Shutting down hospitals a whimsical decision


But, let’s look at the turn of events. The Pollution Control Board has been issuing directions for the last several months that the public health hospitals need to have effluent treatment plants installed soon, as otherwise the very wastes that are thrown out of the hospitals may cause several health problems.

It is an extremely vital issue from the public health point of view. But the government health authorities perhaps don’t think that the treatment plants are important and thus the board’s order was never brought to the notice of the concerned hospitals administrators.

The board, after waiting for a period of time, gave an ultimatum that the hospitals should be closed. While the hospital administrators happily denied receiving the orders from the board, they let the media know that they were being ‘harassed.’ There was a big hue and cry as to what would be the fate of the poor patients.

The board came up with a knee-jerk response that it did not really mean to close down the hospitals but was only highlighting the importance of its proposal. Now it’s all back to square one and this is how a crucial public health issue is treated.

But one fails to understand how a direction can be given to close down the hospitals. Is it one way of punishing the poor and the marginalised, as it is mostly these sections that patronise these hospitals? And why punish them when it was no fault of theirs that the hospitals failed to meet the pollution control norms?

The board should have seriously considered how to take the  hospital administrators to task and punish them. It was their duty (and they get paid handsomely) to ensure that these important public health issues were addressed. But unfortunately, nothing of that sort ever happened.

Now that the Lok Adalat has pronounced that it never wanted the hospital to be closed, everybody seems to be happy, except that the dangerous problem of medical pollution remains unaddressed.

Further victimisation
In the Indian context it is not difficult to find such bureaucratic, whimsical and non-conclusive actions. But the issue of closure of government hospitals needs a greater scrutiny. These are public institutions that are catering to the basic health needs of a vast majority of population which is most vulnerable to ill-health. And it is the poor who suffer the most and are often more in need of medical care. But unfortunately they are denied of it more often than not.

They just cannot afford treatment at the vast and expensive private healthcare outlets. It is beyond their reach. When the poor fall ill, where are they expected to go? Where will the hundreds of people with AIDS go for treatment? The closure of the public health institutions would have meant a last nail in the coffin for those surviving on the margin.
Let’s look at how the government addresses the health issues. The public health expenditure in India has declined from 1.3 per cent of the GDP in 1990 to 0.9 per cent of the GDP in 1999. According to a report by Oxfam, India has some of the lowest levels of investment in the public sector in the world, with less than 20 per cent of the government healthcare budget going to public sector hospitals and clinics, and life saving medicines.
The report titled ‘Blind optimism’ exposes the reality of healthcare for poor Indians thanks to the reality of a massively under-funded public sector and a growing unregulated, uncontrolled private sector. It shows the need to massively increase investment in public healthcare for all.

There is no evidence that private healthcare providers are any more responsive or any less corrupt than the public sector. Regulating private providers is exceptionally difficult even in rich countries. Fraud in the US healthcare system is estimated to cost between $12 and $23 billion per year.

Given this background, the present controversy is another  manifestation of the government’s apathy to the welfare of the poor. Added to this is the fact that the government itself is ‘regulated’ by the unseen hands of the private sector.
The government cannot turn its back on addressing serious problems of pollution, nor can it ignore the legitimate health needs of the poor and the needy. It is high time the UPA government at the Centre took up this issue at the national level and found an acceptable solution.

(The writer is president of Drug Action Forum, Karnataka)

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