If there is one thing that gets everyone in this country raging even more in the mid-summer heat, it is talk about sex and sexuality. No surprises then that health minister Harsh Vardhan’s recent statements about sex education and condoms have stirred the pot. The minister says he is against “crudity” in sex education programmes. He also thinks that “condoms promise safe sex, but the safest sex is through faithfulness to one’s partner”.
We have been down this road before. The debate on what is, or is not, “crudity”, and condoms versus fidelity will continue till the cows come home. Sensibilities vary massively. But while we are on the topic, will the good doctor explain what he considers “crude” in sex education? Lost in the cacophony is the larger question. What is the most relevant “C” word in India’s healthcare system today? Is it condoms, crudity in sex education or corruption? For most people in this billion-plus country, it is corruption.
Out-of-pocket healthcare expenses in India are among the highest in the world. A medical emergency is a catastrophe plunging families into deep debt, even impoverishment. The situation is exacerbated by the widespread corruption that permeates both public and private sector. In 2010-11, the deaths of three medical officials in Uttar Pradesh sounded the alarm on the organised looting of government funds that crippled the flagship National Rural Health Mission in the state, which has some of the worst health indicators.
Last month, the All-India Institute of Medical Sciences (AIIMS) suspended 14 of its staffers and fined 50 others for corruption and absenteeism. The employees whose services were terminated included clerks and housekeepers. But graft is not confined to the lower levels. Private sector hospitals in the country are notorious for prescribing unnecessary tests from private laboratories.
Corruption is also prevalent in clinical research. In some private hospitals, physicians have contractual obligations to admit a fixed number of patients to allotted beds and prescribe a number of laboratory investigations (even if unnecessary) to generate revenue.
All this has far-reaching consequences on patient care, clinical research and medical education. So where do we go from here? T. Sundararaman, adjunct professor (public health) at Jawaharlal Nehru University and National Convenor of the People’s Health Movement, points out that most countries which have a functional healthcare system have checks and balances to deal with kickbacks and referrals. Even the United States, where healthcare facilities are largely owned and operated by the private sector, has the federal Anti-Kickback Statute and the Stark Law.
The Stark Law prohibits a physician from referring Medicare and Medicaid patients for designated health services if the physician (or an immediate family member) has a financial relationship with the entity to which the patient is referred, unless an exception is met.
The Modi government was swept to power on an anti-corruption wave. It has promised to significantly reduce out-of-pocket expenses on healthcare for the common man, a new national health policy and better regulation of medical education, as well as the pharmaceutical market. It would be impossible to operationalise this grand vision without tackling the most crucial “C” word — corruption.
