Tag Archives: système de soins

CEIAS – The transformation of India’s Health Systems – 14/02/14


La revue SAMAJ (http://samaj.revues.org/) a le plaisir de vous inviter à un atelier autour des travaux de Roger Jeffery, professeur de sociologie à l’Université d’Edimbourg, actuellement chercheur résident à l’Institut d’Etudes Avancées de Nantes. Sa présentation sera discuté par Laurent Pordié, anthropologue au CERMES 3 (Centre de recherches, Médecine, sciences, santé, santé mentale, société).

L’atelier est ouvert à tous !

Il aura lieu le 14 février 2014, de 10h à 12h30 au CEIAS (190 avenue de France, 6ème étage, noyau A) en salle 640.

Contact: tawalama@ehess.fr


The constraints and opportunities of the health services of South Asia have fascinated me since 1971, when I carried out fieldwork in Lahore hospitals. My first book, The Politics of Health in India, published in 1988, was an attempt to understand better the origins of the situation I found there. The book used a ‘neo-Weberian’ perspective – understanding health systems by considering class as a framework that structures but does not fully determine them – for the period c1800-c1980.
The book advanced the concept, among others, of ‘medical dependency’, derived from the more general dependencia approach to global inequalities. Since the early 1980s, India’s health ‘scene’ has been radically transformed. In the early 1980s the public sector was dominant, though showing many signs of strain. Innovative attempts to bring health to the masses – ‘Health by the People’ as one familiar slogan put it – were in the air. Energy and enthusiasm could be seen in groups of doctors who set up pioneering local schemes, and formed themselves into a network of public health doctors – for example, the Medico Friend Circle issued its first bulletin in 1976. The diseases of affluence reached public attention only when a politician was excoriated for travelling abroad for surgery. Foreign-owned pharmaceuticals companies dominated the Indian market, but as a result of a 1971 Act, local companies were beginning to realise the potential of reaching a mass market with cheap medicines.
In this presentation I will assess the situation for Indian health services in 2010 as part of a wider Janus-faced reality. In the larger metropolises, in some ‘advanced’ states like Tamil Nadu or Gujarat, and amongst the ‘middle’ classes there are private hospitals that are temples to the most up-to-date services at (and in some cases in advance of) global standards. Many of these hospitals employ doctors they have tempted back from abroad. By advertising world-class standards and traditional Indian attributes (indigenous medicine and graceful nursing care) they attract unknown numbers of ‘medical tourists’. In generics medicines, Indian companies are world-famous, even if sometimes this fame is tinged with notoriety. By contrast, in the urban slums and small towns, in the big North Indian states in dire need, such as Uttar Pradesh, Bihar or Orissa, it does not take a visitor long to find situations that are essentially unchanged from 40 years ago: poorly equipped health centres, hardly functioning, with ill-motivated staff who attend sporadically and treat their poorer patients with barely-concealed contempt. Although many Indian health indicators have improved dramatically, it is difficult to identify many contributions that have been made by public health services. And as the generic drug producers have grown, so their critics suggest that they increasingly mimic those international giants whose products they once copied: how long will low prices, rapid delivery and widespread access remain?
Based on the book I am currently writing, I will discuss approaches to ‘the politics of health’ to be found in three recent publications – Akhil Gupta’s Red Tape; Jean Drèze and Amartya Sen’s An Uncertain Glory: India and its Contradictions; and Angus Deaton’s The Great Escape: Health, Wealth and the Origins of Inequality – as well as in recent works by radicals from within India itself. The question I address is how to place the changes often characterised as a ‘neo-liberal’ turn in processes of contemporary globalization in due proportion, in contradistinction to other tendencies, such as the growth of populist politics in India and the opportunities for resistance, in its many forms.