A draft discussion note, prepared by Dr Maya Valecha, a Gujarat-based gynecologist and activist, sent to the People's Union for Civil Liberties (PUCL) as also a large number of activists, academics and professionals as an email alert, is all set to create a flutter among policy experts for its strong insistence on nationalizing India’s healthcare system.
The note has been prepared following well-known film-maker activist KP Sasi reacting to it, stating that he does not know whether there should be a demand for nationalization at this moment, or whether it should be a demand for 'strengthening the public health care system and implementing tighter control of the private sector'.
Reproduced below is Dr Valecha’s note and KP Sasi’s reaction.
Dr Valecha’s note:
As is thoroughly exposed during this corona time, not only the fact that private sector healthcare service is of no use when it comes to the health care of vast majority of poor people during normal time but during a health crisis it was of no use also to the minority of rich people from whom it earned exorbitantly all along.It was only our government hospitals which were neglected in the era of privatization, that came to the rescue of We the People of India.
About 80% of the patients prior to lockdown were going to private healthcare especially because in the era of privatization governments neglected funding government hospitals. There have been instances when prestigious government hospitals with attached medical college, would not have even proper ECG machine. Patients are advised routinely to get medical tests and medicine from outside. From equipments to staff to drugs government hospitals always faced shortages.
Private doctors in even otherwise normal times charged heavily and large scale malpractice in terms of unnecessary investigations, drugs and surgeries is an open secret. We keep on getting reports in between and label it as some bad apples in the basket. With five star corporate hospitals on one hand to substandard small private hospitals, patients were suffering financially and in terms of healthcare.
But the corona has exposed the whole system fully. As soon as the lockdown was declared private hospitals shut down their shutters. They stop seeing or admitting even the non-Corona patients. And even the ambulance service which is 10 times more in private sector in most cities than government ambulances, stopped functioning. When they were forced to open for Covid patients we know how heavily they charged. Instances were reported when non-Covid patients were treated after bargaining for heavy charge to give treatment. So the greed for money was exposed like any other business.
Government hospitals were overburdened because of this and admitting mild patients of corona and institutional quarantine even of asymptomatic corona positive persons. Obviously some medical and other care was diverted for even asymptomatic persons. And with extra procedures for crematoriums and the patients who were dying all spread over the city, now dying only in government hospitals we saw piling up of dead bodies.
Let us all accept in spite of all this it was the government facilities created mainly after Independence till 1990s that is standing as our backbone in this crisis.The lesson that We The People of India have learnt from this is that health is such a sensitive and important part of our life that we cannot neglect it with private and public sectors running parallel. We have seen that in such a situation with number of factors playing part the public sector is neglected and private sector becomes more and more commercial. In the end public interest is not served. Some Charity Hospitals giving good services can always be integrated in the public health infrastructure created.
The pharma industry is an integral part of healthcare system. Not only for availability of medicine at affordable prices but also orientation of researches as per the need of the people. There are examples. Once BCG vaccine has been introduced in Universal Programme, further evaluation of its effectiveness, need to develop any other variety is never examined.
So when we demand nationalization of healthcare, pharma industry is included, to have the optimum, need based production and availability of medicines.
There is need for immediate takeover of private hospitals with reasonable compensation. Small clinics can be converted to govt mohalla clinicsWhat we need is one robust national healthcare system where all the resources of our country are channelized for the best care of our people. Of course the government will have to spend more. And for that government will have to tax rich people. For years they are given all tax benefits, subsidies, tax free periods, tax cuts, bailouts and host of other advantages. Superrich tax is one such but even otherwise tax slabs are too low for rich.
Lives of the people are far more important than the extra luxurious life for few. It is the experience world over that wherever the healthcare is nationalized with good governance, on one hand unnecessary investigations, medicines and surgeries are avoided but when required, it is always available.
For that we demand following:
- Immediate takeover of all private hospitals with reasonable compensation at depreciated value of assets. Small clinics can be converted to government mohalla clinics.
- Strengthen and expand the already existing chain of government health infrastructure from sub-centres in villages, primary healthcare centres, community healthcare centres to district level hospitals and multi-specialty hospitals.
- Enough doctors, nurses and other paramedical staff should be available at all the levels. A compulsory village level service is a must for all doctors before post graduation and then in rotation as per the need. Let us remember the resources of the country and poor patients are used for training the doctors.
- Let us pay a dignified handsome salary to doctors as well as all other medical staff. Class 1 salary and then as the experience and degree goes higher, the way IAS officers are given, they can go higher in the ladder.
- The most important part is the direct democratic control of people to oversee the functioning of healthcare system.
- A committee of hospital administration, doctors’ representative, other paramedical staff’s representatives and people’s representatives elected directly for this should be formed to solve day to day problems.
- The hospitals have to hold a public meeting every month to hear the suggestions, complains of people apart from complain and suggestion boxes. The boxes should also be opened in these meetings.
- Every patient should be offered a survey form (digital for those who can), about their experience after each visit the way many banks and other companies are doing it to improve performance.
