We have been very excited about our Exclusive Interviews section, where we ask thought leaders in health across India to answer standard questions on their views on health, their area of expertise and on their work.We thought that this would be a good way to start a discussion on what some of India’s best minds think about the wellbeing of the country. We have already received a great response from our readers on our first two interviews .
We would like to increase our circle and have more people working on health in India participate in this conversation. This gave us the idea to create a section for our readers who enjoyed reading the Exclusive Interviews and want to be interviewed as well to share their experiences, ideas and expertise.
Like our previous interviews , they answer standard questions in three sections: on their views on health, their area of expertise (immunisation, prevention) and on their work.Each interviewee can, of course, refuse to answer any question but they can’t re-write the interview.
Here is our first interview with Dr. Anjana Saxena , who was the Former Deputy Commissioner,Maternal and Adolescent Health at the Ministry of Health and Family Welfare. Prior to this, she was a clinician by profession and is now currently retired.
Here is a taste of her thought-provoking responses to our
“I feel that when I talk to 20 people about “don’t smoke tobacco, don’t drink”, even if one follows our advice and stops the abuse, our job is done.”
“Nepal, Sri Lanka and Bangladesh have been able to bring down their Maternal Mortality where India is “on track” but at this pace we will not be able to achieve the MDG target.”
“With the private sector and UNICEF being in the picture, capacity and access is also not the obstacle. Barrier to universal immunisation is lack of knowledge in public and at times a casual approach by the health workers.”
(Please tell us how you would answer our 20 questions.Click here to be interviewed.)
A. On health in India
1.According to you, what should be the top three health priorities in India?
The top three health priorities in India should be in this order
1.Checking the growth in population by increasing advocacy and access to family planning methods
2. Improving availability of skilled birth attendants for every birth taking place in or out of institutions thereby improving our maternal mortality.
3. To prevent our infants from dying from preventable causes in first five years of life.
2.What make you proud about health in India?
We have the finest doctors and surgeons who are performing miracles almost daily.
3.Where is India falling behind the world?
Sadly, we lack in infrastructure in urban as well as rural areas. We have enough doctors but the rural-urban ratio of doctors is poor because of no basic amenities available to the doctors in rural areas. There are no incentives for them to go and work in the rural areas. Therefore, city hospitals are overcrowded and they cannot give their best.
4.Are there examples where other fast-growing economies are handling health problems better than India?
Yes, Nepal, Sri Lanka and Bangladesh have been able to bring down their Maternal Mortality where India is “on track” but at this pace we will not be able to achieve the MDG target.
5.If you think about India in 20 years time, what will the citizens of 2033 wish that we had done in 2013? (Why?)
Control our population. As we wish our legislators had done in the nineties.
6.Which big societal trends do you think will have the most impact on health in India? (e.g. might be growing wealth disparities or environmental degradation)
First and foremost is the rapid growth of our population. This will have a major impact on jobs, economy, food availability, living spaces etc to bring further deterioration in environment, increasing poverty, illiteracy and wealth disparities.
7. Which new technology do you think will make these body difference to health outcomes in India over the next 20 years?
As I have said earlier, access to Family Planning methods , availability of abortion services and and skilled birth attendants at every birth is what we need now.
Also with non communicable diseases catching up fast we need to generate awareness in the public about the consequences of abusing the body now, be it obesity, tobacco or alcohol abuse, sedentary life style or even promiscuity.
8.What do you enjoy most about working in the health services field? What do you like the least about working in this field?
I am a doctor, so bringing relief to my patients is my first priority and I enjoy doing just that. Along with this, educating them about how to lead a healthy life and generating awareness about “holistic Health” that is a healthy mind and body is what I aim to do. This requires a lot of patience. But I feel that when I talk to 20 people about “don’t smoke tobacco, don’t drink”, even if one follows our advice and stops the abuse, our job is done.
9. If you could send a message about health, what would it be?
To doctors-put your heart in what you do.
To patients- follow your doctor’s advice.
B. On Immunization/ Prevention
1.Many say that India will face a wave of non-communicable diseases. What can the country do to prevent this?
Generate awareness in all people, for all NCDs and start it from schools. Kids are most receptive and will take it to the families.
2.Will prevention be led by government, the voluntary sector or the private sector? What — positive or negative — do you think that each is likely to do?
It has to be a combined effort. Government alone with a hand full of people can only give out the guidelines. Implementation at the periphery has to be by both government , voluntary sector and private sector. To our far flung and inaccessible areas it has to be them all together.
3. In many senses, India is a paradox. It manufactures 40 per cent of vaccines used in universal immunization programmes across the world. However, a third of all unimmunised children are Indian. As a public health specialist, how do you see this contradiction?
Illiteracy and poverty are the main causes as parents are still unaware that their children can get shots to save them from certain life threatening diseases. Let alone rural, even in big cities, there still are parents who have not completely immunised their children. Marginalised sections of the villages do tend to get left out. And then there are difficult areas and inaccessible areas in our country where may be the health workers can’t reach.
4.What is the biggest obstacle to genuine universal immunisation? Is it finance, capacity and access, or lack of knowledge about the importance of immunisation?
No, finances are a plenty. With the private sector and UNICEF being in the picture, capacity and access is also not the obstacle. Barrier to universal immunisation is lack of knowledge in public and at times a casual approach by the health workers. At times its even late reaching or non- reaching of the vaccine at site.
5.Vaccine science in India is at its peak. There is an explosion in vaccine R&D and a number of new vaccines. While this is a great opportunity, is it creating a clutter of public and policy debates on which vaccines are ‘necessary’ and which are not? If yes, how can one prevent this?
A fair clinical trial is what can be done to see the efficacy of the vaccines. All interventions have to be evidence based, But as these studies take long, most of the times the companies are in a hurry to utilise their new vaccine, so all ethics are kept on the shelf.
C. About your work
1. Could you tell us a bit about the work that you do? How did you first get involved in the work that you are currently doing.
I was chosen and appointed as DC Maternal Health by the then Secretary, Health.
2. Why this organisation? What most excites you about this organisation’s role in improving health in India?
I am a Central Health Service officer and Ministry of Health and Family Welfare is “the” place to be in to improve India’s health.
3. What has surprised you most about working with in this field?What do you find most challenging ?
I have worked as a clinician for a better part of my life in various hospitals and CGHS and have always followed orders issued to us from the Ministry. But working in the Ministry where the orders are made was a different experience altogether and it also made me realise the amount of good work doctors are doing in rural areas despite the constraints.
Working in a PHC or a CHC or even a District Hospital is a challenge in itself but in some areas these doctors are doing such a good jobs. In very remote areas some ANMs were doing commendable work . To visit these areas , to know their challenges and to be able to help them was most thrilling.
4. What do you think will change in this field over the next five years? What sorts of trends do you see?
A lot will improve. With proper funding and good people at the helm of affairs, things are bound to improve. Monitoring needs to be accelerated and of course wages of doctors and paramedics as well as the conditions that they live in, their security. For remote areas, a compensation should be given to all staff high enough to incentivise them to continue living in these areas without their families and do their best.
5. What’s the best/worst thing to happen since you started working in this field?
I feel that I started working in this field a little late as I was doing clinical medicine earlier. But I hope to continue working in this field now.
6. What might someone be surprised to know about you?
That having worked all my life, that is 34 years with the Government, I am enjoying my recently retired status and am raring to be on the go again.
7. What do you do when you aren’t working?
Lots. I have been tutoring poor children, treating poor people, generating cancer awareness in public, looking after the aged besides doing crosswords, reading and having a good time!