I attended a very big conference in Chennai a couple of months ago on Health Systems Strengthening funded by the World Bank. The World Bank and DFID representatives went up on stage and announced “If any state is interested in privatization, get in touch with us and we are happy to help”
When I specifically directed a question to the WHO (World Health Organisation) asking them who these international players/funders/donors were accountable to, the moderator prevented him from answering the question. The WHO representative subsequently made a very significant statement. He said “No public system has evolved suddenly; they need time and support. Health systems in developed countries became effective only over a period of time. Developing countries need time too.’
This is significant in India because those with vested interest are using the intrinsic weaknesses that any system would have, to push for their own commercial agenda.
India provides a huge market for corporates and international players in health. They have also become affiliated to local NGOs that have absolutely no accountability to the state or central government. These NGOs are arm-twisting policy makers in the guise of civil society representation. What is the credibility and motive of these NGOs? Many of them receive huge funding from donors, with the specific agenda of controlling policy. Developing countries are just not ready for this. Arundhati Roy gives an interesting perspective on how there is a concerted effort to de-stabilise the government in the guise of anti-corruption.
Judith Richter describes how transnational corporations are exerting undue influence in public affairs. They are present at government decision-making meetings, controlling power that suits their own agenda. How do we ensure that these decisions are made for public interest and not for the private gain of a few? Power is not something that has an end point. When powerful transnational companies want to increase their profits, they do so without any concessions or conscience. It is up to the people to take up this movement on their own behalf to question every decision that is made. The civil society representatives are themselves corrupt but pretend to talk on behalf of the people.
Public private partnership is a new mantra. Private players are defined as those that work outside the direct control of the state. Their very motive is profit. Many of them use unethical means to maximize profits, falsifying data, creating a brain drain from the public services and all this without any kind of regulation. This unregulated private sector is clamouring for regulation of public services while they themselves remain outside the ambit of regulation.
This dangerous trend is being seen in health care. Health is unique in that people would go out of their way to procure health in a life threatening situation. One would not sell property, cattle, land for any other commodity and they will access private health care if they HAVE to, but not because they WANT to. This argument that “People are willing to pay”. is used by the private players. Nobody would be willing to pay for a service that pushes them into a spiral of poverty and indebtedness that they may never come out of. Funnily enough, the private sector is not itself known for quality of services. Horror stories abound about private players ripping patients off while providing less than acceptable care – unwanted Caesarian sections, wrong medications, ventilating patients who have already been dead etc., etc. The bottom line is that the public sector – no matter how corrupt or dysfunctional, needs to be strengthened. The answer is not to decompensate and destabilize it. The private players see this as a large loophole that they are manipulating as best as they can.
One solution is – can the middle class start using public health services? Can we create a demand of efficient public health services? Can we work with the government to understand what the issues are? Can we support those government officials who want to do a good job? Can we nurture and support them rather than vehemently throwing brickbats at them?
When the middle class is able to demand and get good public services, the poor automatically benefit. The poor do not have a loud enough voice to fight for this – can the middle class take up the fight for the poor? Can we be outraged with a dalit woman dies during delivery? Can we be outraged when public hospitals have poor quality drugs? We should change the public health system, but not so much that we destroy it. Because then all we are left with are the voracious private sector players – they will not be satiated till they drain every resource that we have to spend.
- ‘Blowing up’ the Canada Health Act not the answer to rising costs: economist (news.nationalpost.com)