- A strong suggestion is made to teach different practices of medicine, that is allopathy, homeopathy, ayurved and others at undergraduate level to all students and only at specialization level they do separate training. That way the best practices of all can be used for patients. Instead of mutually exclusive all these should become complementary. Today, the patient who is the least knowledgeable decides which practice she should choose for a particular sickness.
- Environment science and how different pathogens are entering from wild animals to human should become important part of curriculum.
KP Sasi’s view:
I totally agree with you that this is the right time to demand the strengthening of the public health care system, when the private sector has proven to be a failure, especially for the poor, in dealing with health care during the Carona crisis.
I still do not know whether the demand should be for nationalization at this moment or whether it should be a demand for 'strengthening the public health care system and implementing tighter control of the private sector'.
Because the private sector of health care is already a reality today and how do we deal with such a reality needs further discussions. There should also be more vigilance and control on the research conducted on health by the private companies, since most of them are oriented towards increasing their profits, rather than contributing to the health of the people.
The linkages between the private pharmaceutical companies and private hospitals cannot be ignored since both of them function within the framework of profits rather than service. In between, we also have a large number of charitable hospitals and some of them are also doing much better work than the Government hospitals. This would add to the confusion in order to take a non-compromising stand on this issue.
On the other hand, India does not even spend a small fraction of money spent on armaments. This certainly is a major contradiction. War becomes the priority than providing life to people to such an extent that even the language of health care seemed to change during the Carona days. The government was speaking about `war on Carona'.
It is high time that a more united and stronger resistance is generated against the manner in which health is treated as an industry rather than service. Only when the public sector is active, the people of this country can demand health as a `right' rather than as a `commodity'.
Because the private sector of health care is already a reality today and how do we deal with such a reality needs further discussions. There should also be more vigilance and control on the research conducted on health by the private companies, since most of them are oriented towards increasing their profits, rather than contributing to the health of the people.
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| KP Sasi |
On the other hand, India does not even spend a small fraction of money spent on armaments. This certainly is a major contradiction. War becomes the priority than providing life to people to such an extent that even the language of health care seemed to change during the Carona days. The government was speaking about `war on Carona'.
It is high time that a more united and stronger resistance is generated against the manner in which health is treated as an industry rather than service. Only when the public sector is active, the people of this country can demand health as a `right' rather than as a `commodity'.
In the above context, strengthening of the public health care system is definitely an urgent need. During the Covid-19 days, better results were found in places where better public health care system was functioning. Kerala is an example.
Comments
First of all I must thank you for initiating this mind churning discussion. It’s your response that has started discussion.
Let me make it clear right in the beginning that what is being proposed right now is that the huge resources of our country, material and human in private hands specially in allopathy, to be taken serve the public interest, because that resource is built by public money in the form of loans and used for many unnecessary investigations, drugs and surgeries.
What to do with good charity hospitals should be left to the people of that area. If people are happy with them, let them be. And whenever required they should be given more help and funds. They are a miniscule of the whole healthcare apparatus.
Big Ayurvedic and Homeopathy hospitals would come in the category of speciality or superspeciality hospitals, I am not sure how many but quite a lot of them would be government run even today. For that, basic doctors should know and understand these practices as scientific. Existing small private practitioners of indigenous medicines can be provided separate OPD at all levels of government hospitals, subcenters in villages, PHC to District level hospitals.
That is why I have suggested the need to learn all, allopathy, ayurved, and homeopathy, even Unani at undergraduate level by all students and do specialization in any of them at post graduate level. Today majority of the allopathic doctors do not recognize other branches as even scientific. Monetary interests play a major role in spreading this myth. This is in spite of AAYUSH department.
Right now Ayurvedic and Homeopathy students are given basic knowledge of Allopathy. Majority of them work in allopathic private nursing homes in the initial years. (There, the private allopathy doctors don’t mind using them as they have to pay less but on every other platform they don’t recognize them.)
But still let us be very clear, charity came in existence because the government abdicated its duty to provide healthcare to all, remote areas included. Some of them might be running very good but I have worked for three months in a very old charity hospital in the heart of the city where primary instruments for a gynecological inspection were not there in the OPD and the table also not suited to gynecological examination. Because I was young at that time some thought that because I am inexperienced I need more instruments! Many Charity hospitals feel funds crunch. And if they are not part of the robust healthcare system, how to monitor the standard there, is an issue. Poor patients going there would not understand this.
Also the way even poor feel empowered and understand their right in a government hospital, they would not demand in a charity hospital. Those who want to do charity can provide services in the government hospital, with their name on the board there. Drugs bill, payment of staff, anything they want to, after such ill-managed hospitals because of fund crunch are taken over by govermnet. But a uniform high standard treatment for all is the goal, and not different standard for poor and rich.
Demilitarization? yes. These days I am putting on all social media platforms whenever I get a chance, “People of China and India should pressurize their governments to stop all fighting. We want peace. All ice laden ecofragile region, full of glaciers be declared as No Wo/man’s Land. Let us remember poet Atal Behari Vajpayee’s poem, “Hum Jung Na Hone Denge”. Because the war or war- like situation is the ground for arms purchase and commission.
