High and mighty must become stakeholders in public healthcare


When Union Home Minister Amit Shah was found to be Covid positive, he was wheeled into a fancy private hospital. Shah, who was back home post recovery, was then admitted to the All India Institute of Medical Sciences (AIIMS) in New Delhi when he complained of discomfort. Meanwhile, Delhi’s Health Minister Satyendar Jain successfully recovered after being taken ill by the coronavirus and is back at work. Some Central government ministers and a few state ministers too have been affected by the same virus. But other than being infected by the coronavirus, there is something that is common among all of them. It is the fact that they all chose to get treated at private hospitals, not at government ones.

This pattern is seen not just among politicians, but also among bureaucrats who control the numerous arms of the country’s apparatus, including healthcare. And it seems that this lack of confidence in the government hospital set-up does not stop with them. Even the doctors running many of these establishments seem to have reservations about using their services. In June, the Dean of Atal Bihari Vajpayee Institute of Medical Sciences, attached to the Ram Manohar Lohia (RML) hospital in Delhi, also chose to get treated for Covid-19 at a private hospital over his own institution!

What does this tell us about government-run hospitals and the public healthcare system in India? That those in power do not trust the very system they run or feel it is good enough for them. What message does this send? That these government-run services are okay for the praja, but not for the rajas.

So, why I am raising these questions? Maybe because I worked for a long time as a field reporter, a large part of which was spent writing about healthcare services, or the lack thereof, not just in the capital but also in other parts of the country. Many a time I have noticed an absence of interest in boosting the infrastructure and morale of government institutions by those in charge and in power.

Stakes, interest and investment

 It was not always like this. There was a time when all government servants, irrespective of their seniority, used government healthcare facilities. From Ministers to Members of Parliament, Secretaries to the Government of India to the youngest recruits — the rule was for everyone. Outside private facilities could only be accessed if a particular service was not available at the government institution, and after taking due permission. This meant that the beneficiaries had a stake in making the system work efficiently.

Take the Ram Manohar Lohia Hospital, for instance. It was once a top hospital in Delhi. It may have had its caste system with a “nursing home” section, mostly reserved for MPs and senior officials, but they were admitted and treated in the same hospital as the larger public and experienced it firsthand. And since they used its services, they had a personal stake in not just in keeping it running well but also in maintaining its standards.

 But this changed in the late 1990s. Under the Central Government Health Scheme (CGHS), the government allowed its beneficiaries to use private institutions authorized by the government for their healthcare needs. This coincided with the time when new corporate private hospitals were being set up in the big metros of the country. Now senior government functionaries who could access these new “five-star” facilities had more interest in facilitating these new entrants rather than strengthening their own system.

This meant a two-pronged onslaught on the prestigious government facilities. The setting up of new, wellendowed hospitals meant that doctors had a choice to work for better pay. While money was a big draw, the lack of good infrastructure also played a part. I know many doctors who left government hospitals because they did not have access to the latest technology to treat their patients. So, the lack of upgradation of state facilities and the pull of greater emoluments drained the government institutions of a substantial talent pool.

Over the years, all governments have been complicit in this process. The healthcare budget of India continues to be less than 2% of the GDP and a number of citizens, unfortunately even the poor, have to meet a large percentage of their healthcare needs out of their own money. Data has shown that the percentage of this personal or “out of pocket” spending is increasing each year for those accessing private healthcare. This figure is much less for those using public infrastructure. But with reduced and less trustworthy government health services available, citizens are often pushed towards the private option.

 In this scenario, should the government not be looking at strengthening its own system, rather than letting its money flow towards private operators who provide fewer services for more money? I don’t have the figure for how much money the CGHS has to dole out from its coffers to private healthcare providers each year, but over the years this doubtlessly large sum could have substantially helped augment the public health infrastructure.

This government may have raised certain controversies but it has done some good work in the health sector. New AIIMS’s have been announced with a few being established. New medical colleges are also coming up. Given that India has less than two doctors and 0.55 hospital beds per 1,000 people, this will help meet a long-pending need in the field. When Covid-19 struck, the government facilities were the first port of call as they should be. While some private institutions were forthcoming in the battle against this unprecedented pandemic, others had to be brought in line, often with some coercion.

Many of these private hospitals were given concessions by the government, in the form of subsidised land and other incentives when they were set-up, in the hope that along with making their profits they would also provide low-cost care for a small percentage of the needy. Those special facilities for the poor, as many reporters from my time onwards will testify, have fallen through the cracks. Nothing gets done at a private hospital without money or a bit of arm twisting as we saw during this pandemic. When even the government had to threaten some of them into reducing the cost of the treatment, how can we expect the poor or the uneducated to get their rightful due at these doors?

This is not this writer’s contention that private hospitals aren’t contributing to the healthcare sector. To be fair to them, today they handle a much larger burden of healthcare in India as compared to the government. They have a place and many in India and abroad who can pay for their services should certainly have the option.

 The case I am making is not against anyone but for a robust not-for profit public healthcare set-up which should be available to all. It is a call that was also made by the President of India in his speech on 15 August this year. He pointed out that “public health services helped the poor cope with the pandemic” and they need to be “strengthened and expanded”. This will need investment and many experts have called for an increased percentage of GDP spending. But I think it will also need something more personal — an involvement and a stakeholding in the system. This could be a good first step towards universal healthcare.

 The author is a journalist who writes under @rahrahirasta. com. Views expressed are personal.