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Submitted by K Bouchane on
Dear Rajeev, It sounds as if you did kick off a healthy debate - since that was the objective please include the original blog on this page so that others can continue to respond and discuss. For my part, I can say that there are aspects of private health care that are incredibly worrying from a public health perspective in India - not least in tuberculosis treatment and care. For tuberculosis, most Indians, will first seek treatment in the private sector. A colleague who attended the first diagnostic meeting of its kind in India a couple of works ago noted that of those treated in public clinics, four out of five first sought care in the private sector. The problem is that India's private health system barely regulated, and research shows few of its private practitioners treat TB correctly - a recent study asking practitioners to describe treatment for TB produced 63 different courses of treatment - less then 10% of which met the basic standards of care. TB drugs are also unregulated - available over the counter and relatively affordable - however the WHO estimates many are counterfeit -- containing uneven amounts of active ingredients. Unregulated care and unregulated drugs lead to multi drug-resistant TB strains -- meaning that at least in TB - not treating at all could be better than some of the shenanigans that go on in private treatment. There are more than 100,000 cases of multidrug-resistant cases of TB each year according to the World Health Organization. In short, I think we do well to questions both the public and private sector -- particularly where health outcomes are involved -- and I think we do well not to quash this debate - but get more serious about out value assumption of private over public goods in development and health.