On the face of it, the burgeoning healthcare industry is doing well; it employs thousands of young graduates, the corporate structures have brought with them a notion of efficiency and quality, never mind the exorbitant price tag. Yet, beneath the plush facade are the lived realities of thousands of nurses, who, far from benefiting from this boom, grapple with abysmally low wages, and poor and stressful working conditions.
While the proliferation of the private sector made salaries of doctors and technicians more competitive, nurses have been largely left out of this growth story. A quick survey of salaries in leading private hospitals across the city reveals that the average take-home salary for a junior staff nurse ranges between Rs. 4,300 and Rs. 7,000. This just about meets the State-stipulated minimum wage requirement, pegged at a basic salary of around Rs. 4,500 for a staff nurse. In tier-II hospitals and smaller nursing homes, the situation is grimmer with nurses — mostly diploma holders and auxiliary nurse midwives (ANMs) — paid between Rs. 2,500 and Rs. 4,000. While 1.57 lakh ANMs and diploma nurses work in these smaller hospitals across Karnataka, there are 45,560 registered graduate nurses.
Though their counterparts in government hospitals — where entry level salaries are around Rs. 16,000 — are better off, increasing employment of contract labour in public hospitals has led to a sharp decline in recruitments to government posts. Here too, these nurses, hired on annual contracts, are paid Rs. 7,000, with little by way of benefits or job security. At Victoria Hospital, for instance, only 105 of the 145 sanctioned nurse posts are filled. Despite the hospital's expansion, the number of posts have remained the same. Instead, 101 contract nurses have been hired, and several senior posts remain unfilled. The situation is similar at Vani Vilas hospital where out of 105 sanctioned staff nurse posts, barely 45 are filled, and 94 employed on contract. In all, there are 800 vacancies in nurse posts in the four leading government hospitals.
Sheela, a government staff nurse at Victoria Hospital, says that as teaching hospitals are now autonomous, the management has decided to run the show on contracts. “This is unfair because contract workers are paid a pittance, and that too for doing the same work. Senior posts remain vacant, increasing the work load on regular nurses,” she says. On an average, nurses say, government hospitals have one nurse for every 30 patients (one ward); in some wards this goes up to 50. Ratnamma, a senior staff nurse at Vani Vilas hospital, says basic amenities such as a common rest room and changing area are missing. Often, they are forced to quickly change in patients' rooms, something she describes as “a constantly humiliating” experience.
Private hospitals far worse
Yet, Ms. Ratnamma concedes that things are far worse in private hospitals. Her sister, who works at a leading private hospital, is paid Rs. 5,500, from which hostel and canteen charges are deducted. Like most graduate nurses, she too has a hefty loan to pay off, and is biding her time in a corporate hospital only to get that all-important “two-year experience certificate” to be able to apply for jobs abroad. “How can I repay my loan with the pittance they pay us?” she asks.
Most hospitals make young nurses sign a two-year bond that includes confiscation of certificates and a surety amount ranging between Rs. 50,000 and Rs. 2 lakh (this despite repeated circulars from the Indian Nursing Council against the bond system). Desperate for jobs after a four-year course, young graduates blindly sign whatever bonds they are presented with, and agree to work for embarrassingly low salaries. Most of the young nurses The Hindu spoke with had hefty education loans to repay (to the tune of Rs. 4 to 5 lakh) and not getting a job was simply not an option.
This is why the story of Beena Baby, a nurse at a private Mumbai hospital who ended her life because she could not repay her loan and was not allowed to move to a better paying job due to a three-year bond, struck a chord among nurses across the country. Nurses, a largely unorganised lot in an unregulated industry, staged protests against private hospitals in many cities — many of them were coordinated on the popular social networking site Facebook.
When, last month, over 500 staff nurses at the plush, super-speciality Manipal Hospital struck work, top doctors in Bangalore reacted, terming their agitation “illegal” (under the Essential Services Maintenance Act), “unprofessional”, even “non-compassionate”. Other veiled threats included blacklisting, which could dampen the nurses' chances of getting jobs abroad.
But how long can we keep accepting these working conditions, asks Rajeev, a junior nurse at Manipal. “Across the industry, wages are poor (Rs. 4,500 to Rs. 7,000), and we are made to work overtime without extra wages and basic amenities, even transport facilities,” he says.
"How is any professional expected to live in a city like Bangalore for a monthly wage of Rs. 5,000?," asks Liffy, a nurse from another Bangalore hospital, who says that on at least three days her eight-hour shift is extended to 10, without overtime. The sole earning member of her family, she took to nursing to be able to fund the education of her siblings. Many of her friends, unable to find decent-paying jobs, are even working as home nurses to be able to repay their loans. Rajeev complains things are far worse for men, because they are discriminated against when it comes to jobs. We are seen as "troublemakers", he protests.
Needed: more regulation
Officials in the Labour Department say that unions, which were active a decade ago in this sector, are “now dormant”, and they have not been approached with any complaints on this issue. But following the recent spurt in organised action, the buzz is that some top hospitals in Bangalore are promising employees a salary hike in May, and some are even discussing payment for overtime duty.
Protests have shown these hospitals in a bad light and in some states such as Kerala Kerala there is also political pressure building on them on this issue, says a head nurse from a private hospital, speaking on condition of anonymity. However, she insists, that this cannot be a long-term solution. “Up until now, this issue has been ignored, and kept under the wraps. Now that there is a debate that has been triggered on this, the right thing to do would be to evolve a law or some guidelines to regulate working conditions in this large workforce, and of course, create awareness on these laws,” she adds.
(Many names have been changed on request)