As the Coronavirus invaded our country, our vulnerability in the health sector became apparent. No doubt, even countries with the best of infrastructure were unable to withstand the corona onslaught. Our home minister, tested Covid-19 positive preferred a private hospital to treat the infection. AIIMS is the best medical institution in the country. Patronizing a government hospital by the powerful in the country may boost public confidence of government hospitals but the fact is only a few of them really trust the public health care institutions.
In Goa, a MLA despite being Covid positive is treated for pulmonary infection at the Goa medical college, which is not a designated Covid hospital. He is there upon him giving in writing that he wants treatment at Goa’s premiere health care institution. That shows confidence in GMC. But as Covid deaths rise in the state, this sends a clear signal to the common man, that the state Covid hospital where many have died is ill-equipped.
Atal Behari Vajypayee and Manmohan Singh may be last of the powerful to repose faith by taking treatment at AIIMS. There could be number of reasons for a patient to take treatment in particular hospital. There are issues of security, privacy or proximity to certain medical professionals or it could be the distance or family worries as stated by Delhi’s health Minister. Finally it is all about patient’s confidence when it comes to medical treatment. The sick would always prefer the hospitals and doctors whom they trust.
We do not have enough health professionals and experts in government hospitals. The Government hospitals lack facilities and adequate infrastructure. Medicines, furniture and equipments are always in short supply. Public health care administration is as good as our general administration!
Inspite of the cost of treatment in private hospitals being obscene and despite knowing how the patients are fleeced unnecessarily by diagnostic tests, even the poor prefer private hospitals. The quality of government service is such that the government hospitals are shunned by people. There is a total trust deficit between government hospitals and the patients. The poor may even beg and borrow to go to a private hospital. Millions in this country are forced to turn to private hospitals only because of lack of quality in services at government hospitals. It is only the most vulnerable sections that depend on government hospitals. At the time of our independence about 15% used public health-care services, currently that figure has gone to about 55%.
By April this year, two thirds of the hospital beds were and 80 percent of country’s ventilators were in private hands. Over 60% of health professionals are in private sector. In the first few weeks of the pandemic, the private sector not only abandoned their responsibility of Covid combat but even withdrew from non-Covid services until certain state governments involved them by force of law. Despite all its failings, the public health care system emerged as the real warrior in the corona fight –back.
Various states mandated Covid-19 treatment in private hospitals and certain states even capped the unaffordable costs and the rate lists. But the state of Goa did precious little. The state which always boasted of health tourism with state of the art health facility, left it’s people with no choice except to go to a designated Covid hospital. The Goa chapter of the IMA has claimed non availability of senior experts in super specialties and non-availability of investigations like CT scan, MRI scan as major factors behind the covid deaths. It only exposes the poor preparedness to meet the challenge posed by the virus invasion. May be if private hospitals were also involved earlier or some private hospitals were designated as Covid hospitals or the comorbidity patients were treated like the fortunate MLA, many lives could have been saved.
The situation of overdependence on the private sector has been due to our country spending about 1.28% of the country’s GDP on healthcare and family planning schemes. Even countries like Indonesia and Sri-Lanka spends more than us in GDP terms. The Covid-19 pandemic is an opportunity to have a re-look at our spending on public health system and the pandemic must be used as a game changer. It’s great wake up call for developing countries which spent little on health care.
The hands of the Corona warriors need to be strengthened. The country must invest more on health so that quality of health services improve and public develops confidence. Trust and faith in public institutions come in only when they are efficiently run. We are fortunate that our GMC still commands trust of people. We have two district hospitals with great infrastructure. The South District hospital is not fully operational except for medicine ward and OPDs. For unknown reasons, the two floors of the building are not put to use. The lockdown period was deliberately frittered away for reasons best known to the health minister.
As privatization sets in services bit by bit, the fear of even hospital services being privatized looms large. The way corporate health sector behaved during the Corona pandemic holds lessons for the future. They have failed the country at a crucial time. In present times, when sick public sector enterprises are being privatized as part of liberal economic reforms, health sector needs special protection. Healthcare cannot be left to market forces. It is a part of social justice and it ought administered in public interest with no profit motive. The South Goa District hospital must be protected from the winds of privatization and predatory tendencies.
(The writer is a practicing advocate, senior faculty in law and political analyst)