In my previous articles I had tried to enunciate the fact that, in spite of the massive onslaught of the Covid-19 pandemic, the administration would definitely lack forethought both on the state level and private medical establishments at the corporate level.
The reasons were also elucidated for the visible and naked failure of the whole medical system. Nevertheless, it would not be corrected in any near future because the fundamental defect lies in the unholy corporate-political nexus which will not allow the course correction to happen and maintain its prominence as a prime driver of the irrelevant and sometimes harmful health care for the people.
Even after the disaster like situation happening in front of everyone’s eyes, in which scores losing lives due to lack of oxygen, beds, ICU infrastructure, etc happened, there is not a single proper introspection into the fundamentals of the economics of health care in this country, not only in the government side (which is of course blindly pursuing neo-liberal economics of policy appeasement for the sake of international finance capital) but even the so-called corporate giants in the medical sector are mum.
Against this backdrop, it is very essential to expose the facts about the medical infrastructure in this country, so as to know who or what is at fault or whether any fault is even there in the medical system of this country.
Firstly we should know who is what in terms of economics terminology in the health care sector of the country.
–Government – supposed to provide health care to all as a fundamental right of the citizens.
–Corporate health sector establishments- supposed to be regulated by the government so as to function for the sake of the health problems of the country (instead of for – profits or investor returns)
–Global finance capital in health care- wants to invest in lucrative areas irrelevant to public health like cosmetic gynecology etc but is weary of the responsibility towards public health needs of a country it invests into.
–Global charity- funds are frequently raised through charity and many organizations for example medicine sans frontiers do very commendable job but it basically takes the responsibility off the heads of the actual people who are supposed to be doing it–the government.
–The doctors – there are two types of them – owners of hospitals and workers in a hospital – both can be called petty producers of health care service about whom no one is bothered to either help or invest into but definitely want to regulate through draconian laws like the PCPNDT etc to indirectly benefit the corporate sector.
–Other paramedical staff- the training standards of the paramedical staff is appalling and they almost need constant upkeep of their skills and training on job and due to exploitative conditions of work (both in corporate and government sector) they are usually a demotivated force.
–The aspect of capitalism in health care and surplus production – all industry need surplus production to gain profits and even to be relevant in a capitalist world, hence all health care personnel especially in corporate sector are asked to achieve targets so as to generate returns so as to run viably and give profits for the investors and be able to grow with possible further investment.
–The patient or common man- most of the lower strata of the society have no access to any form of basic health care because even the 1947 recommendations of doctor patient ratio for the population of the country had not been met even now.
–Medical education sector – usually invested into by local rich politicians and those who can manipulate the regulatory agencies to allow for commercialized education which dispenses degrees for money. Government colleges suffer due to lack of infrastructure in most cases partly due to corruption and partly due to political control at the top level.
–The general masses- most of the Indian masses at least 60 per cent are school dropouts and lack any insight into the situation and are at the mercy of the system and sheer luck ( repeatedly referred to as “god’s mercy” or “Bhagwan bharosa” by the high court’s and Supreme Court of the country).
In this backdrop of a system in which the health care delivery sector if considered as an essential service and part of a larger economy there needs to be considered how the dynamics of the various elements in this have contributed to the present crisis.
Any course correction in that direction can help but if the situation is made to look like a war zone where chaos rules and there is only blame game on each other’s inside the democratic setup itself, then it would be more like a family member quarreling with each other whereas the root cause could be a defective society at large which needs correction.
Firstly primary secondary tertiary and research education need to be focused on to make the society a completely reliable educated society conscious of the problems of itself so as to be no mercy at the defects of the system.
Secondly, the government and bureaucracy need to become more sensitive to the health needs of the country.
Thirdly, an independent organization accountable to the Supreme Court and the president needs to be established.
The organization will develop and train and put in place educated and trained medical manpower which is motivated to serve the country including a pharma sector which is for service to people rather than profits.
It is also accountable for the quality of medicines to its regulatory authorities, just like the corrupted medical council of India is now being replaced by the national medical council; the pharma regulatory bodies need to be fully revamped.
Doctors at all levels including the petty producers of the service in small hospitals and clinics need to be actively supported and private investment to be regulated by the government to compulsorily invest in the rural and deficient areas.
Corporate health giants need to be accountable at times of crisis as they were allotted land and given sops from the government side.
Government hospital infrastructure needs urgent improvement and also staffing with motivated manpower.
Global capital finance in health care also to be regulated with the aim to help the country’s possible health crisis (present and future) rather than for its own whims and fancies.
The preventive and social medicine units of all medical colleges to generate reports of areas of public health deficiencies into which a serious look is given so as to tackle all health issues in a holistic sense rather than knee-jerk reactions of pandemics and then forgetting the whole thing.
If necessary this may be considered as a war-like situation wherein the only difference is that instead of conventional war which helped the fascists to come out of the Great Depression of the 1930s the present neo-fascists states across the globe are nevertheless getting support out of a biological war of ongoing nature wherein the dead are not even getting the status of martyrs.
Dr (Maj) Haricharan Tk is a gynecologist based in Bangalore. He can be reached at: [email protected]