Viswanathan K's Thoughts

Karthik Muralidharan has a chapter on the healthcare system in India in Accelerating India’s Development . Unsurprisingly, across India, the majority of healthcare providers are private players.   In the private sector, both in rural areas and in poorer urban areas, the private sector practitioners are not MBBS qualified. “How then do they learn what to do?” By being in roles like compounder, ward boys or assistants. Many also “learn” from pharma representatives who tell what medicines do as well as their dosages. You’d think the pharma guys would exaggerate the effectiveness, but that tendency is balanced by their need to maintain long term relations. Overall, the private providers do have a decent amount of medical knowledge.   How effective are these unqualified practitioners? At least for primary care, they are comparable to MBBS doctors. But as things get complex, an MBBS is definitely better. How to measure the effectiveness of medical practitioners isn’t ob...

In a recent blog , I had mentioned infant mortality rate (IMR) as a good proxy for the quality of life in a country. But, as Nilakantan RS says in South vs North : “Describing India with one metric is as accurate as describing the planet with one metric.”   Which is why in his chapter on health, he uses several other metrics to compare the southern states with the rest of India. Life expectancy is not one of them. Why not? Because it is a lagging metric, i.e., it takes a very long time for any improvement to show up (a person has to die for it to show up in the data!). Nilakantan uses IMR (Infant Mortality Rate), U5MR (Under 5 Mortality Rate), and MMR (Maternal Mortality Rate). On all of these parameters, the south does far better than the north. It speaks about the kind of governance over time: “(The strategies to improve these metrics) call for time, effort, long-term commitment and budgetary support from state governments.”   A lot of child and mother deaths...