Violence against Women as a Health Care Issue

Women often approach health facilities to seek treatment for health consequences emerging out of violence. Health facilities are also mandated by several laws in India to play a therapeutic and forensic role in responding to women facing violence. Despite India being a signatory to international treaties, health professionals are unable to respond to violence owing to their own biases and misconceptions related to the issue. The chapter discusses the prevalence of violence against women, the resultant health consequences, and perceptions of health professionals towards this violence. While doing so the chapter raises concerns about the lack of institutionalised health care response and draws attention to the policy gaps that keeps the government from committing itself to ending all forms of violence against women.

Medical Education and Basic Health Care

Medical education in India is not sufficiently oriented to the health care needs of the country. The knowledge of medicine has primarily originated in western countries and there are mismatches between medical knowledge and health care problems on the ground in India. While specialties such as cardiology and thoracic surgery have grown, basic treatment of coronary artery disease is not accessible to the majority of people. Medial colleges are also not adequately linked to the health care system, therefore not optimally effective in improving health care delivery and exposing students to all levels of the health system. Addressing these structural problems may involve making medical colleges responsible for health care of geographic areas, development of primary care education, and medical curricula that engage with the local context.

Introduction: Health Inequities in India—The Larger Dimensions

This chapter provides a narrative that explains the politics of access (distribution, utilization, outcomes) as well as the context in which health inequalities are produced in India. While fields such as medical sociology, medical anthropology, health economics, community health, social medicine, epidemiology, and public health, among others, with their own theories, methods, and approaches are able to contribute distinctive dimensions, it becomes essential to engage across the boundaries in a collective manner to understand the complexity of health care that is increasingly shaped by the global market forces and ideologies. This volume thus opens up the possibility of constructing a new paradigm for understanding health sector as well as signalling a new field ‘health care studies’.

Body as ‘Resource’ in Surrogacy and Bio-Medical Research

Medical research on human bodies for the purpose of drug development, and the use of technology to assist human reproduction are not new phenomena. However, the marriage of medical technology with commercial interest in a globalising world has led to a reinvention of the status of the body as a resource. Today, the global traffic in body parts and their renting and selling is unprecedented. This is throwing up new challenges, especially ethical and legal challenges. Clinical trials and surrogacy are two sites where these challenges are playing out. This chapter explores themes that emerge from the work of Sama, a Delhi-based resource group working on issues of gender and public health through research, advocacy, and inter-movement dialogue.

Access to Pharmaceuticals

Affordability, accessibility, availability, and rationality of medicines are a big challenge in India. Notwithstanding the tag of 'pharmacy of the developing world', the India story is one of poverty and poor access among plenty. The pharma market in India is riven by market failures due to asymmetries of various kinds: between patients, doctors, and pharmaceutical companies. Expecting the market to regulate itself will not work and proactive state intervention is necessary in pricing and provision of medicines and health care services to deal with the extraordinary crisis of public health in India.

Social Roots of Medical Education

Allopathy has become the dominant system of medicine in India today. Since mid-nineteenth century, allopathic medical education institutions have grown exponentially. However, its growth has been problematic. Further, the political influence of modern medicine practitioners has enabled them to gain monopolistic control of state health system, even though they remain marginal to the provision of primary care in the rural areas.

Medical–Industrial Complex

This chapter analyses the role and social characteristics of market forces in the health service system in India. It argues that while there are studies that have individually focused on financing, provisioning, drugs and technology, there is a need to take a systemic view of it. It also examines the rise of corporate sector health care through the example of Apollo hospitals and illustrates the complex interaction between regional, national, and international capital and the support from the political class to facilitate the corporate sector in health care. The role of the diasporic networks and their access and influence on policymaking during the last three decades has been highlighted.

Caste, Class, and Gender on the Margins of the State

Dichotomous view of state and local communities remains a dominant theme in the theorization of state. State often gets depicted to be mainly working on the basis of a rational principle as opposed to the irrationalities of the local communities. This chapter makes an attempt to understand how such claims about state takes an actual course while making available some of the basic needs like health services. It argues that gender and class bias remain inherent at the very structuring level of the health programmes. Further, the bureaucratic hierarchy of the state and the hierarchies of the local communities seem to converge on many occasions.

Structure, Organization, and Knowledge Production of Clinical Trial Industry

This chapter reviews the evidence about the scale and significance of clinical trials in India. After describing some of the new social forms that service these trials it assesses the growth in their number from 2005 to 2012 and the reasons for—and implications of—a decline since then. The main argument is that the nascent Indian clinical trials industry rapidly adjusted to the opportunities provided by reforms, linked to India’s accession to the TRIPs agreement and the World Trade Organization in 2005. By contrast, Indian regulators were slow to come to terms with the challenges of responding to well-co-ordinated trial sponsors and contract research organizations.

A Financing Strategy for Universal Access to Health Care

Given that health is a state subject, an independent working group of experts was set up in Maharashtra to evolve a framework for Universal Access to Health Care (UAHC) and it has developed a framework document for restructuring the public healthcare system and its financing that will help facilitate the implementation of a UAHC model. This chapter reviews how, over the years, the health financing strategy failed to develop a robust public health financed system through underinvestment in health and further discusses the financing strategy of the proposed Maharashtra UAHC model to establish universal access to healthcare.