that could be worked out in collaboration with our Social Service Societies, Health Institutions and NGOs.

7. Emphasis on the spiritual aspect of healthcare: Any health assistance given to a person, in order to be effective, it has to be integral and holistic. The health care personnel have to recognize the physiological, psychological, social and spiritual needs of the person. The total good of the patients, their families and the community should be the ultimate goal. The spiritual need, especially at times of crisis, has to be attended to.

Conclusion

Pope John Paul II, in his Apostolic Letter, Ecclesia in Asia, n. 36, wrote: “Following in the steps of Jesus Christ who had compassion for all and cured “all kinds of disease and illness” (Mt 9:35), the Church in Asia is committed to becoming still more involved in the care of the sick, since this is a vital part of her mission of offering the saving grace of Christ to the whole person. Like the Good Samaritan of the parable (cf. Lk 10:29-37), the Church wants to care for the sick and disabled in concrete ways, especially where people are deprived of elementary medical care as a result of poverty and marginalization”. In India, and other developing Nations, the presence in the field of healthcare of the Church and NGOs needs to be evaluated and new strategies for better effectiveness need to be adapted. It is in this direction the central theme of the 10th World Day of the Sick invites us: “to re-examine the role and task of Christian health care facilities, hospitals and personnel”. It is the need of the hour. Also, the challenge ahead!

HEALTH POLICY OF THE CATHOLIC CHURCH IN INDIA