Abstract

PIP: Indian society adhere to certain articles of faith: health is a right of everyone and when the normal healthy state fails illness arises. Therefore health maintenance should prevail over treating illness. Still influential Western trained physicians in India operate under a top down technomanagerial approach where the beneficial health services center around large expensive specialized curative services in urban hospitals. Yet 70% of the rural population do not even have access to basic health services and communicable diseases continue to be the leading health problems, especially among children who compromise 45% of the population. This happens despite adoption of a decentralized health services model where basic health services would be accessible to all, particularly the rural population after Independence from Great Britain. Some in India advocate a model created by 2 research centers that minimizes the importance of medical technology and recognizes the influence of socioeconomic, cultural, and political determinants of health and of health services. This model does not incorporate indigenous and traditional systems, however. For example, Ayurveda is a more holistic approach than Western medicine and more suited to Indian society. Experiences in Kerala state and other small and effective projects reinforces the positive effect of community health services. The new approach needed in India begins with people not the elite and centers on their real problems which include not only medical problems but also socioeconomic and cultural problems. This approach also attempts to know their perception of health and illness. This model begins at the village level with a primary health care center. It is used in projects in Mandwa and Malshiras.