Millennium Post

Cure corruption in healthcare first

Cure corruption in healthcare first
Corruption in the healthcare sector is old news. So it comes as little surprise when a foreigner who has worked in the Indian medical system says, ‘kickbacks and bribes oil every part of the Indian healthcare machinery’.

Yet the observations made by Australian district medical officer David Berger, who has written an article in the British Medical Journal on his experience in working with an Indian hospital, has once again sparked a debate — both in the public and political domain — on how to fix the rampant corruption in the healthcare system.

The solutions are obvious, suggests Samiran Nundy, a senior doctor with Sir Ganga Ram Hospital in Delhi. ‘There is a need for collective will and it has to be backed with transparency in the system,’ he says. Instead, every time a scam is exposed, the government announces new steps, which seldom get implemented. A good example of the lack of collective will in reforming institutions is the Medical Council of India (MCI), which was embroiled in a scam in 2010. The statutory body was set up to ‘establish and maintain high standards of medical education and recognition of medical qualifications in India’. But its former president Ketan Desai was arrested for accepting bribe of Rs 2 crore from Gian Sagar Medical College in Patiala. As a knee-jerk reaction, the government dissolved the body while announcing in Parliament that it will bring in reforms. But in 2013, the government restored MCI without any reforms.

Ashutosh Mishra, executive director of the India chapter of Transparency International, thinks corruption in healthcare is thriving because of lack of transparency. In a 2006 survey conducted by Transparency International  it was found that every year people from below poverty line category in India shell out over Rs 10,000 crore as bribe for basic needs, including healthcare. The amount that is being wasted because of corruption is close to a third of what the government plans to spend in the sector (Rs 33,725 crore) in 2014-2015. Abhijit More, an activist with non-profit SATHI echoes Mishra’s sentiment. He says the government should make it mandatory for doctors to write detailed prescriptions with the diagnosis and the medicines prescribed. ‘Talking about lack of transparency, T Sunderaraman, joint convener of Jan Swasthya Abhiyan (JSA), says government health insurance scheme Rashtriya Swasthya Bima Yojna is a major source of corruption and needs redesigning. ‘Under the scheme, the beneficiaries should always be alerted about how much they are paying for treatment,’ he says.

Monitoring colleges
The process of individual corruption in private medical colleges begins early by charging capitation fees for entry to the MBBS course, writes Nundy in an editorial in Current Medicine Research and Practice. He believes corruption in medical education is the reason behind the worsening situation in healthcare.

India is the only country where sale of medical seats by private medical colleges is part of official policy. It means the ability to pay counts more than merit. The government, along with MCI, did try to ensure a minimum level of competence by mooting a National Eligibility-cum-Entrance Test as qualifying requirement for all students. But the idea was opposed by medical colleges and they got a stay from the Supreme Court in May 2013.

As per MCI, there are 27 medical universities in India. Of these, 14 are in the private sector. Till 30 June, there were 387 medical colleges, including six new AIIMS, in the country. Of these, 205 colleges are run by private players, informs Union health minister Harsh Vardhan, who admits to the problems in the education sector. “We are looking into how to improve medical education in the country and MCI’s reform is under serious consideration,” he said.

Ban on kickbacks
The other major issue is that the law is silent over the kickback culture, points out More. JSA has written a letter to the health ministry demanding that kickbacks be made illegal and seen as conflict of interest. Sundraraman says the government should include this in the existing Clinical Establishments (Registration and Regulation) Act, 2010 (CEA). The Act is the only effective initiative taken by the government so far to check malpractices. It calls for registration and regulation of all clinical establishments including public and private.

The new government recently said it is committed to the idea of health for all. The health minister on 22 July told Parliamment that his ministry is drawing up a panel of reputed medical practitioners and consumer law experts to suggest measures for introducing greater transparency in medical practices.

By arrangement with Down to Earth magazine
Kundan Pandey

Kundan Pandey

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