The Weekly Dose: A Money Bags Buying Seats degree
When a team of public health surveyors visited each of its eight government-run Health and Wellness Centers (HWCs) recently, they did not find a single doctor on the rolls. To combat this paucity of doctors in public health centres, the Haryana Government has issued a notification making it mandatory for all medical students in state-run medical colleges to pay the state ten lakh rupees for every year of their MBBS course (minus the annual course fees).
Over ten lakh people live in the Kaithal district of Haryana, more - Wikipedia points out - than in the American state of Rhode Island or the entire nation of Cyprus. When a team of public health surveyors visited each of its eight government-run Health and Wellness Centers (HWCs) recently, they did not find a single doctor on the rolls.
Elsewhere in Haryana, they found that in the absence of full-time Medical Officers, HWCs could not meet the medical needs of their assigned population. In some cases, pharmacists and nurses had started prescribing medicines. There was an increasing clamour among the public for more government doctors to be appointed, so that they might access better diagnosis and treatment, the report said.
This is a familiar story. But it’s not that kind of story.
To combat this paucity of doctors in public health centres, the Haryana Government has issued a notification making it mandatory for all medical students in state-run medical colleges to pay the state ten lakh rupees for every year of their MBBS course (minus the annual course fees). The government’s argument is that if these students do not want to serve in the state’s public health system once they graduate, they should not expect a medical education subsidised by the state.
The stated intent of this policy is “incentivizing doctors to opt for Haryana Government Medical Service in any Public Health Institute or Government Medical College to strengthen the medical facilities of the state.” MBBS students can choose to pay the whole sum and enter private practice after graduation, or avail of a loan, the instalments of which will be repaid by the state until the graduate continues to serve in a public hospital, or for seven years, or until the loan is repaid.
What could go wrong? Oh let me count the ways.
To start with, ‘to incentivise’ means to motivate or encourage someone to do something; making a teenager pay through his or her family’s nose, and holding him or her hostage in public healthcare for seven or more years until he or she is in his early thirties - is not incentivisation, but coercion. The policy stipulates that should MBBS doctors leave government service before the entire loan is repaid, it becomes their responsibility to repay the outstanding amount, with interest. The principal amount? Over 36 lakhs.
This extended bond period itself may be enough grounds for courts to rule in favour of the parents of MBBS aspirants, who have filed several cases. The policy was announced on 6th November, with final seat allocation on the 23rd; students who have spent the last two years cramming for a highly competitive entrance exam had less than ten days to make a life-changing commitment, or scrape up the dough that families of few MBBS students can afford.
Let’s assume the policy withstands legal scrutiny. Is an MBBS graduate who has availed of the loan and paid the bond amount assured of a government job after qualifying? No. There is no mention of a state medical cadre, with all its associated benefits and compensation. Instead, the government absolves itself of responsibility by saying that it is not mandatory or obligatory for the state to provide employment. How then are the Haryana government and its medical colleges different from Arindam Chaudhari and his promising-much, guaranteeing-nothing steeply-priced IIPMs?
Should the policy be enforced, the government will be sitting on crores of rupees collected as what can only be described as ransom. Apart from using it to repay the loans of candidates who complete the bond period, it proposes to use the money to improve medical infrastructure, purchase equipment and improve teaching facilities. That a government should justify hiking fees in the language used by for-profit private medical colleges, and rely even in part on student contributions to bolster its healthcare system, is plain shameful.
Let us pause to consider who will now claim these MBBS seats. Across the country, most aspirants come from middle-class or upper-middle-class families who can afford to pay for coaching classes that prepare their wards for the entrance exam. Despite reservations, the truly underprivileged are almost always excluded. Should such a person crack the exam, he or she already finds it increasingly unaffordable to live in a semi-urban/urban area where medical colleges are located, purchase expensive medical textbooks and study for four-and-a-half years without any source of income. Can this individual commit to a course that does not assure employment at its faraway end? No.
Doctors who qualify from private medical colleges are often accused - justifiably - of charging exorbitant consultation fees to recoup the massive amounts they have spent as fees or ‘donations’. In the present context, the only people who will be able to pay several lakhs upfront are the upper classes, who will then want to overcharge their future patients to recoup the amount they have paid the government. A recent survey showed that over three-fifths of Haryanvis rely on private healthcare for treatment.
Perhaps you disagree with me and think I’m biased. Fair enough. Imagine that this policy works without glitches, and the over 500 positions for medical officers currently vacant in Haryana are filled. Will this solve the problem of its poor public healthcare?
The report I mentioned at the beginning also mentions that most HWCs in Haryana do not have regular lab technicians to perform diagnostic tests or enough pharmacists to procure and dispense medicines. “In spite of spacious and modern physical infrastructure, HWCs lack medical, paramedical and other manpower which acts as a constraint on healthcare services”, it said.
In one centre, it found no OPD slips available to prescribe medicines. In another, it found that animals entered the building. Poor road connectivity made some centres difficult to reach. Due to chronic shortfalls of medicinal syrups, children were made to swallow tablets instead. Power cuts and unreliable internet made delivering medical services a game of chance.
Gurugram - the poster city of Haryana - does not yet have a government medical college to treat the impoverished thousands who make life comfortable for its uber-rich. The website of its civil hospital specifies that it does not have the facilities to treat strokes, cancers and kidney failure. Almost 85% of patients admitted in Haryana’s public hospitals have to pay for treatment out of their own pockets as well; medicines account for almost half of this expenditure.
Doctors who hold government jobs, draw government salaries and then abscond should be brought to book. But Haryana cannot solve its public health crisis by throwing young doctors at it.