The people and health service development in India: a brief overview.

Health is politics, and politics is health as if people matter--this has been a refrain of such scholars as Rudolf Virchow, Halfdan Mahler, and B.C. Roy. Many seeds of hope for health were generated during India's struggle against colonial rule. After Independence, with the changes in power relations, these seeds could not find the appropriate soil to nurture them. Power relations influence health service development, which is a sociocultural, economic, political, organizational, and managerial process with epidemiological and sociological dimensions. Even within the power structure, however, a carry-over of the democratic process of the pre-Independence era has created a pro-people ambience. Despite considerable difficulties and shortcomings, India has developed an endogenous, alternative body of knowledge more suited to the prevailing social, cultural, economic, and epidemiological conditions. This has formed the content of alternative approaches to education, practice, and research in public health--strikingly similar to the Alma-Ata Declaration. The response to this declaration of self-reliance by the world's poor, together with the earlier specter of population explosion, brought together the political leadership of all hues, the bureaucrats, and foreign agencies to impose prefabricated programs on the people. The result was a decimation and decay of the health service system, causing considerable suffering to the poor. The remedy is a return to the heritage of the alternative approaches that emerged during the early years of Independence.