I agree Nationalization in Cuba came with revolution but even under the pressure of socialist countries nationalization was done in many capitalist countries and was running fine till 1990. After that, during liberalization this weakening of government institution started. But they are still much better.
Politics and healthcare are not two different entities. Not only the fact that politics is economics by other means, but BJP is having their doctors’ cell. The way women’s cell is to fulfill women’s demands, this works to fulfill their demand. Majority of private doctors are BJP members in Gujarat. Will they advise to strengthen the public sector? Other parties I don’t know.
After independence, like all other sectors, it was the government who was running hospitals in India and we already have a prescribed structure of primary, secondary and tertiary healthcare structure. The best equipments and best brains were supposed to be in government hospitals at that time. But like in every other field with the rise of private sector the public sector is neglected, big private sharks would not let the public institutions survive. All debates are managed with the intention to decrease government spending.
It works at many levels. Apart from policy levels, drugs meant for government hospitals being diverted to private hands (stolen), because private avenue to sell is available, a big anesthesia trolley being stolen from a hospital attached to a medical college. Who can use it?
Now comes compassion. There is a book named ‘Spirit Level’, the authors have done 40 years study of mainly developed countries (because of reliable data available) and concluded that empathy, trust towards fellow citizens is more where the inequality is less. Many other things were studied crime rates to teen pregnancy to death penalty.
I just recently met a doctor who has studied her medicine in China. Among other things I specifically asked about the behavior of doctors and other staff towards patients and she described it to be polite, human, full of empathy. So nationalized does not mean bad. They were crowded but neat and clean, patients being guided well and so on. She has finished her studies in 2013. Once the attraction of vulgar money earning is gone more people with service orientation would come to medicine. Also there will be superviosion.
Totally agree about health, environment and economics. I have mentioned even to include environmental science in medical education and beware of the corona and other pathogens have their origin in climate change, deforestation.
Let me tell one last thing that with this primary draft I am getting huge positive response on WhatsApp, Twitter and emails. Facebook just started. May add Instagram. The group here has people from different states and Hindi translation is already done. Gujarati and Tamil are about to get finished. A person in Mumbai just after reading it on site has offered to translate in Marathi. It’s not just the middle class. The staff here in a housekeeping contract is from UP, Bihar, Bengal and they all read it and say, “Sahi Aavaz Uthai Hai” I tell them to send the same to their native. Whatsapp has changed the world. My contacts from slum work have gone back to their native. I started sending to them from yesterday and awaiting response.
Two offers for arranging webinars one from Indore and one from Pune are in the pipeline. Local webinars in Gujarat are on. So people are ready. Some who were pucca Bhakts so far have responded positively.
Your publishing at Counterview.net has definitely helped.
We are also loosing a lot of medical students to other countries where the medical education is much cheaper. We could on the contrary be a doctors hub, just like the IT hub to provide doctors to world over.
In UK, USA and other advanced countries the fight between the people and the finance capital is getting severe, albeit in bursts, sometimes in form of massive rallies and protests over the health system. The National Health System (NHS) of UK is being eyed by the MNCs, and Trump, with the help of Boris Jonson wanted to usurp this massive industry/services. India is the next priority, even if not at number one, as it is one of the biggest market in the world, at par with education, insurance.
MNCs, other monopoly capitalists, financiers, petty bourgeois class, middlemen, their loyal political agents (no better than managers) lifeline is profit, without which they will lose the unending competition with the winning ‘entrepreneurs’ and will cease to even exist.
And health care system, world over is huge. The initial Coronavirus killed hundreds of thousands of people in Italy, Spain and even Brazil, UK, USA, India not because their medical services were of old era, in fact, they were very advanced but equally expensive, where the patients were objects of profit, and unable to pay the service charges & cost of medicines, bed and perished even if their governments ‘wanted’ to save them.
A line for the rabid anti socialist society rogues; nationalization is not socialism in capitalism, but an aid to the capitalist class, when it is unable to erect particular industry or sector, due lack of capital, technology and other wherewithal or save the working class to ensure steady flow of the workers to the capitalists in future, or on occasions, due tilt of balance of power in favor of the working class, in the ongoing class struggle.
“So when we demand nationalization of healthcare, pharma industry is included, to have the optimum, need based production and availability of medicines.”
And of course, as discussed in the article, for the right research works, on preventive medicine, patients, etc.
This article advocates nationalization of all the private hospitals, clinics, pharmaceuticals, etc. on “reasonable compensation”. The readers must understand, this demand is in synch with the liberals, social democrats, reformists, pseudo Lefts, etc. who are mortally scared of socialism. They perceive loss of private property (even though, they do not possess) as their loss of freedom to think!!
In building socialism, the expropriation of the capitalist class, financiers, bankers will be done as soon as possible, and WITHOUT any Compensation! And this can not be done, unless the state power is in the hands of the proletarian class, through its revolutionary party.
lacs. Charitable hospitals management be asked to take over dist rural hospitals or all govt hospitals .