The rape and murder of a doctor from Kolkata’s RG Kar Medical College sparked protests across the country. Currently, junior doctors in Kolkata are on hunger strike for nine days and their peers in other parts of the country have expressed their support through their symbolic strikes. The three striking doctors had to be admitted to hospital after their condition worsened. The State Government has so far punished many police officers and administrative officers.
Even during pauses in their unrest, health workers have been adamant that their issues have not been resolved. Their protest demanded, among other things, a complete overhaul of the health care system. They have reported working 36-hour days for little pay, having no proper restrooms or toilets, and being left at risk of workplace violence.
These working conditions of health workers are not limited to West Bengal. A report by the Indian Medical Association in 2018 said that 75% of doctors in India have experienced harassment or violence within health facilities or hospitals, mainly due to lack of infrastructure, medicines, long working hours, and excessive political interference. . However, successive governments, at the Center and in the States, have swept these pressing problems under the rug.
Problems with insurance
India’s declared expenditure on healthcare is only 2% of its GDP, compared to 5-10% in China and Brazil. The success story of Cuba’s health care system is based on its use of 14% of its doctors in health care. In India, continued government-led indifference to favorable government policies, along with long-standing substandard health infrastructure, has allowed the private sector to flourish at the expense of the public sector. From 8% in 1950, the private sector will account for nearly 70% of India’s healthcare market by 2024.
According to the National Sample Survey, treatment costs in private hospitals are seven times higher than those in public hospitals, yet only 14% of the rural population and 19% of the urban population have health insurance to help cover the resulting costs.
The results have been disastrous. Even as India’s per capita public sector spending on health care has steadily declined, out-of-pocket costs have risen. According to official data, for every 100 rupees a person spends on health care in India, he spends Rs 52 in savings, while the Central and State governments together contribute Rs 35. In comparison, citizens of Brazil and Cuba spend Rs. 22 and Rs. 8, respectively, out of their pockets.
A study by IIT Mandi published in December 2023 reported that the government’s most recommended health schemes – including the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and West Bengal’s ‘Swasthya Sathi’ – mainly pay for inpatient treatment but do not provide any outpatient care. services, with the latter accounting for 80% of total healthcare expenditure in India.
West Bengal is the second worst
Another result of this situation has been a corrupt conflict between certain profit-seeking doctors, corporate organizations, pharmaceutical companies and political traders who take advantage of patients who want timely and good quality care.
In an October 2021 report, the NITI Aayog estimated that the high cost of medical treatment has forced nearly 7% of the country’s population into poverty every year. The situation in West Bengal is worse considering that the state government’s expenditure on healthcare is only 1% of its gross domestic product. According to the Union Finance Ministry, 68% of health care expenditure in the state is out of pocket – the second highest in the country after Uttar Pradesh.
In addition, the World Health Organization has recommended that the health sector of any country should have at least one doctor for every thousand patients. In the last 77 years, India has never met this goal. The doctor-patient ratio in West Bengal is the same while Kerala has four doctors per 1,000 patients. Also, this measure alone does not fully explain the health care problem especially in Bengal.
The need for whistleblowers
First, the actual number of doctors and health care workers in rural health centers and community health centers is lower than in cities. Junior doctors complained that the allegations of the State government to build high-quality hospitals in different regions mean nothing because there are few health workers to monitor them and there are no essential medicines and equipment. Where there is some equipment, its use is constrained by a lack of skilled workers.
When newly recruited doctors are assigned to work in these institutions, they face the frustration of patients and their families because of the poor environment. This fact remains constant regardless of the ruling party. And again, this state of affairs is not only found in West Bengal.
According to the human rights organization Transparency International, corruption is bad for health. Of the $7.5 trillion spent worldwide on health care each year, nearly $500 billion is lost to corruption. It has also been estimated that one in five people is forced to bribe workers and officials to get medical help and that corruption is responsible for the death of 1.4 lakh children every year, with the poorest and most disadvantaged communities suffering the most.
The healthcare teams working in the hospitals of West Bengal are a good example of such corruption. As part of the proposed solutions, the Transparency International report calls on industry stakeholders and employees to come forward as whistleblowers to prevent corruption. Junior doctors and other agitators in Kolkata and other cities are currently speaking this role.
Loss due to corruption
Other schemes of the West Bengal government have also been completed. For example, as in ‘Swasthya Sathi’, Bengalis were interested in the ‘Kanyashree’ scheme when the State proposed it in 2013 to increase enrollment of girls in school using conditional funds. But a June 2023 study conducted by researchers from the University of Pennsylvania and the University of Kalyani (West Bengal) revealed that although the program had gotten more girls to enroll, they were learning less because – as in health care – there were no suitable classrooms or teachers.
West Bengal, like many other States, spends less than 3% of national GDP on education even as privatization in this sector has been growing since the 1990s.
In any healthy democracy, the government should be fully responsible for ensuring the basic rights of citizens, including education and health care. Paving the way for high health care costs and not improving the infrastructure and workforce is defeating this mission.
In a paper published in 2023 by The Lancettwo social science researchers have reported that the actual spending on health care in India has fallen to just 1.2% of GDP as the Central government has disputed this conclusion. Corruption also reduces the contribution of this population to health care services. It is not surprising then that the poor and disadvantaged are often forced to seek care in private institutions and risk poverty.
‘Bread for the price of precious stones’
In short, this is why it is important for Indian governments to listen to the complaints and demands of junior doctors. In line with the aspirations of the welfare state, the government should immediately increase its spending on health care and demonstrate its commitment to eradicating corruption.
Norman Bethune, a Canadian doctor who dedicated his life to serving the poor, traveled the world and cared for those in need during the Spanish Civil War and the Sino-Japanese conflict. He finally died in battle in 1939 while tending to Chinese soldiers. He was critical of the idea of ​​health management as a market commodity and said: “Treatment, as we do it, is a luxury business. We sell bread for the price of precious stones. Let’s take profit, private economic profit, out of medicine, and clean up our profession of cruel humanity. We don’t tell people ‘how much money do you have?’
Anindya Sarkar is a professor, Department of Geology and Geophysics, IIT Kharagpur.
Published – October 14, 2024 05:30 am IST
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