India slammed for jailing health activist

Just two weeks after Human Rights Day on December 10, the Indian government has sentenced a leading health and human rights activist to life in jail amidst fierce protest from noted academics and health professionals. Binayak Sen, an Indian public health expert and pro-poor advocate, was jailed last week after being accused of helping Maoist rebels.

Human rights groups such as Amnesty International say that the Indian government has unjustly sentenced Sen to an extraordinarily harsh and undeserved life sentence on the basis of dubious evidence. India has openly declared that left-wing ideologies are a threat to its economic growth - which it continues to pursue as aggressively as ever - and Sen's supporters say that in its desperate bid to quash growing Maoist insurgency, India is also ignoring basic human rights.

Sen has been globally lauded for his work to improve rural healthcare in India, and was awarded the 2008 Jonathan Mann award for Global Health and Human Rights. Respected intellectuals such as Amartya Sen and Noam Chomsky have petitioned against his life sentence.

Sen's various imprisonments (in 2007 too, he was held without trial for several months) expose serious weaknesses in India's judicial and political system. The government is growing politically more conservative while paradoxically trying to push for a more open and liberal economy. Yet Sen's jailing is also disastrous news for the country's public health. Sen has for decades fought for the health of marginalised people, such as India's vast and neglected tribal populations, which the government has virtually ignored.

Government schemes to improve healthcare in rural areas often fail through a lack of resources and corruption. For instance, a policy advisor at one of India's major health institutes told me that doctors who are recruited to work in remote villages often bribe a local to fake records for them while they themselves remain in the city. Thus, on paper it looks as though these populations are receiving healthcare when in fact, they never even see a doctor.

It is this broken health system that health professionals like Sen are struggling against. For India to jail one its few true champions of the poor is nothing short of a travesty.

How to fix mental health in poor countries

In developing countries, depression and anxiety are widespread, but the requisite healthcare to treat them rarely is. There are several reasons why mental health is woefully neglected in poor countries.

Often, such illnesses are harder to identify. Doctors and nurses are not always trained enough to spot these disorders in patients they see, nor is the population always educated enough to seek treatment themselves. Not only that, there is an extreme shortage of skilled mental health professionals even in relatively wealthy developing nations.

As a study published by The Lancet today shows, in these situations, lay health counsellors could provide vital support for mental health programmes in poor countries.

The use of lay health workers is highly controversial, and there are ferocious debates over how much responsibility they should be given, and what tasks can be delegated to them. These arguments are entirely valid - doctors are trained not just in medical knowledge but also in ethics. How much can a training course, however rigorous, compensate for years of experience? Still, while countries are trying hard to recruit health professionals, and trying even harder to stop them flying off to more prosperous countries, the shortage of staff is impossible to ignore.

Vikram Patel, a mental health expert at the London School of Hygiene and Tropical Medicine, UK, also runs a clinic in Goa, India. Patel has for some years argued that for countries like India, people with mental illness will continue to be neglected unless less formally trained healthcare workers are incorporated into the health system.

Now, Patel and his colleagues have found that adding a lay health counsellor to a team of a primary care physician and visiting psychiatrist meant that after 6 months, patients were much more likely to recover from mental illnesses such as depression.

The lay health workers effectively oversaw the patients' care from educating them about mental health issues, and advising them on ways to communicate their illness to family members, to coordinating non-drug treatments with the physician or psychiatrist.

Essentially, these health workers are the driving force behind ensuring that patients turn up to appointments, and that their care is well-coordinated - which can be difficult in remote areas. In patients treated privately, lay workers made no difference, which is perhaps understandable since private care is likely to be more personalised and have a better ratio of doctors to patients.

If properly trained and supervised, there doesn't seem to be any reason why health workers shouldn't have some role in delivering healthcare. After all, without them, some patients have no healthcare at all.

Should India refuse foreign aid?

With an economy that is continuing to gallop ahead, should India still receive overseas aid from countries like the UK? That's what Andrew Mitchell, the UK’s secretary of state for International Development, and Pranab Mukherjee, India's finance minister, met to discuss last week.

India has for some time struggled with an identity crisis. It is battling to reconcile its image of emerging superpower, that has itself given millions in aid to countries like Sri Lanka and Pakistan in times of crisis, with the reality of being a nation that is still home to a large proportion of the world's poor.

India's rich are getting even richer, and this wealth is starting to manifest in startlingly crass extravagances. Witness, for instance, the billion-dollar, 27-floor monstrosity of a house recently built by the Ambanis, one of the wealthy Indian business dynasties.

Yet India is still ranked 119th among 169 countries in the latest edition of the Human Development Index (HDI) published last month. This means India is well below similar emerging economies such as China (ranked 89) and even behind poorer neighbours such as Sri Lanka (ranked 91).

The HDI ranks countries on measures of well-being such as life expectancy, education, and standards of living. Under the shiny visage of India's economy, indicators such as the HDI are particularly telling, revealing the extent to which the government still neglects much of its population. India's social development lags so far behind its economic development that it is a scandalous betrayal of its poor.

December 1 was World AIDS day, and India has a staggering 2.5 million people with HIV. Understandably, many Indians feel frustrated that their country's image in the West is too often one of dirt and disease.

There's much more to India than that, it's true. But though India might want to feel that it has moved beyond the dependency of foreign aid - and countries like the UK might wonder why they are still giving millions to a country that is rich enough to have a competitive space programme - until the government honours its duty to all of its citizens, not just the wealthy and privileged, it is too early for aid donors to give up their commitments.