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The unholy health harvest

The unholy health harvest
Indian healthcare industry is ailing due to corruption and malpractices in the system. Helpless and prolonged tolerance to corruption has rendered the society to live with these corrupt practices. Government and people, in general, are not bothered anymore as they have become habituated to live in these conditions. Real condition of India’s health, as described in the WHO report, is quite disturbing. It shows that India’s health parametres are worse than many other developing countries like Sri Lanka and Iraq. According to the UN Human Development Index 2014, a child born in India today has less probability of survival than in Sri Lanka or Iraq, due to lack of health awareness in public, poverty, illiteracy, and malpractices in the healthcare system.

Prevalence of corruption in healthcare has multiple forms. The health problems faced by India’s poor population are caused not only by lack of drugs but also by prescription of substandard drugs by the doctors; the pharmaceutical companies lure the doctors for monetary and material gifts, and in the exchange have them to prescribe their substandard drugs. Although interaction between medical practitioners and industry is necessary to familiarise the doctors about the therapeutic qualities of new drugs, but such interaction almost always leads to corrupt practices like bribing and profit maximisation.

The influence of industry on physicians is an issue of concern in both developed and developing countries, but it can be particularly dangerous in developing countries where doctors make paltry salaries and may rely heavily on gifts (both monetary and material) from the pharmaceutical industry to supplement their livelihood. Corruption in this sector undermines quality of health services and health outputs. Vulnerable section of the society is victimised by the collusion of doctors and pharmaceutical industry. Substandard medicines weaken the immune system of the patient’s body and as a result of this a lot of non-curable diseases have chances to affect the patient. All this fills disbelief in the healthcare system in the mind of people and discourages them to go to evidence based therapy and instead motivates them to go for traditional and non-scientific therapy.

Many cases of hysterectomy (removal of a woman’s uterus by surgical operation) have been registered in rural India. Only after a woman’s ultrasound doctors tell them that their uterus was cancerous and needed to be removed, were they subsequently removed. And thus the greedy private medical practitioners perform unnecessary hysterectomies on rural women, and take advantage of weaker and illiterate people. Neo-liberal policy of United Nations is giving too much emphasis on privatisation of healthcare systems which provided a favorable environment for corruption.

This privatisation allowed  arbitrary behaviour of private hospitals fostering highly constrained environment in hospitals where patients have to pay illegal fees and doctors prescribe unnecessary medical test for their maximum profit. Inappropriate and irrational use of  high-tech and expensive diagnostic tests are widely prevalent in hospitals such as CT scan etc. The great scale of privatisation of healthcare sector is responsible for weaker position of vulnerable people.

Doctors working for government hospitals are getting paltry salaries in comparison to private doctors and this has increasingly allowed them to open private clinics, spend more time in their private clinics and consequently influence and refer patients to take treatment in their private clinics. Lack of effective monitoring systems by the government gives a chance to doctors to either be absent from duties or not be serious while performing their duties.

Lucrative government procurement contracts create potentiality to extract bribes which result in unnecessary over-consumption of unwanted substandard medicines and bribes, that leads to lack of necessary drugs, equipment or other materials. This further leads to unavailability of required resources at the time of need, outcome of which can lead to the usage of same syringes for many patients which in place of cure and prevention can cause diseases like AIDS and Hepatitis.

MCI (Medical Council of India) has recognised 355 medical colleges for 40,000 seats of MBBS admissions. The stake of  private colleges is less than half  here. The basis of admission in private colleges is high fees rather than merit. In such a situation there is no guarantee that India will have a pool of skilled and talented healthcare professionals.

Indian prenatal care services are neither qualitative nor easily accessible to all. Women suffer injuries, infections and disabilities during pregnancy or childbirth which in turn has lead the mortality ratio to be pegged at 560 deaths per 1,00,000 live births. This is comparatively worse than other countries. Inadequate healthcare services affect women’s health which has been stunted by chronic malnutrition and anemia. This causes India’s children to be underweight and generally rural children are likely two times more under-weight than urban children due to these inadequacies.

Dearth of ethical values in healthcare industries is shifting their paradigm ‘for service’ to ‘for profit’. Large stakes in Indian pharmaceutical business is captured by corporates making the  government, vulnerable on price and quality control of medicines. Privatisation is changing the social and economic order of society. Poverty and diseases have a correlation; poverty joggles mostly diseases such as TB, HIV, Diahrrea, Malaria etc. and  they in turn shove poverty. Over pricing of drugs by private pharmaceutical companies has resulted in multidrug resistance to TB. Because TB requires 9-12 months course for complete eradication, vulnerable economic condition does not allow them to have 9-12 months course of treatment, and this gap of medicine is resulting in TB becoming multi drugs resistant. Although government hospitals are also providing free medicines but their usage is causing side-effects  more than cure and prevention.

Lack of ethical practices leads to corruption and due to corruption unequal distribution of resources take place, which in turn becomes the basis point for poverty. Poverty, in turn, is realised in the form of lack of food, shelter, security and social protection etc., and makes people more vulnerable towards infections.

Links between lack of nutrition and infectious diseases are already well known. According to a Unicef (United Nations Children’s Fund) report, nearly 66 per cent of the Indian children are suffering from diarrhea due to lack of the ORS (Oral Rehydration Solution). Although the price of ORS is almost negligible but its availability and quality is a big concern in hospitals. Diarrhea can be eliminated by chlorinated water but government’s inadequate fund distribution and faulty implementation of national health programmes’ results inepidemics.
           
Indians continue to suffer from health problems and all these sufferings are caused by whatever that has been discussed above. All of the above mentioned causes can’t be eradicated until inadequate healthcare infrastructure, mismanaged healthcare system, political unwillingness, futile health policies and mismanagement are vanished. The national health mission, which accounts for about half of central government’s spending, has seen its allocation being reduced by Rs 2,679 crore.

Government has to change its mindset that spending on health is investment rather than wastage.

The author is assistant professor at Deshbandhu College, University of Delhi

Keshav Niranjan

Keshav Niranjan

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