By: Anita Cheng
For those of us who have taken Introduction to Global Health, we have learned that one of the Millennium Development Goals is to improve maternal mortality. India adopted this goal as one of its major health priority and implemented free maternal health care for poor women as well as cash incentives for those who choose to deliver at a health facility rather than at home. From the perspective of a public health practitioner, these initiatives should theoretically reap better health outcomes for these pregnant women. However, a follow-up carried out by the Human Rights Watch in 2009 on the progress of these programs revealed contradicting results. In fact, no conclusive result on the efficacy of India’s maternal health initiatives can be gathered because of a lack of health records and poor health monitoring. Important questions such as exactly how many women die each year and how many women are benefiting from these programs cannot be answered with reliable figures.
A recent article in BBC reported the suspension of three senior doctors in the state of Rajasthan in connection to the deaths of eighteen pregnant women. Their cause of death was traced back to severe hemorrhaging after tainted intravenous fluids purchased by these physicians were administered. This horrific incident demonstrates yet another barrier to successful implementation of public health programs – corruption. In the second week of class, defining characteristics of community were discussed; among them, the class reached a consensus that a sense of trust between healthcare providers and patients is vital to preserving the quality of healthcare administered. Here, this sense of trust is betrayed, breaking the bonds of community. Moreover because physicians are among the most highly respected individuals in a community in the Indian culture, this blatant act of deception could generate a sense of distrust and absolute disappointment between patients in this community and their physicians. This mentality can generate repercussions such as a decrease in utilization of medical services in an already broken healthcare system. In addition, the public health initiative of distributing cash incentives to pregnant women who opt to give birth at a health facility instead of at home can completely backfire. It is evident that the negative consequences of this incident extend far beyond the victims and their families.
One of the defining characteristics of public health is its interdisciplinary nature. This situation questions how public health practitioners can address the issue of corruption among health care providers that plagues not only India but other developing countries as well. The answer lies not only in the field of public health but also requires collaboration with public policy and law enforcement. This tragedy proves that seemingly adequate public health initiatives can result in unforeseeable adverse consequences.