Written during the 6 week Eisenhower Fellowship in the U.S. in 2012
‘It makes sense to work towards making systems working smarter rather than individuals working harder’– Dr. Michael Lu, MD, MPH, HRSA.
I and Shrikar Pardeshi were at the Brookings Institute today. We had a joint meeting with Dr. Bruce Katz, Vice President and Director, Metropolitan Policy Program, Brookings Institution. Although the municipal administration system here is much different from India (in fact, it varies here from State to State too!), few things we found interesting. One is the much greater role the business associations, philanthropists, universities and communities play in the preparation of ‘business plans’ (they are not just regional spatial plans; but reflect the ‘form and function’ of the economy of the city). The much important role of universities (the anchor institutions of the city!) is a testament to the value given to higher education. With so many private opportunities, city government does not seem to be the best attraction for professionals- finance, transportation, housing. Competition is the key.
My next meeting was at HRSA- Health Resources and Services Administration, the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable. US has a uniformed public health service! The striking things about this organisation was creating partnerships towards public health goals, no-complacence, evidence based work and efforts towards ‘closing the gaps’. The National Health Service Corps is a programme where the government gives scholarships to doctors to work in rural areas to repay their loans. The Maternal and Child health programme emphasises home visits to at-risk families. There is a programme specifically for the high risk communities called the Healthy Start programme. The priorities for national strategy for reducing infant mortality include improvement in women’s health before pregnancy, quality and safety of perinatal healthcare, investment in prevention and health promotion, promotion of service coordination and systems integration, strengthening of surveillance and support research (including translational research-bench to bedside, bedside to curbside, curbside to policy) and promotion of inter-agency, public private and multi-disciplinary collaboration (COIN-Collaborative Improvement and Innovation Network). The economic development, community development, educational development and health development are all being considered vital to ‘closing the gap’ (the social determinants of health).
Finally, Dr. Thomas Mampilly, MPH, Program Officer for South Asia, NIH (his native place is Kerala) gave me an overview of NIH, an organisation which prides in its systems for selection of researchers and spends a sizeable share of their budget internationally. The tour of National Library of Medicine, with innovations such as ‘Turning the Pages’ (a virtual tour through the most prized and precious literature), the visible human project (as a tool for virtual study befor the actual surgery!), the genome project, the Medline Plus (information to consumers), images from the history of medicine were all fascinating.