Roadmap for accessibility

Hands that serve are holier than the lips that pray. Medical care is one of the most essential needs, and those providing it are the noblest hands of all. No doubt there has been a lot of improvement in health systems; however, with our vast population, certain more modifications are needed, inter alia carrying the best and cheapest services to the remotest parts of the country.

Health is one of the fundamental human rights. Article 21 of the Constitution of India guarantees the fundamental right to life and personal liberty. The right to health is inherent to life. Article 47 states that it is the duty of the State to raise the level of nutrition and the standard of living as well as to improve public health. The 1948 Universal Declaration of Human Rights mentioned health as part of the right to an adequate standard of living. It was also recognised as a human right in 1966 in the International Covenant on Economic, Social and Cultural Rights. The Supreme Court, in Bandhua Mukti Morcha vs. UOI, inter alia said the right to live with human dignity enshrined in Article 21 derives its life breath from the Directive Principles of State Policy and therefore must include the protection of the health and strength of workers, men and women, and the tender age of children against abuse, etc. The Apex court said these are the minimum requirements that must exist to enable a person to live with human dignity.

While we have some of the best doctors in government hospitals, there is a lack of appropriate support staff in certain places, which doctors have complained about on several occasions. It is interesting to note that many of the regular employees in government hospitals have equal or even better pay structures than those in some private hospitals and nursing homes. The staff-level regular employees receive perks, etc., which are not available in many private institutes. In fact, there are pending litigations wherein employees of private hospitals have been urging to be paid equivalent to government employees. Perks, job security, lenient policies with respect to leave, etc., in the government sector are well-known. With all these facilities, it is important that there is well-regulated control over the performance of the personnel. In the healthcare organisation, strict rules must be established to address misconduct such as rude behaviour towards patients, indiscipline, and insubordination. While there are existing service rules, their implementation is lacking. To enhance execution, it is recommended to have a clear-cut strategy, including mandatory time-bound inquiries in case of persistent patient complaints. Essentially, a robust policy is required.

Owing to poor services by regular staff, many healthcare institutions, including both private and public ones, have outsourced some of their activities, thus employing contract laborers. In the event of deficient service, the contractor is expected to take immediate corrective measures, including staff changes. It's worth noting that regular employees, who are paid significantly higher salaries, are expected to deliver a higher degree of performance, especially when funded by public taxes.

Transparency and effective regulation are essential components of the healthcare system. A thorough and periodic check of operations is necessary, with employee records being maintained both manually and digitally. These records should include frequent performance appraisals. In cases of misconduct such as non-performance, unauthorised absenteeism, or indiscipline, memos, warnings, or show-cause notices should be issued promptly. Moreover, in cases of disciplinary action, there should be a fair opportunity for a hearing and full compliance with the principles of natural justice to ensure that innocent individuals are not made scapegoats. Adequate protection for whistleblowers is also crucial.

A lot of hue and cry in government hospitals is about the lack of infrastructure and machinery. Those who fail to take appropriate steps and action should be held accountable and provide explanations. Furthermore, there is a need to assign doctors and medical staff to remote areas. The formulation of policies providing better incentives to doctors and staff working in such areas can be considered.

In our country, there are hospitals associated with spiritual institutions that lack accounting sections. There could also be opportunities for integration and occasional learning from such institutions. The health of the nation is of paramount importance for its prosperity.

The writer is a practising Advocate in Supreme Court and High Court of Delhi. Views expressed are personal