The recent direction of the Supreme Court of India to government hospitals in Delhi to refer poor patients to private hospitals gains significance not only as one more pro-poor judicial pronouncement but also because it highlights one of the major contradictions in India's health care service: even as there has been a mushrooming of huge, well-equipped, multi-discipline hospitals in big cities serving the rich, thousands of rural India's poor patients have to go without even a semblance of medical care when they desperately need it.
A two-member bench of the apex court comprising Justice R.V. Raveendran and A.K. Patnayak said that private hospitals would provide the patients from the crowded government hospitals necessary treatment free of cost, pending the preparation of a scheme that would involve private hospitals in treating the poor. It is perhaps to find out how far the private hospitals are right in claiming that if they provide total free treatment to the poor they would become bankrupt. When one of the counsels of the private hospitals told the court that nobody was occupying the beds allotted for the poor, the Bench responded stating, “It means you are not welcoming anybody.”
The Bench was hearing an appeal filed by private hospitals against a 2007 judgment of the Delhi High Court, which directed the private hospitals to ensure free treatment to 10 per cent of in-patients and 25 per cent of outpatients. The High Court ruling made it mandatory for private hospitals on the ground that they had received subsidised land after giving an undertaking that the hospitals they built would provide free treatment to the economically weaker sections of the people.
The Supreme Court directed the Delhi government and the private hospitals to draw the necessary modalities for the purpose. During an earlier hearing of the appeal, the court came down heavily on the private hospitals. Stating that they behaved like “star hotels,” they were highly critical of these hospitals for collecting abnormal charges from the poor. They also took strong objection to their failure to honour their word and violation of the condition that the poor be given free treatment.
The Supreme Court's bold initiative should enthuse social activists, political parties, and the media to carry the message that there is an urgent need to strengthen the public health security system in the country so that deprived sections of the people could have greater access to medical assistance in time. Only recently Nobel laureate Amartya Sen warned that gigantic inequalities in access to healthcare would lead to poor health in general. Commending the splendid work done by human rights activist, Dr. Binayak Sen among tribal people, he said that inequality in access to healthcare was not only bad distribution of the overall health benefits; it also reduced the overall health benefit.
Practical, valuable suggestions
Many readers, in their response to the last column (“RTE: States can still do it with media backing,” July 18, 2011), have come out with practical suggestions to get the RTE enforced in its true spirit. Dr. A. Padmanabhan, a former Governor of Mizoram with long civil service experience, highlighted in his letter the urgent need to give adequate attention and importance to elementary education. His five-point suggestion will be of value to educational administrators in their efforts to put the school education back on the rails.
First, free night coaching classes for rural students could be organised by NGOs and others. Such classes were conducted by Village Development Sabhas or Sangams in the 1950s and 1960s. Secondly, frequent parent-teachers meetings could help everyone understand the needs of students and guide them on the right lines. Thirdly, a separate elementary education inspectorate must be set up in each Education District under the overall guidance and supervision of the District Collector and the District Education Officer. This inspectorate should visit schools more frequently, check on attendance, and ensure availability of the needed facilities, including mid-day meals. Fourthly, all elementary schools should have an adequate number of teachers and attendants. Finally, the media, NGOs, and public-spirited persons could play a vital role in addressing problems such as the high dropout rate, the poor quality of education, and non-fulfilment of the constitutional mandate that free and compulsory education be given to all children under 14.
Saji V. Nair (Kochi) emphasised in his e-mail that the States should provide free primary education to children, now that they could afford to do it without private sector help. Kerala's commendable achievement in this field was possible thanks to the vision of its political leaders. Government-run and state-aided schools also deserved acclaim for this. He also suggested a common curriculum for schools across the country.
Referring to the dearth of qualified teachers, Ritvik Chaturvedi (New Delhi) commented that the institution of teaching had been degraded to such an extent that teaching as a profession had become the last option for highly educated persons. Corruption and irregularities in examinations had devalued classroom teaching. Poor students found it difficult to study under such circumstances. In States such as Chhattisgarh that were affected by terrorist organisations, schools were being used for stationing policemen, he pointed out.
S.V. Venugopal (Chennai) in his e-mail saw the issue from a different perspective. He commented that the neo-liberal supporters targeted the school education with ulterior motives because they were fully aware that it was elementary education that shaped the future of children. Hence blatant commercialisation of education began at the pre-school level, he stated.