The human mind occupies itself with problems in various ways, but the quientessence of wisdom lies in simplifying our philosophies and in solving intricate problems in the simplest ways. It needs the greatest wisdom to be simple and to take a commonsense view of great problems. That is what we shall have to think of. For us as physicians, charged with the maintenance of National Health of an impoverished country like ours, the task becomes almost hopeless if we fail to take a broad view of the various factors that affect life and the living. Life does not function in a vacuum. It is related to and is affected by its environment.
Its reaction to and relation to its environment becomes the reality. The reality in our country is the terrifying problem of its stark and naked poverty. It, therefore, becomes all the more essential to assess with great exactitude the material possibilities that exist, so that we can reasonably hope for in the visible future in our country. That means a comprehensive knowledge of economics and economic possibilities. We must know as to what is possible and what is not, what is feasible and what is not, what is essential today and what is not, for a limited sum of money that our country can bring together.
Factors governing economic changes in a country are not so easy to influence or alter as factors governing political changes. It is also advisable to remember that political changes come far in advance of economic changes and that while political revolutions can be easily brought about, an economic revolution takes it own time and obeys quite a different set of laws from political upheavals. Failure to recognise this fundamental point has been responsible for the wasting of much time, energy and national finances in the shape of “Post-War Plans” in India and elsewhere, and elsewhere, except in Russia. All Russian Plans, the great 1st, 2nd and 3rd “Five Years Plans” have been based on fundamentally very sound principles.
They never looked centuries ahead or made schemes for forty years to come. No economist in his senses can foretell what the shape of things would come to be ten years hence. In this uneasy, unhappy world of today, full of strife and unrest, it becomes almost impossible. And yet The Bhore Committee Report has put up a plan which would take forty years to complete. The fundamental principles upon which the Russians have based all their plans, as realists, are on a realistic and thorough analysis of things as they really exist which is taken as the starting point. We can and must make plans on the basis of facts as they exist and of things already achieved. Only then do we make few mistakes.
BASIS OF A PLAN.
It is therefore essential to differentiate between what constitutes a plan and what a programme. A plan is built on what is available, ready at hand, capable of being exploited, consolidated and enlarged. A programme is a promise of the future and a hope capable of being fulfiled only when certain preconditions are granted or facilitated. It remains only a promise until it is fulfiled. Having worked as a member of the National Planting Committee of our country I had good deal of trouble in making my colleagues there appreciate the fundamental point, and therefore I must stress that point again. If our plans are to be built on the realities of today and of the facilities available, then the greatest single reality in India is its financial stringency.
As a competent economist I fear no challenge of this statement from any Finance Minister. The second greatest reality is the discrepancy between the health needs of the people and the inadequate medical services they receive, which, as the Health Commissioner with the Govt of India plainly admits “so far has not touched even the fringe of the problem”. The third greatest reality is the paucity of allopathically trained men as mentioned in the Bhore Committee Report. Therefore, I must tell you something about the Bhore Committee Recommendations. What is the Bhore Committee Report? Is it a plan or a programme?
Can it be a plan at all? The answer is No! Why? Because it is not based on the realities of today nor does it seek to make use of the facilities at our disposal now and here, nor based on the possibilities that can be guaged with reasonable exactitude and which can be developed if we had the will and had known how to, as I shall prove to you very soon. What it is therefore? A programme, a promise of the future that can only be fulfiled if premises be granted that do not exist today. I have not met a single allopath, be he Health Minister in the Provincial Govts or the learned Surgeon General, who could stand upto my economic arguments.
What is the greatest weakness, apart from several other glaring weaknesses in the Bhore Committee Recommendations? It lies in the fact that these excellent plans can only then go into operation when a very large sum of money is placed at its disposal. It is not less than 1000 Crores as initial capital and recurring expenditure. And that money, I as an economist can tell you without fear of challenge from any quarter, and judging from the trend of events as our country is suffering and must necessarily pass through, will not be available for a long time to come.
The Bhore Plan is like a beautiful motor car, a beautiful piece of machinery, but which cannot move because of the dearth of petrol. And that means that, however fine and impressive the Bhore Recommendations may be, however desirable and as a piece of scientific thinking certainly an achievement, they will not and cannot work because of one single and at present insuperable hindrance, which is a terrible and tangible reality, namely, the lack of the necessary finances.
It may be argued that money should be made available and you will tell me that Pandit Jawahar Lal Nehru has said at the The Health Ministers Conference at Delhi on Oct. 10, 1946 that “If funds could be available for big wars, there was no reason why they should not be provided for to fight against ill-health and which was like the enemy from within and weakened the nation. No doubt it was a gigantic task but it was one of those urgent questions which had got to be attended to if we were to avoid situations like the after math of the Bengal famine.”
I say with all due deference to Pandit Jawahar Lal Nehru that, while I agree with him in his desire, I cannot agree with his optimism that the finances can be so readily found. We have neither the trained army nor the munition nor the money, but we have, what the Bhore Committee could not appreciate, and which the allopath would hate to admit, a band of guerilla fighters who have often snatched a victory when the regular armies were routed. In order to know how to use them one must see how others have done it. It was the Boer, ill-armed, that inflicted defeat upon defeat on a highly military British army.
It was the Russian Guerilla and Partisan armies, ill-trained, that helped the regular Russian armies to defeat the worlds most fearful military machine, the German Army. And while British arms were suffering one defeat after the other in this last world war, it was the common man of Britain who held on undaunted and never admitted defeat. If we should accede to the Bhore Plan it assumes that no battle should be fought against an enemy already in our midst unless we have a large and well-trained army of death and bacilli fighters which will take forty years to prepare, provided we can find the money.
This is typical of the antiquated British way of thinking, and it is a fact that till recently the British never knew the technique of guerilla or of mobilising a people, until it was taught to them by a British Communist. That is the difference between the narrow British way of thinking and the broad realistic way of mobilising a people at which Soviet Russia is an expert. If we should apply this analogy to the Bhore Committee Report, we see immediately its glaring weakness, it narrow thinking, its attempt to preserve the rights and privileges of a small body of allopaths who are so small in numbers, but whose privileges are so great that it is almost like the struggle between the Zamindar trying to keep his rights and the peasant demanding his own rights.
The proportion of the Zamindar, who has too much, to the peasant, who has too little, is beyond all decency. Let us be clear about one thing beyond all shadow of doubt. The Bhore Plan is unworkable under existing circumstances. These circumstances will not change for a long time to come. On the contrary, there is every possibility and probability of their becoming worse. I am speaking of the financial aspect. Let us be clear about this one cardinal fact. Still more, let the Health Ministers and Surgeon Generals be clear about this fact. We stand today just where we were yesterday, before all these impressive but inapplicable “Post War Plans” began. What then?
It means that we still need a plan that can work under existing circumstances. With regard to Public Health we are as static as we were before. I say it is a great pity, because the Bhore Plan is a very thorough and painstaking analysis of present health conditions in our country, a very thoughtful and exhaustive study of things as they are and as they ought to be. But what a pity that these men who made the report did not know what is possible and what is not possible economically in our country.
