JOIN USHidden cost of negligence in PHCs
Negligence in public health services is not new in India. Instances of lack of infrastructure and diagnostic facilities, non-availability of qualified medical personnel, corruption, poor management, absenteeism of staff, discrimination, rude behaviour of service provider etc, are reported quite often from various parts of the country. It has reached a level that such stories now not only fail to surprise us but normalise these humiliating events to an extent that we accept them as part of the public health system at great ease. What is often forgotten here is that public health services (PHCs) still are heavily used by the poor in the country since they are the only affordable and available options for them. The consequences of medical negligence, therefore, would obviously be more for the poor.
Unfortunately, many a time, such stories will not come out until it takes a massive toll since the sufferers are often voiceless, poor and marginalised. I would like to shed some light on the severity and magnitude of the consequences of negligence in public health services for the poor by drawing from an empirical study conducted in two villages, namely Meenkera and Boral in Bidar district. Our survey of 200 households in the villages showed that public health services continue to be the main healthcare option for all people in general and the poor and marginalised communities in particular in Boral and Meenkera. The general problems with the public health services that the respondents revealed relate mostly to poor infrastructure, lack of specialists and support staff, medical negligence and non-availability of prescribed medicines. While some of these are common problems, the consequences of the same were found to be varying for people across social and economic groups. For instance, the share of SCs and STs who reported having come across instances of medical negligence, apathy and avoidance behaviour in the study was notably higher than that of non-SC/STs.
While nearly 73% of SCs and 88% of STs felt that the doctor did not speak to them properly and spend adequate time in listening to their problems, only 27% of OBCs and 15% of forward caste groups felt so.
It was also found that although the facilities were limited and services were not ‘up to the mark’ in the public health centres and hospitals, those who were easily identified as “clean, educated, influential, rich and upper caste” received relatively better services than that of who are visibly “dirty, ignorant, poor and less powerful”. Likewise, while the poor, SCs and STs faced varying forms of medical negligence and discrimination, the dominant caste groups who were also politically powerful in the village, often managed to get better facilities from public healthcare facilities. The study showed that it was the forward castes and rich people who often get/make use of the facilities of specialist treatment at taluk hospitals, district hospitals and medical colleges since they possess the social capital and network support to influence ‘important people’ in the public health systems.
Medical negligence
The burden of medical negligence was found to be enormous for the poor in the two villages. The most common response from the poor and less educated belonging to SC/ST families was that they would tend to ignore the problem as it would be difficult to endure spells of prolonged treatment and the direct and indirect costs associated with travel and loss of wages for the patients and family members. This eventually led to worsening of disease conditions for them. The elderly, women and children from the poor and marginalised sections were the worse sufferers of medical negligence. They reported that they would either neglect their disease conditions or depend on home remedies since approaching public hospitals is a highly time-consuming affair for their family members.
The prolonged time for diagnosis and treatments due to delays and negligence in public health hospitals also have forced poor people to depend on RMPs (registered medical practitioners who can be ayurvedic doctors also) or even quacks. It is also reported that the RMPs would prescribe “effective injections”, which are mostly a higher doses of medicine for immediate relief. Although it is not desirable, the daily wage labourers, in order to avoid loss of wages, would take strong doses of medicine administered by RMPs, which in normal case would cost between Rs 20 and Rs 30 for the patient. In effect, the RMPs and small private clinics turn out to be less expensive options for the treatment of minor illnesses like fever, body pain etc, for poor people than the public hospitals.
The consequences of negligence hence appear to be huge for poor and the marginalised sections. It not only increases their spell of morbidity and suffering but also pushes them to the vicious cycle of debt, poverty and further illness as well. This is an important policy concern and what we need are focussed interventions to sensitise service providers in the public health delivery system.
(The writer is Assistant Professor, Institute for Social and Economic Change, Bengaluru; the article is drawn from a research study sponsored by the Indian Council of Social Science Research, New Delhi)