Bilaspur, Chikalguda and the dichotomy of Indian public healthcare #indiahealth

8118957521_d0f8f8b170India’s latest healthcare shame is a shoddily-conducted government sterilisation drive that proved fatal for 13 women in rural Chhattisgarh. The tale that unfolded in Bilaspur has more than its share of dystopic elements : unhygienic surgical instruments, tainted drugs and women reportedly herded like cattle (or lured like prey) onto the operating table, surgeries completed at alarming speed, and the women sent home with little or no post-operative care, only to fall sick. Or die.

In the media, the spotlight is on a range of pertinent issues such as medical negligence, corruption and the unfairness of letting women bear the entire burden of family planning.

What’s come out looking really worse for wear, though, is the public healthcare system. Once again. The drive was government-funded, was ostensibly working towards targets set by the government, and used drugs reportedly bought through the public procurement machinery.

Losing faith

India’s public healthcare system has been identified for a long time now, with inadequate resources, corruption and, with the exception of certain established tertiary care hospitals, general decrepitude. Over the decades, Indians have steadily lost faith in state-owned healthcare and opted for pricey private providers. Incidents such as the Bilaspur tragedy would only serve to reinforce the trend. Cynics may shrug and suggest, yet again, that the focus instead, should be on strengthening the private sector with tools such as health insurance and quality assurance. That, by itself, is not a bad idea.

Is it all bad?

Yet, an experiment that began some years ago, suggests that it is possible to create a middle-ground, and that too, within the existing system.

Around three years ago, I visited Chikalguda, a neighbourhood in Hyderabad that houses many of the city’s working poor. There, located in an unassuming building, sat a branch of LifeSpring Hospitals, a chain of maternity hospitals.  In its own words, LifeSpring exists to “expand opportunities for lower-income women to access affordable, high quality maternal care” as “public hospitals’ free services often compromise quality, transparency, efficiency, and attitude towards the customers” and private care is beyond their reach.

The hospitals rooms were modest yet there was no evidence of neglect or slovenliness in the surroundings. The nurses didn’t seem either harassed or disgruntled.  The doctor appeared competent. It was relatively peaceful – as it should be, but, often, is not.  The hospitals in the chain have a tie-up with an international institution that works in the area of improving health outcomes suggesting it considers quality as important as affordability.

Now here’s the interesting part. LifeSpring is founded by HLL Lifecare, a Government of India enterprise. Yes, the same chaps who manufacture  ‘Nirodh’ condoms. HLL owns 50 per cent and the balance is owned by the non-profit venture philanthropy fund Acumen. Just goes to show that not everything in health that is touched by the public sector turns dysfunctional. As of August 2014, LifeSpring says it has has helped deliver 30,000 babies. In addition, it also conducts other gynaecological procedures such as hysterectomies (uterus removal), and even female sterilisation.

True, it is not an exact replica of state-funded healthcare, which is completely free. In Chikalguda, women had to pay. But the amount was a fraction of what they would in a private facility  without being at the mercy of indifferent care that they have they come to expect from public hospitals. At least they had a choice.

Similarly, HLL Lifecare has a a family planning promotion trust that owns and runs the Uttar Pradesh-based Merrygold Health Network  which has been “offering quality reproductive and child health service at pre-fixed prices.”

Need of the hour

India stands on the cusp of an ambitious universal healthcare programme, set to cost billions of dollars. Such a programme can have a symbiotic relationship with a functional public healthcare system where government funds strengthen the latter (either through investments or funding treatment) which, in turn, helps to keep costs down – a vital consideration for any state-funded programme.

Unfortunately, bad news travels halfway around the world, while good news is still putting its shoes on. Incidents such as what happened in Chhattisgarh can end up becoming inflexion points in the course of public healthcare, but not in any desirable way. We need many, many more Chikalgudas to counter the effect of one Bilaspur.


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