Odisha’s Institute of Medical Sciences and SUM Hospital mishap appears like a shrill alarm. The country’s comatose health system is in desperate need of a lifeline. The hospital accident should not be considered merely as another case of negligence in the long history of medical tragedies in India. Hospitals cannot be graveyards.
Is Right to Health the answer to all our ills? Will medical disasters end once every citizen enjoys healthcare as a fundamental right?
The NDA government has, in its draft National Health Policy 2015, proposed a "National Health Rights Act, which will ensure health as a fundamental right, whose denial will be justifiable". Undoubtedly, the merits of such a legislation cannot be denied. Countries like Brazil and Thailand got more teeth to implement universal healthcare due to the presence of such laws. We also have the success stories offered by our own Right to Education Act (2010) that has contributed substantially to the increasing literacy rates and making education more accessible and inclusive.
But the road to legislation still appears very long, and may not address all the challenges of the health system. The SUM Hospital tragedy has once again put the spotlight on the government’s commitment to healthcare.
India, according to the World Health Organisation, accounts for 21 percent of the world’s global burden of diseases. It witnesses the highest number of maternal, newborn and child deaths in the world. Nearly 36 percent Indians suffer from depression in a nation that has 0.47 psychologists per million people. For an Indian, the probability of dying, between ages 30 and 70, from four major non-communicable diseases (cancers, cardiovascular diseases, chronic respiratory diseases and diabetes) is close to 26 percent. One World Bank report (2010) even argues that we lose close to six percent of our GDP every year due to premature deaths and preventable illnesses.
The SUM Hospital fire has exposed the fragile health system of our country. Initial investigations have revealed that this super speciality hospital did not have a fire clearance certificate even though it has been operational for almost a decade. Its website claims that it provides "global standard health care services", yet the 750-bed hospital did not have a functional sprinkler system to fight the fire. Its staff too was untrained to handle an emergency of that scale and magnitude.
A large number of hospitals across the country (several private and some government) lack functional sprinkler systems. For decades, we have been struggling with overcrowded, understaffed, poorly maintained and appallingly unhygienic government hospitals. Twin-sharing of beds is today an accepted norm in many government hospitals.
Since the early 1990s, the private sector has been touted as the only alternative to India’s healthcare crisis. But in the absence of a clear regulatory mechanism, the performance of private hospitals has been both terrible and terrifying. In 2011, nearly 90 people died in a huge fire in AMRI Hospital, a Kolkata private hospital. In June 2016, an inter-state kidney racket was busted in Apollo Hospital, New Delhi. In September 2016, a private hospital, along with two orthopaedics, was asked to pay Rs 25 lakh to a patient who had suffered 40 percent disability due to medical negligence.
A healthcare system is not just about accessing hospital care. It is also about identifying strategies to reach certain, definite health goals. These strategies may involve multiple services/activities ranging from prevention of diseases (immunisation campaigns), insecticide spraying against vector-borne diseases, printing horrific pictures on cigarette packets to deter smokers, ensuring safe abortions, keeping a check on drug pricing and to even distributing condoms. A health system has multiple stakeholders – policymakers, medical practitioners, health volunteers, industrialists, researchers, nurses, midwives, alternative medicine practitioners, and most importantly, patients.
In recent years, successive governments have demonstrated their inability to grasp the key challenges of the health sector – how to make healthcare universal, of better quality and thereby reduce inequality.
Since 2000, there is a growing concern about the government's dwindling commitment in providing basic healthcare to its citizens. Take India’s expenditure on health. It is just four percent of GDP and public expenditure is only 1.2 percent of GDP. This implies that between 60-70 percent of the population's medical needs are met by the private sector.
The proposed National Health Policy has made no radical shift in its budgetary allocations. The current government has proposed 2.5 percent of the GDP (WHO recommends 5 percent for a better health system) as a "realistic" figure to achieve health goals. This implies that even after 70 years of independence, tribal regions are likely to be neglected and basic immunisation services will continue to be inadequate for both urban and rural poor.
In its much-debated World Health Report 2000: Health Systems, Improving Performances, WHO ranked India as 112 out of 191 countries in health systems. France and Italy topped the list. A host of smaller countries – Ecuador, Syria, Armenia, Azerbaijan, Iraq, Sri Lanka, Bangladesh – fared better than India.
WHO has not conducted another such study but experts state that the ranking would not be dramatically different today as successive governments have failed in protecting citizens against the financial costs of illnesses. Indians today struggle with a huge "out-of-pocket healthcare expenditures" that does not even guarantee quality care. Even the National Health Policy 2015 admits that this expenditure is "catastrophic", draining family incomes and neutralising the gains in income increases.
Unless the government considers its citizens' health as a critical national asset, the health system will continue to remain unplugged.
The author is a senior journalist and teaches at the Apeejay Stya University, Gurugram, Haryana.
Updated Date: Oct 21, 2016 11:30 AM