In this article, Dr. Maya Valecha details the need for nationalisation of the Indian healthcare system in light of the failures of the current part-privatised system that the coronavirus situation highlighted. In Dr. Valecha’s formulation, these failures, in conjunction with older, systemic injustices require social change.
The corona era has exposed the fact that the private sector healthcare service is not only useless when it comes to the health care of the vast majority of poor people (which it is even during normal times), but also to the minority of rich people from whom it earned exorbitantly.
Only our government hospitals, which were neglected in the era of privatization, came to the rescue of We the People of India.
In the era of privatization, governments neglected government hospitals. This led to 80% of patients prior to lockdown being seen at private healthcare facilities.
From equipment to staff to drugs, government hospitals always faced shortages;there have been instances when prestigious government hospitals with attached medical colleges, did not even have basic medical equipment, such as ECG machines.
In the era of privatization, patients are advised routinely to get medical tests and medicine from outside their healthcare system. 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 in India.
We often hear reports about these things yet we label them as the exception rather than the rule; from five star corporate hospitals on one hand, to substandard small private hospitals, patients are suffering financially and in terms of healthcare.
Corona has fully exposed the whole racket. As soon as the lockdown was declared, private hospitals lowered their shutters. They even stopped seeing or admitting non-corona patients. The ambulance service, which has 10 times more in the private sector in most cities than government ambulances, stopped functioning. When forced to open for covid patients, private healthcare charged heavily for their services. As with any other business, their greed was exposed through Instances when non covid patients were only treated after bargaining with these hospitals.
large-scale malpractice in terms of unnecessary investigations, drugs and surgeries, is an open secret in India.
The sudden closure of private sector hospitals and the policy of admitting mild patients of corona as well as institutional quarantine of even asymptomatic corona positive people meant government hospitals were overburdened.
With extra procedures for crematoria and patients dying only in government hospitals instead of both government and private hospitals, we saw a piling up of dead bodies in certain areas.
In spite of all this, it was the government facilities created mainly after independence until the 1990s that stood as our backbone in this crisis.
The lessons we’ve learnt
Health is such a sensitive and important part of life that we cannot neglect it with private and public sectors running parallel. We have seen that when this happens, the public sector is neglected and the private sector becomes more and more dominant. The public interest is not served.
The pharmaceutical Industry is an integral part of the healthcare system. Not only for the availability of medicine at affordable prices but also for the orientation of research towards the need of the people. There are examples where this has not been the case.
Once the BCG vaccine was introduced in the Universal Immunisation Program of the Government of India, no further evaluation of its efficacy, or development of any other variety or tubercolosis vaccine was ever undertaken. Is this really the right course of action now that we have more than 1400 people dying of Tuberculosis daily?
In spite of the harm the administration of Oral Pulse Polio vaccine caused, it took years to change to a different mode of administration. Though an injectable polio vaccine is the safest for children, oral doses are universalized, because an injectable polio vaccine is more expensive
When we demand Nationalization of Healthcare, the Pharma Industry is included under the umbrella of Healthcare, so as to have the optimum, need based production and availability of medicines and vaccines.
What 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. For that, the government will have to tax rich people. For years the rich have been given tax benefits, subsidies, tax free periods, tax cuts, bailouts and a whole host of other advantages.
Because of the schemes like the Ayushman Bharat scheme or the Medical Insurance Schemes, poor people’s money is ultimately transferred to private drug companies and private doctors.
My citizenship of this country should be my permanent health insurance. No other insurance or premium should be necessary. It is possible to create a system where quality healthcare can be provided to all without any payment. It has been calculated that just the wealth and inheritance taxes can cover basic necessities like health, education, an old age pension and schemes for differently abled people.
The lives of ordinary people are far more important than a more luxurious life for a rich few. It is seen across the world that whenever healthcare is nationalized with good governance, unnecessary investigations, medicines and surgeries are avoided and proper treatment is always available.
- An immediate takeover of all private hospitals with reasonable compensation at depreciated value of assets. Small clinics can be converted to government Mohalla clinics.
- Strengthening and expansion of the existing chain of government health infrastructure from the Sub-Centers in villages, Primary Healthcare Centers, Community Healthcare Centers through to the District Level Hospitals and Multi-specialty Hospitals.
- That enough Doctors, Nurses and other paramedical staff should be available at all levels, from village to district. Compulsory village level service is a must for all doctors prior to graduation and then placed into their rotation as per need. Let us remember that the resources of the country and its tax-paying patients are used for training doctors.
- A dignified, handsome salary to government doctors as well as all other medical staff.
- Direct democratic control over the functioning of the healthcare system.
- A committee of hospital administration, doctors’ representatives, other paramedic staff representatives along with people’s representatives elected directly for the purpose of exercising democratic controls over the day-to-day running of the healthcare system.
- That hospitals have hold a public meeting every month to hear suggestions and complaints of those under their care.
- That every patient should be offered a survey form (digital for those who can), about their experience after each visit, similar to those used in banks and other companies, with a view to improving performance.
- The teaching different practices of medicine, that is Allopathy, Homeopathy, Ayurveda and others at the undergraduate level to all students. Only at specialization level should they do separate training. That way, best practice can be used for patients.
Instead of being mutually exclusive, all of these practices should become complementary. Currently, the patient, who is the least knowledgeable about their situation, decides which practice she should choose for a particular sickness. This must change.
- That environmental science should become an important part of the curriculum.
- That after the nationalization of pharma companies, all decisions be taken in a transparent manner. Where the administration of these companies is concerned, experts and administrators are consulted after open public discussions, leading to greater trust in their decisions.
A society-wide demand to force the government to do the above and in doing so, take the lives of ordinary people seriously is the only way to a secure future.