Today is Monday morning. As a doctor tending to operated patients in the Surgical ICU of a corporate hospital in Kochi in the Southern Indian state of Kerala, I begin a new week at work on the back foot. On a sullen note. This isn’t uncommon.

A patient who had been operated for advanced rectal cancer passed away while on treatment in the wee hours on Sunday morning. The cancer was so bad that it had broken into the urinary system, causing urinary infection, resulting in hypotension (low blood pressure).

Though he was operated, infection had the last laugh. The patient was financially poor. His family could not afford adequate doses of antibiotics that could have pulled him out of death’s unyielding clasp. He didn’t give time to doctors to arrange antibiotic samples from pharmaceutical representatives, as they do for poor patients unable to afford them.

Another poor patient had succumbed to his disease, despite treatment as he lacked financial wherewithal to avail ‘adequate treatment’. His family could not afford costly antibiotics to avert septic shock, to which he ultimately succumbed. The treating team watched helplessly as a distraught family carried away their dead relative.     

Healthcare continued to remain a poor and neglected orphan in the state budget presented by the Kerala Finance Minister recently. The state will continue to have financially poor patients and their hapless families running from pillar to post to pay exorbitant bills levied by Kerala’s private hospitals. This isn’t unique to Kerala. It involves the entire country.

What ails healthcare in Indian public sector? Public healthcare sector, which is cheaper, and often labeled as one of ‘poor quality’   pales in repute, when compared to the private sector. What ails healthcare in Indian public sector? Why are people hesitant to avail its facilities? Reasons are multi-factorial;

  • Lack of adequate staffing such as 1:1,700 doctor: citizen ratio, which is below WHO stipulated 1:1,000.
  • Inaccessibility of Indian hinterland to basic healthcare provided by Primary Health Care Centers for want of roads and conveyance. Pregnant women and neonates perish. Unable to reach these facilities on time, carried on the shoulders of able-bodied men for want of ambulances.  
  • Some of these centers are reportedly run by just a ward boy, for lack of adequately qualified staff.
  • Inadequate government funding of healthcare. Healthcare has always been low on the priority list of budgetary allocations, unlike defence.
  • Government’s inability to modernize and render public health sector technologically-competent.  This is direct fallout of poor government funding.
  • Work-to-rule work culture resultant of poor pay structure, compared to healthcare personnel in private sector. Healthcare can excel only if willingness to ‘walk that extra mile’ is adopted by healthcare personnel.
  • Poor condition of public healthcare facilities. Patients and bystanders render public hospitals dirty by spitting and sometimes answering the call of nature within these facilities publicly.
  • This is compounded by inadequately understaffed sanitary departments, unlike spick and span private hospitals.
  • Overcrowding. Two patients sharing a bed and patients lying on the floor aren’t rare sights in public hospitals.

Nevertheless, things have definitely improved in the public sector over time, borne on dedication and determination of superintendents and health ministers of hospitals and states respectively.

Many public hospitals have managed to secure most-vied NABH accreditation. Complicated surgical procedures like cardiac bypass and organ transplantation are now performed in public hospitals. They are flag-bearers of primary prevention of communicable diseases through vaccinations through numerous Primary Health Centers dotting the nation. They also rose to expectations when Covid struck in a big way.    

Despite these giant strides made by the public healthcare institutions, people prefer to knock on the doors of expensive private healthcare institutions for their healthcare needs.

  The only solution to heart-wrenching human drama of financially poor being reduced to penury from seeking expensive treatment being played out in private hospitals across the country, is to buoy up the ailing public healthcare sector. Given the boost monetarily, healthcare facilities in the public sector have it in them to stand up to the healthcare needs of the economically poor, who cannot afford treatment in private healthcare sector.

Though the centre recently hiked allocation for healthcare sector by a whopping2.71% in its Union budget,   there’s a limit to which the government can finance modernization of public healthcare sector. Various healthcare schemes promulgated by central and state governments have failed to render affordable quality healthcare to the poor.   A mechanism by which the sector can self- finance it’s upgradation must be examined.

This can easily be achieved by charging a very menial fee for outpatient consultation and services availed of in government hospitals. The humongous money thus generated from thousands seeking outpatient services in the public health sector can easily meet the demands of upgradation of the financially wanting public healthcare sector.

But, such a huge step can only be achieved through determined political will. An effort in that direction on previous occasions in Kerala was scuttled by leftist political outfits, as they considered the move ‘anti-people’. The fact is such a decision will ultimately prove pro-poor in the long run. Such a mechanism to self-finance modernization of ailing public healthcare sector must be implemented not only in Kerala, but across the nation, in the interest of healthcare needs of the poor. Tears of families of poor patients must no longer fall in costly private hospitals. Poor patients mustn’t die as they cannot ‘afford treatment’. Political forces which shoot down efforts to shore up public healthcare sector, which has the potential to deliver healthcare needs of the poor, indulge themselves in short-sighted political stunts.

They must remember that if people do not think twice about spending money to ruin their health through the use of liquor and cigarettes, it is also their responsibility to spend some money for their healthcare needs too.