Plenary sessions

Health and medicine in the 21st Century. New challenges for social science.

By V. Sujatha, Professor, Centre for the Study of Social Systems, JNU, New Delhi

Health is a topic of immense importance both to public institutions and to individuals and the social sciences have strived to conceptualise this dual aspect of health in multiple ways. The increasing role of the state in delivering health care services and the consequent bureaucratization of health care delivery has created a divergence between governmental goals and targets for collective health status and the individual’s efforts to maintain health and wellbeing. While the lack of governmental health care is found to adversely affect the health status of a population, greater interference of medical services through the government bureaucracy and the rapid diffusion of privatised medical care leads to what is known as ‘medicalisation’ of society. Medicalisation bestows enormous powers on capital and technology intensive interventions as the only arbiter of the health of the people, leaving little for the understanding and evaluation of the non-experts and the individual. This is also evident in the global north where the proliferation of psychotropic drugs has led to a medicalisation of socio-psychological problems.

Different disciplines involved in health studies, namely, public health and social medicine, economics, demography, sociology and anthropology, are trying to grapple with some of the issues raised above at various levels of specificity and degrees of proximity to governmental policy and initiatives. To this we may add the concerns raised by the visible entry of medical systems like homeopathy, ayurveda and Chinese medicine that were hitherto kept out of public institutions of health care. But the compartmentalization of disciplines, such as that between sociology and anthropology, that produces dichotomies of the knowledge and experience of the richer countries and from that of the poorer ones, inhibits an appraisal of what systems of medicine could do or not do with regard to tackling health problems. The question as to whether the focus at the level of the population and at the level of the individual follows a similar logic and whether medical systems are capable of addressing both, requires among other things, an analysis of medical pluralism which has been somewhat muted in mainstream social science. This presentation does not answer all the questions, but will try to place them in perspective, so that young researchers are exposed to generic concerns in health studies.

This presentation will serve as a general introduction in the methodologies and themes covered by the Workshop 4.

Universalisation of health care in India: questions, methods and assessments.

By Bertrand Lefebvre, University of Rouen, Faculty of Tropical Medicine of Bangkok

Universalisation of health care is at the heart of health policy in India since Independence in 1947. Since then, the country has experienced different models to improve access to health services and ensure universal care to entire population. Despite the proliferation of governmental and private initiatives, the majority of the Indian population still has great difficulty in obtaining appropriate health care services. Along problems of spatial distribution of health services, other barriers stand between patients and health care services.

Availability of services, financial, organizational, social and cultural barriers as well as health needs are all components of access to health, and whose evaluation requires a multidisciplinary approach. In this presentation, we will review several methodologies that have been used to assess and analyse the universalisation of healthcare. From PPP in hospital services, gender inequalities in medical expenditures, to health insurance programmes, we will see how different methodologies can be applied for a deeper understanding of the failure and success of universalisation policies and programmes.

This presentation will serve as a general introduction in the methodologies and themes covered by the Workshop 1.

Regulations Governing Private Healthcare in India.

By Narayanan Lalitha, Professor, Gujarat Institute of Development Research, Ahmedabad

Private healthcare[1] has grown in an exponential phase in the recent decades. There are regulations governing practically every sphere of this sector, as this is a sector, where the products are consumed by the consumers based on the recommendation of a skilled person (healthcare provider), than based on the market survey and considering alternatives available. Unlike the developed countries, regulations governing the healthcare sector in India, which caters to the majority of the population, are not adequately defined and ineffectively enforced leading to high cost for questionable quality of care. This paper focuses on issues relating to regulations governing (a) health education, (b) retail drug distribution, (c) production of drugs and medical devices and implication of the clinical establishment Act, 2010 of India.

This presentation will serve as a general introduction in the methodologies and themes covered by the Workshop 3.

Impact Evaluation of Health Programmes: Insights from a Conditional Cash Transfer Programme on Maternity Benefits in India.

By Sumit Mazumdar, Fellow, Program coordinator, Institute for Human Development, Delhi

We will introduce the theme of using scientific impact evaluation techniques and methods as a key toolkit for researchers – and policy-makers – to understand the impacts of development programmes, and concentrate on those associated with public health outcomes. We will discuss how the evaluation approaches have evolved over recent years in their empirical adaptations, particularly to the context of low and middle-income countries such as India. As an illustration, we provide a synoptic review of different statistical approaches used to evaluate Janani Suraksha Yojana (Safe Motherhood Scheme) – a conditional cash transfer (CCT) maternity benefit scheme in India, providing cash payments to pregnant women to undergo childbirths in government health facilities instead of delivering their babies at home – aimed to reduce maternal and early childhood mortality. Two papers are discussed, and the results compared, involving some of the most common and essential approaches used for evaluating programme impacts from non-experimental data. We conclude by outlining the positive development of greater acceptability of impact evaluation among development practitioners and decision-makers in India, underlining the importance of building required methodological as well as applied research capacities.

This presentation will serve as a general introduction in the methodologies and themes covered by the Workshop 2.

Thinking through the road: fracture therapeutics and the traffic of
bodies, technologies, passion

By Guy Attewell, Associated Researcher, French Institute of Pondicherry, Pondicherry

This paper frames an economy of injuries and orthopaedic practices in which value, fame and notoriety have been created and articulated through ‘traffic’ – of bodies, materials, knowledge, skills, passions, rupees. It focuses specifically on one clinic within this wider economy where muskulo-skeletal trauma, injury and pain are managed, at the margins of mainstream of orthopaedic surgical practice. It is interested in the implications of the transition from ‘local’ village practice to its current location on an arterial and yet also liminal highway (NH 202): how this move has enabled circuits that connect sufferers, their escorts, orthopaedic surgeons and other ‘traditional orthopaedic practitioners’ (‘bonesetters’); the affordances (positive as well as negative for the clinic in question) of the road for particular kinds of mobility at local, regional and intercity levels; the socially transgressive potential of a widely-resorted to ‘open’ roadside clinic in which touch, displaced clothing, bodily contact and expressions of acute pain within this particular public arena are the norm. This paper proposes to view the making/unmaking of credibility as material-social processes in which the road, widely viewed as an icon of India’s modernity, enables reconfigurations and growth of non-establishment therapeutic practices and reputations. Through this case study, the paper reflects on theoretical trends in science and technology studies (STS), and their juncture with anthropology and postcolonial studies. It argues that the road is good to think with to in order to understand the constrained and enabled enmeshments of lives and things.

[1] Includes, healthcare providers, health care institutions and health product producers and in this paper, the scope is restricted around providers, institutions and producers of modern healthcare products only.

Methodological approaches in social sciences