The Hindu : National : Exploitation, deceit plague healthcare, says Amartya Sen

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Sunday, Nov 20, 2005

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Exploitation, deceit plague healthcare, says Amartya Sen

Health servants prefer seeing patients privately for money: report

High charges ruin patients Public health service non-functioning Quacks fleecing ignorant patients

Amartya Sen

Kolkata : After his criticism of the poor state of primary education in two eastern States, Nobel laureate Amartya Sen has carried out another investigation into the healthcare sector which, he says, is reeling under "non-performance, exploitation and medical deceit."

In a stinging report brought out by the Pratichi (India) Trust run by him, Prof. Sen is baffled at the two widely acknowledged maladies in Indian medicare — "public health servants prefer seeing patients privately for money and quacks fleecing patients in exchange for providing nothing other than placebo satisfaction."

Survey in West Bengal, Jharkhand

The culmination of a survey among a cross-section of the rural population in West Bengal and Jharkhand, the Pratichi report, brought out recently, also speaks of the economic ruination of the poor who go into indebtedness and have to sell assets because of the high "charges" demanded by private practitioners.

"We found many cases in which the patients were economically strained — or even ruined — through high charges, sometimes for services falsely claimed to be curative like giving saline injections to deal with malaria," Prof. Sen says in the 134-page report.

In 24 villages that his team of investigators surveyed, the most immediate problem was the non-functioning of public health service, particularly in the Dumka region of Jharkhand.

The situation is much worse in the sub-centres.

"Alas, only 11 of the 18 sub-centres in Birbhum were actually functioning and the picture was much worse in Dumka, with only five of the 13 designated sub-centres working, and even those functioned with much irregularity."

The lack of basic facilities in the clinics that actually did function was the second problem the team encountered. "The availability of medicine is extremely limited in both districts. Some of the patients interviewed claimed that the Public Health Centre (PHC) and block PHC staff charged them money for medicines which were meant to be provided free as part of public health service."

A major fallout of the non-functioning of public health services was that patients were forced to go to private practitioners. "Sometimes, they are sent there by the public health servants themselves who in some cases seem to prefer seeing patients for money in private rather than for free as part of public service," Prof. Sen rues.

Another problem was ignorance among the patients, which allowed quacks and "miracle healers" to operate in the private sector.

On the neglect of basic healthcare knowledge, Prof. Sen says "the fact that some patients believe that faced with dehydration they should drink less rather than more water is an appalling example of this."

Neglect of AIDS awareness

To this, he adds the almost total neglect of awareness of AIDS as an epidemic, "the grip of which over India is expected to rise sharply."

The economist prescribes greater regulation and monitoring, something comparable to the "inspection system" of schools.

"Another policy possibility is much greater control and supervision of the activities of state sector doctors... When some citizens cannot even get free medical diagnoses or blood tests, or obtain basic medication for clearly identifiable substantial illnesses, there is something deeply wrong with the framework of state health services," says Prof. Sen. — PTI

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