I was having a great discussion with a physician the other day in a social gathering until he stopped abruptly and asked me if I was a “lefty”. He works at a teaching hospital and has a busy private clinic. We had been discussing how the health status of people was determined by a complex interplay of physical, social, economic, cultural and environmental factors leading to the health status of a country or a community. References were made to the wealth of literature produced on these social determinants of health in the last three decades.

Our discussion had come to an abrupt end at the point in where I had argued that while achievements of modern medicine over the last century were impressive, the health system is failing to deliver even the most primary of the health services. I had suggested that this is primarily because of the hegemony of doctors over what goes in health care. It is this stifling control of doctor over health resources and systems that has become the problem. I had suggested involvement of stakeholders, most importantly the patient, in making decisions about how health systems work in the country. My good doctor had no stomach for this kind of ‘lefty’ talk and he moved on to another discussion in another group.

I have heard this argued in health professional and health user circles alike how advances in diagnostic procedures, non-invasive interventions, pharmaceuticals, and effective health promotion and disease prevention strategies have greatly improved the ability of health practitioners to diagnose, manage and treat numerous health conditions. But the reality of the matter is that, a majority of the people are still unserved and underserved in the public and private health sectors alike.

The major challenge confronting health systems today is the need to tip the balance away from health services that are overly biomedical oriented, disease focused, technology driven and doctor dominated. There is a clarion call to restore balance in health care, and the health system itself.

The health vision we need to support as consumers of health care systems and services is one which is people-centered in which individuals, families and communities are served by and are able to participate in trusted health systems that respond to their needs in humane and holistic ways.

Such a health system would be designed around stakeholder needs and would be centered around enabling individuals, families and communities to collaborate with health practitioners and health care organisations in the public, private and not-for-profit health sectors in driving improvements in the quality and responsiveness of health care.

Had our discussion continued on, I would have told the good doctor that unless we re-establish the core value of health care, which is health and well-being of all people as the central goal, we as health professional will be failing ourselves and the system. But he did not listen to me. I really hope he will be willing to talk again! I really need to argue with him for a more holistic and people-centered approach to health care, and a balanced consideration of the rights and needs as well as the responsibilities and capacities of all health constituents and stakeholders, most importantly the patient.

The overall vision for people-centered health care is one in which individuals, families and communities are served by and are able to participate in trusted health systems that respond to their needs in humane and holistic ways. The health system is designed around stakeholder needs and enables individuals, families and communities to collaborate with health practitioners and health care organisations in the public, private and not-for-profit health and related sectors in driving improvements in the quality and responsiveness of health care.

If my doctor friend is reading this I would like to underline for him what a people-centered health care may be like. Perhaps after reading this he can make up his mind to meet again and talk about it?

Such an approach towards health care is rooted in universally held values and principles which are enshrined in international law, such as human rights and dignity, nondiscrimination, participation and empowerment, access and equity, and a partnership of equals. It aims to achieve better outcomes for individuals, families, communities, health practitioners, health care organisations and health systems by promoting culture of care and communication, responsible, responsive and accountable services and institutions, providing affordable, accessible, safe, ethical, effective, evidence-based and holistic health care.

Whether or not we are able to move from a doctor-dominated to a people-centered approach is no more a choice – it is indeed an existentialist question both for the doctor and the consumers of health care systems whether in public or private sector.

Perhaps, it is time consumers were talking about rights-based approaches in health provision and consumption. A charter of patients’ rights might be good place to begin?


Ayyaz Kiani is a public health specialist. He heads Devnet – a network of development consultants. Based in Islamabad, he has travelled around the world and continues to do so to meet fellow travelers. He can be reached at ayyaz_kiani@hotmail.com.


The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.

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