India Heading Toward Uncontrolled Privatisation of Health Sector: Dr Fuad Halim

Kolkata: Dr Fuad Halim – also known as the ‘people’s doctor of Kolkata’ is the secretary of the People’s Relief Committee (PRC) and one of the outstanding physicians in the city. The CPI(M) leader is also known for his deep understanding of health issues as well as that of the progressive movement in the state. He is the son of the well-known West Bengal Assembly Speaker Hashim Abdul Halim – who considered to be a pillar of constitutional democracy in the country. Dr Halim spoke to NewsClick about a range of issues, including the history of the PRC, the state of the health sector, and the role of the government in regulating it.

Sandip Chakraborty: Can you talk about the context of the PRC’s formation and a little bit about the people who took the lead in the process?

Fuad Halim: The 80-year-old organisation, known as PRC, has got its roots in the latter part of the 1930s when every year, cyclones and floods used to ravage Bengal. The British government had a despotic attitude towards giving service to the people who were at the receiving end of nature's fury. Then, a permanent Bengal flood and cyclone relief fund came up.  To give a permanent shape to these efforts in 1943, in the Bharat Sabha Hall of Kolkata, the People's Relief Committee was constituted. The president was Syed Nausher Ali, the then speaker of the undivided Bengal’s legislative Assembly. Amongst the members – also part of the steering committee of the organisation – were ‘Kakababu’ Muzaffar Ahmad and noted Bengali writer Tarashankar Bandyopadhyay (who was nominated twice for the Nobel prize). Bandyopadhyay, in his novel Arogya Niketan, portrayed the state of people’s health for the first time in Bengali literature.

Another noted member was author Manik Bandyopadhyay, whose Putul Nacher Itikatha also focused on health issues. Then, there was A R Malihabadi, who ran a press from where the literary magazine Langol – edited by poet Kazi Nazrul Islam and Muzaffar Ahmad – used to be published. Dr D K Basu and Dr Dwarkanath Kotnis were well-known physicians, who were known for their work in China. All these people brought their progressive thoughts to PRC to lay its foundation.

SC: PRC provides health services often at cheaper rates. For example, you charge only Rs 50 for dialysis when patients would have to pay at least Rs 2,500-3,000 in private hospitals. How is this made possible?

FA: The right to health should be a constitutional right of every person. But sadly, it is still not considered a basic fundamental right here. The right to health still has to be attached to the right to life and under this condition, Kolkata Swasthya Sankalp is doing the wonderful work of providing dialysis to kidney failure patients at Rs 50 only since 2008. About 35 to 50 patients undergo dialysis every day.

We work based on three principles. It is a no-frills service where the patients are given two bedsheets at the time of the start of the procedure. We don't have lifts or any other amenities like a front desk or receptionists. And the material suppliers are part of our organisation, they supply the material to us at lower prices. There is also a donor pool to keep the service running in Kolkata so that it caters to the needy.

SC: What facilities has PRC made available for this?

FH: We have dedicated outdoor facilities where medical consultations and medicines for three days are provided to patients for a low cost of Rs 10. Then, services like ultrasound, X-ray and diagnostic tests are also arranged at a low cost for needy patients.

There is an eight-bed nursing home called ‘Kimber Nursing Home’ attached to PRC where hernia operations are conducted for Rs 50. This year, we have a target of conducting 80 hernia operations within one calendar year.  There is also an old age home associated with PRC. We have got medical centres in multiple districts and ambulance services attached with us.

SC: How do you see private players in the health sector? Why does one need to stand against privatisation – specifically pertaining to health services?

FH: In 1959, Kenneth J Arrow had written an article where he categorically said that if health becomes a marketable commodity, its characteristics still differ from other commodities. For example, if a buyer goes to the market to buy bananas, then the seller cannot give him guavas and send him home.   However, when health comes to the market as a commodity, the consumer does not know what purchase he is going to make. The whole decision-making process lies with the seller. Hence, when health enters the market as a commodity, the information asymmetry between the consumer and (service) provider acquires wide gaps. The seller has to take decisions on behalf of the consumer/buyer. Here, a moral hazard takes shape. In this case, buyers are in a helpless situation and there is nothing substantially preventing the seller from seeking unlimited profit. Arrow ultimately got the Nobel Prize in 1973 for theorising this and got attributed as the world’s first health economist.

As this was popularised in the 60s and 70s, most of the developing countries made health a government (public) sector. Only a handful of developing countries allowed private entities to be players in the health sector. India, despite its mixed economy, is now heading toward uncontrolled privatisation. We stand against this kind of profiteering.

SC: Do you think governments worldwide that retained control over the health sector have been effective in regulating it?

FH: The successful campaign to eradicate smallpox shows the efficiency of the government-run health sector. In the 60s, the wealthy capitalist nations and the socialist countries came head-to-head during the Bay of Pigs crisis. On one side, the US-led capitalist bloc was professing that all the problems of mankind can be solved through the market economy. While on the other hand, the socialist world led by the USSR remained steadfast in its belief that the market is the main reason hindering development.

In the 60s, the initiative to do smallpox vaccination raised the question of whether it will be done through the market—meaning those who have the purchasing power can purchase it—or through universal no-cost people’s health network. This question was settled in favour of a robust public health network. In the 70s, we were successful in eradicating smallpox and this happened due to the movement by robust public health networks and infrastructure sponsored by the government.

In Alma Ata (1978) all the health-conscious countries of the world met and resolved to achieve ‘Health for All’ by the year 2000. The health ministers of 148 countries agreed to erect a robust public health network in their respective countries to attain that objective. After the 90s, however, due to the neoliberal policies pursued in different countries of the world, the public health network was deliberately weakened.

Institutions like the International Monetary Fund and World Bank, in the name of aiding the health sector, started schemes like ‘pay at the point of service’. In the name of financial reconstruction, they started giving tied loans and changed the basic outlook of the whole issue.

As a result, in 2000, the target of ‘Health for All’ could not be reached and this marked the obituary of health for all declaration.

A new term called millennium development goals was coined, which too, later proved to be unattainable. Then in 2014, health for all turned into ‘healthcare for all’. It was a paradigm shift from the tertiary medical facility-oriented social determinant to the only realisation of medical services.

SC: How do you see government-run insurance schemes?

FH: It can be recalled that the great economic depression after the 2000s affected various sectors; the notable exceptions being health and education. Hence, international finance capital started investing largely in these two sectors. Accordingly, we saw in 2013 -2014, that 35-40% of those hospital beds were underutilised as people did not have the economic capacity to avail of services in these hospitals. Now, schemes like insurance have been brought in to transfer patients from government hospitals to private hospitals. In West Bengal, the Swasthya Sathi Card is also a part of it. Through these, the public health infrastructure is further weakened. Vaccination receives low priority now in the government sector. Taxpayers’ money is channelised toward private players. Under this model, government expenditure is mainly channelised toward financing other hospital costs, including their profit.  

According to NHFS (National Family Health Survey) data, when only 13% to 15% of mothers should have a caesarian, at present, in West Bengal, over 83% are having c-sections. This is happening because the charges for c-sections are higher than that for normal delivery. The health of the mother is of the lowest concern here.