Village Belle

Indian health minister Anbumani Ramadoss recently said,

“The government has subsidized medical education in India. While studying in private colleges may cost Rs 4 lakh, the annual tuition fee of a medical student in a government college is just Rs 4,000 in Tamil Nadu. In AIIMS, it is just Rs 210 while in JIPMER it is Rs 125. So by asking them to serve India’s poor for just a year, we aren’t asking too much. Moreover, the stint will help them gain experience.”

According to the officials, MBBS doctors will have to spend four months each in a primary health center, community health center and district hospital. They will be paid a monthly stipend of Rs 10,000.

The World Health Organization(WHO) recognizes health as a basic human right. That means, every individual, irrespective of their caste, creed, religion, social and financial status, has a right to good health care. The WHO defines health as “the state of complete physical, mental and social well being and not merely an absence of disease and infirmity. [1948]”

From this definition, it can be clearly understood that, health is not a natural phenomenon, that is the health of a person is almost always in deteriorating condition until and unless proper action is taken to maintain it. Furthermore, to convert the diseased society into a healthy one, a large amount of money and human resources are required.

To realize the right to health, in Alma Ata declaration, the concept of primary health care was introduced. Primary Health care is defined as “the essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of development in the spirit of self-determination. [Declaration of Alma Ata, USSR, 1978.]”

So, the liability of providing the health care for the community lies with the community itself.

Indian Government introduced National rural health Mission[NRHM] in 2004 to realize the unfulfilled aspects of primary health care.

Let us look in to this matter a bit.

The concept of primary health care introduced so as to realize the right to health. But, health care is a service which requires service providers such as Doctors, nurses, laboratory-technicians, health workers and lastly, the research scholars.

From time immemorial , the physicians has always belonged to the strata of the most knowledgeable men in society. Physicians were great philosophers, mathematicians, and often social pioneers. In classical age, there were no distinction between a philosopher scholar or a physician. Society trusted its brightest and most enlightened men to serve as doctors. With the advent of modern technologies, the earlier philosopher physician, to whom medicine was just another way of understanding the world was replaced by a more dedicated and specialized physician. The result was an increase in the health expenditure. Today with the latest technology at disposal we have come to an age where there are specialists for almost every organ and every disease They devote almost half of their life in learning the process. And hence, the cost of health services has touched the sky.

But the government regards its subjects as resources, the human resources. The output from these resources is directly related to the health and happiness of their subjects. Health is an important deciding factor of citizen mood. So maintaining a healthy society is one of the most important objectives of the government. The government does this by categorizing health as one of the human rights.

How can a government force the service providers to serve in realizing this right? The service providers are, by the virtue of human nature, more prone to be profit oriented than to try to help the society into becoming a healthy society. Though the division between profit and common goal is non-existent, it is created by the government to assert its importance in providing the essential human requirements. Government proclaims that no provider will willingly provide health care to the poor.

In its effort to control the providers, it controls their education, i.e, it controls the service which they utilize. The government is the sole provider of training for the health professionals, and it controls them by giving this training at a subsidized cost. The government has not allowed a private boom in the medical education sector through the guidelines and actions of Medical Council of India(MCI), its working hand. The government argues that the quality of education will be degraded if it allows a boom in this sector. So what is the result?

Almost all the competent doctors are produced from a government institution, and they have made a bond of five years of service in government run health centers. Thus the government is controlling the health care providers.

Why is the government interested in adopting this new policy of appointing fresh graduates as trainees without actually employing them despite of the fact that it has a five year bond with every graduate?

The government clearly understands that it is beyond its payable capacity to employ doctors to fill up all the positions and improve the quality of health care provided. So, the government of India is handing the life and death matters of its beloved citizens to the under-trained graduates from its sub-standard medical institutions, and all that at a price of Rs 10,000($250) per doctor per month.

Even the junior most employee working at a Business Process Outsourcing(BPO) Office in Bangalore or Hyderabad earns more than this trainee. So, its clear the doctors are not willing to go for such a deal. Therefore the health minister of India cites humanitarian grounds to solve this issue and he makes it mandatory for the doctors who are willing to go for higher studies to serve in his rural PHCs for peanuts.

The important point is that the medical graduates from a foreign university would not need this rural stint to practice in India. This discrimination illustrates the government’s desire to eat the cake without having it.

Lets see what opening up of sector can do for us.

A privatized medical education system would result in opening of a number of private medical schools, and therefore the number of MBBS graduates graduating every year will increase thousandfold. Liberalizing the medical education system will also decrease the cost of medical education in addition to increasing the quality of the service provided.

In the present scenario those who can afford better quality health care almost always prefer private hospitals to government hospitals. Unfortunately, these are the same people paying the tax money used to subsidize the health care. It means that, the honest taxpayers paying for the subsidized health care are have to again buy it from private providers. The government argues that it is not forcing them to seek private health care, but they are choosing themselves to go to private health care. Unfortunately because of the high rush at the government hospitals, the low quality of service, and the huge back log of patients forces them to seek private health care. So, although the government is not encouraging the taxpayers to opt for private providers, they are discouraged by the condition of public providers.

A doctor working in a out patient department of a government hospital is examining almost 70 patients per hour. This rate of work will invariably result into mistakes on the part of the doctor. In additin to that the consumer is under the security of a consumer protection act which holds the doctor responsible for mistakes committed by him. The doctor is in a no win situation and hence has a little interest in a government job.

Under “Janani Suraksha Yojana” the government has decided to pay the BPL over 19 mothers according to the following scheme:

In Low performing states,

• Mother: Rs. 700 Accredited Health Worker( ASHA) Rs. 600 in rural areas and
• Mother: Rs. 600 Accredited Health Worker( ASHA) Rs. 200 in Urban areas,

up to 3 deliveries and another Rs. 1500 would be provided in case of a Cesarean section.

In High performing areas,

• Mother: Rs. 700/-

All this in a country that is facing population problems
The Indian government has been messing up the Indian health care system for a long time, and it can be clearly demonstrated by an assessment of failures of every health policies of the government. these policies failed due to unrealistic goals, faulty planning and uncoordinated use of available resources. Just when you thought that people might be now fed up of the government, or at least the government has finally realized its mistake, it comes with a brave savior’s face, its socialist health minister is trying to do what socialists have been trying to do for centuries, that is sacrificing the capable for the incapable.

India is now spending millions of rupees on the development of a dead rural health care system and on building up the infrastructure, without paying the producers.

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