In April, two men attacked a doctor at a Mumbai hospital by smashing a chair on his head out of frustration at the delay in treating their relative. The assault was one of a growing number of attacks on doctors by the families of patients unhappy at the level of care they were offered.
On a recent visit to a state-run primary health care centre at Bhatodi village in Rajasthan, I found a deserted place where birds had nested on the ceiling fans. This was the main health care clinic for local villagers.
Walk into most clinics across India and they won’t be as bad as this one, but there are often no basic medicines to be had. The absentee doctor is the biggest problem, forcing villagers to travel by bus to private clinics or to the far-off district hospital.
The Indian government has failed to provide the most basic health care to Indians in rural areas. It spends only about one per cent of its GDP on public health, far less than many other countries. The lack of basic amenities is partially responsible for 1.26 million children under 5 dying every year and a maternal mortality rate of 44,000 a year, according to government statistics – higher than Bangladesh or Nepal.
For decades, hardly anyone has tackled the problem, though some states have tried involving the private sector. Now the Rajasthan government is trying to find a solution. The Bhatodi clinic is part of a new pilot project to improve the quality of care in remote areas.
It has launched a partnership with the Wish Foundation under which the government provides the infrastructure, medicines and equipment. The private partner provides the doctors, paramedics and runs the clinics. Seven months ago, the foundation took over 30 of the state’s worst-performing clinics.
There was a palpable sense of purpose in the Bhatodi clinic I visited. It was clean and well-organised. The staff too looked efficient and enthusiastic. A doctor lived on the premises and was treating an average of around 80 patients a day.
Encouraged by these initial results, the government has invited bids from more private partners to scale up the project.
There are more than 23,000 primary health care centres in India and most need help. Kiran Mazumdar Shaw, an entrepreneur, wrote recently that a 2013 law requiring corporations to spend 2 per cent of their profits on corporate social responsibility activities could be a catalyst for more health care joint ventures.
It’s true that a lot of large Indian companies want to do something to benefit poor communities through their corporate social responsibility work but often don’t know what to do.
“This partnering with the private sector can lead to a huge improvement in health care delivery … through a combination of good infrastructure, latest technology and the best available medical expertise,” she wrote.
Ms Shaw is right, although, as critics of health care joint ventures point out, the government should not abdicate all its duties and devolve health care to private parties.
But the health care partnerships, if they work in Rajasthan, must be given a go elsewhere.
After all, anything is better than the current state of primary health care. They have to be given a fair chance, despite the critics, because what poor Indians dread most is an illness in the family.
Such events can plunge them into debt when they opt for private treatment but they do so only because the state has failed to provide the most rudimentary level of care.
The clinics where there is no cotton wool to be found need a public-private partnership. The government hospitals where the X-ray machine broke down years ago and has never been fixed need something similar. And people like the woman I met at Bhatodi need a clinic run by a joint venture.
Rakesh, 30, had just delivered her fifth daughter.
“When I came here earlier, in labour, for my other daughters, the doctor demanded a bribe. When I refused, he waited until I was screaming in agony and asked again. I gave it to him, naturally. This time, no one has asked for a bribe. Everyone has treated me nicely,” she said, smiling.
Amrit Dhillon is a freelance journalist in New Delhi
