Medical negligence, overcharging, substandard care, wide spread production of spurious drugs by pharmaceutical companies, bribery of doctors by pharmaceutical companies with trips to foreign countries including sundry pleasures, even financing education of their wards abroad, drug procurement scams, underhand commissions, a wide spread racket in medical college admissions, glaring failure of regulators like Medical Council of India (MCI), Nursing and Dental Councils and Drug Controller in ensuring quality of drugs and services, speak volume of rampant corruption in healthcare across diverse medical profession in India. Bad governance and corruption are very much present even in the Complementary and Allied Medicine better known as AYUSH (Ayurveda, Unani, Siddhah & Homeopathy). There are, however, doctors, who despite apathy and corruption, have been able in their particular disciplines and spaces, to make a difference, and they outshine.
Healthcare corruption is broadly linked to inadequate resource allocation, from 0.8 per cent to a little over one percent of GDP, unequal access to technology and individual greed of doctors so much so that India ranks below Bangladesh and Nepal in South Asia in health accomplishments and life expectancy. India is far below China and Thailand in health care in terms of expanding longevity, reducing infant/maternal mortality, curbing child undernourishment, eliminating health-cost-induced indigence and other indicators. Within the country, Kerala outshines compared to all other States and Union Territories. Corruption is also linked to hospital practice, whether government or private, with different manifestations. Doctors in government facilities are notoriously suspect of charging patients for private consultations, of malpractice in purchase of drugs and equipment, and of rent-seeking behaviour in transfers and postings. In this connection, a case study of the Justice Lentin Commission of Inquiry into affairs at the government-run JJ Hospital in Mumbai in the mid-1980s, reveals how a combination of ‘lies, deceit, intrigue, ineptitude and corruption’ is prevailing in the mega public hospital.
In a well researched substantive book titled ‘HEALERS OR PREDATORS? HEALTHCARE CORRUPTION IN INDIA’, edited by three medical doctors of repute Samiran Nundy, Kesav Desiraju and Sanjay Nagral, which contains eight chapters comprising 41 essays by leading medical professionals and research scholars with a foreword from the Nobel laureate Amartya Sen that discusses comprehensively all aspects of healthcare problems in India, its debacle and likely solutions, makes a fascinating reading. The book describes background to healthcare corruption, corruption in practice, commodification of country’s healthcare services, role of regulators, malpractice in medical education, corruption in everyday medical practice, hospital practice and healthcare corruption, ethical issues, role of regulators, moral, legal issues and consequences, governance and healthcare corruption, major scandals, beacons of hope in the form of developing a health and social care system for homeless people with mental illness: the Banyan Experience in Tamil Nadu, Christian Medical College, Vellore, the Mahatma Gandhi Institute of Medical Sciences, Sevagram, experience with health worker based medical programme, palliative care as a way to true health as shining examples of standards of excellence in healthcare, medical education etc.
The book describes India’s healthcare failure is far more extensive than the resource story alone can capture. The entire organization of Indian healthcare has become deeply flawed. The story that emerges from such carefully researched studies is that of a comprehensive healthcare crisis. Dismal picture of healthcare that the book depicts speaks of the extensive triumph of avarice of medical doctors over public duties and professional behaviour. Apart from meager resource allocation, primary health suffers from behavioural corruption that includes the frequent absence of public healthcare personnel in their assigned duties, the distressing frequency with which public sector doctors direct patients to private medical practitioners for fee-paying services, often delivered by exploitative, at times by untrained medicine dispensers. The dominance of quackery and crookery in primary healthcare across rural India reflects a combination of policy failure and extensive behavioural failure including widespread slease. India’s premature reliance on private healthcare goes hand in hand with neglect of public health care, the book reveals.
The way forward suggested in the book calls for a well regulated, transparent, accountable and functioning system in place if universal healthcare is to become a reality. This is, of course, in addition to adequate financial resources and well trained health human resource at every level. Over the 71 years since Independence, India has established the system needed, but it is now increasingly realized that paralyzing corruption has crippled the regulatory agencies with a substantial part of the medical profession. The book arises from a conviction that the nature and history of healthcare corruption needs to be well understood in perspective for needed reforms and moving towards universal healthcare!