The Road from Sickcare to Healthcare
by Solomon Darwin and Sampath Kumar
Peaceful Evolution Publishing
Berkeley, California, USA
Rs 583/-
A book review by Glenn C Kharkongor
This handy, readable, and timely book provides an evidence-based approach to the healthcare predicament of our planet, especially in middle- and low-income countries. Co-authored by Dr Sampath Kumar, principal secretary, health and family welfare, of the state government, it draws on his experiences in Meghalaya. His co-author is Solomon Darwin, a professor at the University of California, Berkeley, USA, known as the “Father of the Smart Village Movement”, who pitches in with his expertise in innovation.
Sickcare, an uncommon but important term, refers to the prevalent medical model which is focused on the treatment of illness and injuries after they occur. This model is reactive, episodic, and high-cost. Healthcare on the other hand, that prioritises prevention is proactive, and better ensures wellbeing and quality of life. It is also low cost and works well at the grassroots level, compared to tertiary hospitals that are urban-centric and out of reach for rural populations.
The book commences with a slate of worldwide data on the enormous, yet inefficient, cost of hospital-based healthcare. Despite the increasing use of technology, the medical sector is becoming less inefficient, with huge sums spent on end-of-life heroic treatments with diminishing returns, while better healthcare that helps to prolong longevity is much less expensive. A quote from the book says, ”So we have a model in which patients often find out that they have a problem long after it’s too late to deal with in a relatively easy and inexpensive way”.
The authors make the point that while the forecasts for the global burden of disease are not reassuring, the good news is that lifestyle changes and early detection can mitigate the staggering burden of illnesses. According to the American Heart Association, every $1 spent on prevention could save $5 in healthcare costs. A Lancet study has estimated that investments in prevention can save $350 billion annually.
In a preface authored by him, Sampath Kumar makes the critical point that local solutions are key. In rural areas, citizen-led health councils can coordinate government, civil society, traditional health providers and mothers to address social and cultural factors that impinge on health, and energise and mobilise local actors. The empowerment of women has been a positive factor in the improvement of maternal health in Meghalaya. He says this book is a “manifesto”. He is well-positioned to write this manifesto, having initiated and compiled the two health policies of the state, one of which exclusively engages with mental health and social care.
The book invokes the Triple Helix Framework that brings together governments, business and research institutions such as universities. This synergy can deliver far more than the sum of its parts. For this model to work, governments must not be dominant, and should allow the other two sectors to work with autonomy, so that innovation and capital can yield optimal social value.
The penultimate chapter of the book lists the various stakeholders and describes their contributory roles, suggesting how each of the nine stakeholder groups may overcome inherent gaps and shortcomings, while retaining sustainability. Case studies have been cited to supplant the points that the authors make. This is the longest chapter in the book, spanning 65 pages and indicates the comprehensive nature of the coverage of this important topic.
An example of this broad canvas is the inclusion of informal practitioners and traditional healers. There are perhaps ten thousand traditional healers in Meghalaya. This respected, widely-accessible, efficacious and low-cost human health resource needs to be formalised. Meghalaya has recently constituted the State Allied and Healthcare Council. Task shifting some of the medical care conventionally assigned to doctors and nurses to allied health professionals can add to the workforce for preventive care. These cadres can provide the low-hanging fruit that can supplement the health efforts of the state in a cost-effective way.
The innovative ideas presented in this book, are shorn of the top-heavy burdens of conventional healthcare. The book shrinks from lofty ideas and is grounded in real-life case studies, many of which are based in ground zero Meghalaya. These tech-based, community-grounded, and stakeholder-sharing strategies are scalable and sustainable and can yield the health dividends that our state, and indeed the world at large, badly needs.
