Are the policy makers only focusing on expanding public health services (NHP 2017) but without protection of those who compromise it? – A commentary
Post Graduate Student
Prasanna School of Public Health
Manipal Academy of Higher Education
“The idea that some lives matter less is the root of all that is wrong in the world.” – Paul Farmer
Health is a fundamental human right. Sadly, in a developing country like India, health has become more of a privilege due to multiple factors such as fewer hospitals to deal with the burden of NCD’S such as cancer, a poor doctor-patient ratio and the large urban-rural divide. While there are multiple government hospitals set up to cater to the low socio-economic classes, the burden on these hospitals is massive due to a poor doctor-patient and patient-beds ratio. In an ever-increasing population economy of 1.35 billion, wherein approximately 3% of people pay tax, it’s a huge amount that remains unaccounted for. As a result, there is a large amount of healthcare disparity and poor commitment to achieve the health for all targets.
Of late, the Modi government has been in the limelight for its work – be it swatch Bharat abhyan or ayushman Bharat. Also, the National health policy 2017 aimed at targeting health for all in terms of rural healthcare, starting rural medical colleges and more. But sadly, this is with the current statistics of only 2.5- 4% GDP involvement whereas the global average is 6%. (1) The lack of commitment at various levels, red tape and mismanagement of health resources still exists and thus any policy aimed to achieve goals is still in a lurch from achieving its expected targets. In lieu of the same, the target of these goals will fall on the existing health professionals, be it agreeing to rural postings or dealing with a massive overload of patients. If we aim to strengthen health systems with the existing infrastructure and a small number of medical colleges, there will definitely be a bias in functional delivery and utilization. Thus expanding health services without paying meticulous attention to the existing cripples will only add to additional issues and moreover not solve existing issues such a hospital /medical violence, a factor which deters many from getting into the medical field. With the rising cases of medical violence in India, how do we aim to expand health when we cannot protect those who frontier it?
Hospital Violence has been a rising issue for the past few years. Every now and then, health personnel are abused, hit and tortured due to a variety of reasons by the patient’s relatives. While some resort to massive strikes to deal with it, the long-term solution isn’t that. Rather, to solve the issue, we need to target the multi-factorial aspect of violence.
The past few years have been an economic blossom for India. With the rise of corporate hospitals, the mentality of physicians has changed from a charitable to a lucrative one. Though not necessarily deleterious, this change has drastically influenced people’s perception of physicians. There has also been a discord in the doctor-patient relationship. Additionally, the welfare model practised by government hospital establishments for low socioeconomic groups does provide services for all those who cannot afford it and don’t have any insurance but at the cost of one doctor seeing over 300 patients a day. This may lead to poor quality of care, patients feeling neglected due to lack of time given to explain something and frustration due to long waiting hours. Communication gaps, poor health literacy and mob mentality also add to violence in such situations. Thereby, the problem lies all across the ladder and without working on each of these it’s impossible to ensure an effective expansion of health services. Protection of health workers is a must and should be ensured. One cannot expect health personnel to deliver explicitly under the paradigm of violence. Long-term violence does deter the quality of work and hence it’s highly crucial that steps such as increasing security, increasing the medical seats for a better doctor-patient – ratio, increasing the health budget and changes in the existing IPC to make violence a cognizable offence with stringent punishment be taken. (2, 3) If the patient’s life is crucial, so is the life of the one attending to it. The all or none policy holds true for all.
So the next time we think of a health policy, an Ayushman Bharat …remember that it’s impossible for India to become Ayush without safeguarding those – the health personnel, who provide our government with their most vital global development indicator – the health index.
Paurush Ambesh.Violence against doctors in the Indian subcontinent: A rising bane. Indian Heart Journal.Volume68, Issue 5, September–October 2016, Pages 749-750
Neeraj Nagpal. Incidents of violence against doctors in India: Can these be prevented? THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 30, NO. 2, 2017.