Catch me if you can. This is the challenge that the novel coronavirus has thrown at the superheroes of the world. However, Dr. Soham D Bhaduri writes that despite the grim circumstances of the pandemic, this could be the right time for the medical fraternity to take up the cudgels for healthcare reform.
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The preceding few months have seen an unprecedented lionising of doctors and other healthcare personnel as ‘COVID-19 warriors’ leading the global battle against the pandemic. Multiple heartfelt occasions and demonstrations were held for expressing admiration and gratitude towards them. The top political order was mobilised into bringing an anti-violence ordinance with an agility never before witnessed. News portals, earlier surfeited with political bickering and destitute of scientific discussions, became replete with doctors sharing invaluable information for public benefit. Last but not the least, the pandemic has served to exalt the health ministry into a position of consequence it has hardly ever enjoyed before.
Still, many instances have insinuated that such admiration and lionising could be largely situational and fleeting, rather than established and enduring. A perennial lack of trust in the patient-provider relationship has frequently surfaced in the form of healthcare violence even in the midst of the flaring emergency. And subtle expressions of government high-handedness have often managed to breach the semblance of gratitude: from threats of cancelling licences on failure to report to duty, to coming down hard on personnel clamouring against shortage of personal protective equipment (PPE).
What cannot be denied is that medical workers have been among the worst-afflicted by the pandemic, both physically and mentally. They have constantly risked their lives in grossly unsafe conditions, negotiated unimaginably stressful work hours and scenarios, been ostracised by their neighbourhood, and even fallen victims and succumbed.
The COVID-19 pandemic has been thought of as a crisis that could open a critical juncture in our history to push long-pending public health reforms. But central to the discourse of such reform has been only one stakeholder – the common man. It must leave no doubt that given the tribulations medical personnel have been through, they have equally high stakes in reforms that aim to avert any such future disaster.
And what can make this realisation more acute than the fact that the state, in its perpetual failure to prioritise public health, has failed to care adequately for its physicians in addition to patients? For decades before corona came upon, the public health system – characterised by underinvestment in manpower and system capacities, overstretched facilities during perfectly normal times, abysmal staff- and bed-population ratios, and poorly incentivised workers – has sat on the brink of an impending disaster. It is only fitting that the medical community now took up the cudgels for health reform.
Organised medicine in India has forever sought greater autonomy in medical practice and services. It has benefitted from an open healthcare ecosystem rather than an institutionalised one denoting greater governmental control. This explains the pervasive footprints of an unregulated private health sector in India.
The biggest lesson from this pandemic is that an emergency doesn’t respect the private-public dichotomy, and that a health calamity on the nation wreaks havoc on the entire healthcare landscape, not just the public sector. Neither does the false dichotomy between medicine and public health possess any merit. Many private hospitals during COVID have seen acutely reduced footfalls, and been compelled to remain functional while battling the four-fold threat of deficient supplies, staff attrition, infection and unsustainability – while others had to shut down all together.
The pandemic has thus exposed that partisan lobbying with sector-specific interests are abortive – and that it is in the entire medical fraternity’s interest, including the private sector, to speak in one voice for an equitable, resilient, and organised health system.
A common misconception that needs to be addressed here is that such an equitable system isn’t synonymous with extinction of the private health sector, neither does it always connote lesser power to the medical fraternity. Many universal health systems around the world have accorded greater institutional powers to their medical practitioners.
Crises translate into reforms only in presence of certain pre-requisites, among which are political will and public pressure. The unprecedented nature of the current pandemic is no guarantee of either. Leadership is instrumental to mobilising public pressure and has traditionally been deficient in India, at least in health. Political will is largely subject to mass opinion and promise of electoral gains, and given the protracted nature of the current pandemic which could last for years, one can’t guarantee that the topic of reform won’t lose vigour with time. This is why the role of the medical fraternity in espousing reform becomes particularly crucial.
Further, with the nationwide vetting of the medical fraternity during the pandemic, it will be ideally placed and carry the legitimacy to lead a post-crisis reform movement. Albeit under different sets of circumstances, Thailand and Brazil serve as notable examples where long-standing networks of doctors helped push health reforms.
Crises of such magnitude are rare, and those presenting a window of opportunity are rarer. Our traditional approach to health crises has been largely ad-hoc in nature, and valuable lessons have been repeatedly forgotten, leaving behind little legacy. It is high time the medical fraternity, in its own interest in addition to that of the public, considered strongly espousing the public health reform cause by not letting this opportunity slip by.
Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
The write, Dr. Soham D. Bhaduri is a Mumbai-based doctor, healthcare commentator, and editor of the journal ‘The Indian Practitioner’. He can be reached at firstname.lastname@example.org