SONGSOPTOK: Do you consider primary healthcare to be a fundamental right? Is it deemed as such in the society you live in? Please explain your answer with a few examples if possible.

SANTOSH BAKAYA:  Although primary health care is not a fundamental right, Article 21 of the Indian constitution talks of the right to life. How can one live a dignified life if one is unhealthy and does not have the wherewithal to be healthy? Article 47 makes improvement of public health a primary duty of State.  I earnestly feel that Primary health care in India needs to be revamped. Although there are more than 20 thousand primary health centres in India, they still leave much to be desired. The Alma Ata Declaration of 1978 by the WHO members mentions safe water supply as very crucial, for public health but the provision of drinking water is woefully inadequate in many rural areas. In many cases, Villagers have to walk ten kilometers to fetch water. If there is a dearth of water, ill- health will always be there. Moreover, there is an appalling level of air pollution which adds to the woes of the people.  Public health needs to be regulated. Water quality monitoring, hygiene and food safety are very important, but often there are gaps in monitoring, enforcing and evaluation, which adversely affects public health.  Right to a dignified life is a fundamental right, but a dignified life cannot be lead, without a healthy life.

SONGSOPTOKWhat is the system of health care in your country?

SANTOSH BAKAYA: The public health system in India comprises a set of state-owned health care facilities funded and controlled by the  Ministry of Health & Family Welfare,  treatments being  either fully or partially subsidised. There are the All India Institutes of Medical Sciences in New Delhi, Bhopal, Bhubaneshwar , Jodhpur, Raipur and Rishikesh owned and controlled by the central government, which are referral hospitals having specialized facilities, -  Regional Cancer Centres  and research institutes controlled jointly by the central and the respective state governments. Government Medical Colleges which are also referral hospitals. District Hospitals or General Hospitals Taluk hospitals: Taluk  serving the respective taluks (administrative divisions in India, and smaller than districts). Community Health Centre CHCs are the basic health units in the urban areas. Primary Health Centres: Equipped with the most basic facilities, they especially serve rural India, generally at the level of a panchayat. Sub-centers are the first point of contact between villagers and public health care system in India. The ultimate goal of health care is the better health of all, irrespective of caste, creed or religion, but in my country, I am afraid, all citizens do not enjoy the same benefits across economic and social classes. Indeed the healthcare landscape in India is not very smooth, there being a wide gap between the rural and urban population as far as the healthcare system is concerned. For the investors, it is not a profitable venture to invest in rural sectors, hence the villagers have a limited access to hospitals and clinics, while the urban scene is choc-a bloc with private hospitals with five star facilities.

SONGSOPTOK: Do you think that free healthcare cannot be a right, but it can be a privilege and a shared burden of sacrifice for the sake of the social contract?

SANTOSH BAKAYA: Ideally speaking, it ought to be a right, but since the real world cannot conform to the ideal, the civil society can at least try to share this burden. A major population of our country is languishing in poverty, and there are others who breathe in an atmosphere of luxury. Reminds me of a quote of Mahatma Gandhi, ‘earth provides enough to satisfy everyman’s needs, but not every man’s greed.’ So, I strongly believe that those who have no dearth of wherewithal, should give up their greed and go all out to help the underprivileged. This is indeed a challenging strategy, but such collective action is absolutely needed. If a doctor with a flourishing private practice, waives the fees of those patients below poverty line, he will not be struck poor, so I think that such magnanimity will go a long way in helping the poor.

SONGSOPTOK: What, in your opinion, should be the role of the government for ensuring equal healthcare to all citizens? What role is played by the government of the country you live in?

SANTOSH BAKAYA:  I feel that the government has a proactive role to play in ensuring equal healthcare to all citizens. Since independence, the major health issues have been tackled by the governments, by successful concerted action leading to decrease in mortality rate. In accordance with the principles outlined at Alma Ata, 1978, the health issues need to be revitalized. Two crucial determinants of health, undoubtedly are: Safe drinking water and sanitation. Although the Indian government is making important strides in these directions, more needs to be done, and this will definitely decrease the danger of the spread of communicable diseases. Kerala has set an example by upgrading the status of public health and successfully addressing the basic issues of primary care and public health. The other states should pick up their cues from it. Even in many urban areas, sewerage and waste management are in a pathetic condition. The Integrated Child development Services [ICDS] have been working well in certain areas, but in certain states, their performance is poor, which also needs to be regulated and monitored.    

SONGSOPTOK: According to the data published by World Health Organization (WHO), nearly 16 000 children under the age of 5 die every day in the world (5.9 million in 2015) from infectious, neonatal or nutritional conditions. Is this a reality in the country you live in? If so, what would your suggestions of improvement be?

SANTOSH BAKAYA:  In India, it is estimated that 26 million children take birth every year , however , within one year of birth , 81 percent of under-five child mortality takes place , implying that almost 10 . 5 lakhs infants die, whereas 55 % of under- five deaths is within the first one month of life, which is about 7. 3 lakh of neonatal deaths every year in the country. Living conditions, safe drinking water, and sanitation need to be improved, because this has a detrimental effect on child health. Moreover, it is absolutely essential that mother and child should receive good care during labor and delivery. Awareness should be increased about neonatal sickness, neonatal health education, and   inequalities in maternal and neonatal care should be removed.

SONGSOPTOK: “Free access to healthcare is a fundamental human right. Access to free healthcare is not” – do you agree with this statement? Please explain your choice.

SANTOSH BAKAYA:   Healthcare should be freely accessible, and available to people, based on non – discrimination.  Although free health care appears utopian, yet it is imperative that health care should be within affordable limits. My washerwoman should have the same access to health care, as I do. Let me cite an example, my washerwoman’s husband has been diagnosed with a heart problem, and advised an immediate operation. But she is dillydallying because as she says, what will her children eat, if they spend all their savings on the operation?  Health care should be at least such that one is not forced to postpone the saving of life.

SONGSOPTOK: How important is the role of the private sector for providing healthcare and related facilities in your country? What it is your opinion about it?

SANTOSH BAKAYA:  The private sector indeed has a very crucial role in the provision of healthcare and related facilities. It goes without saying that it needs to be a care provider in government –funded schemes. It can also initiate awareness programmes, helping the youth recognize the dangers of tobacco smoking, impart skills required for the practice of public health. Public – private partnerships can also come up with innovative schemes.

SONGSOPTOK: Are charitable and Non-Governmental Organizations (NGO) active in the domain of public health? If yes, then in what spheres? Do you think that the civil society, either independently or through these organizations, should become the prime actor for ensuring healthcare for all?

SANTOSH BAKAYA: NGOs and charitable institutions are active in the domain of public health, and they can definitely play an important role in integrated human development , and  community participation , but it is very important that their activities should be above board and transparent. They have emerged as service providers, especially to slum dwellers, tribals, and people in the rural areas. Of course, the civil society should become the prime actor for ensuring health care for all , it can do so on a collaborative basis , roping in volunteers,  asking for donations , also combining health with income generation programmes .

SONGSOPTOK: Do you think that multinational pharmaceutical and healthcare companies are responsible, to a certain extent, for the widely variable quality of healthcare in different countries? Can you please illustrate your reply with some examples?

SANTOSH BAKAYA: Yes, indeed, the multinational pharmaceutical and healthcare companies, are responsible, to a certain extent, for the widely variable quality of healthcare even in the strata of industrialized, middle, and low income countries. Although a daunting task, if an assessment of pharmaceutical price comparison is carried out, this can lead to interventions leading to reduced medicinal prices.  Governments can control this by enacting price control policies, by eliminating taxes and tariffs. Moreover, the market power of the buyer can be enhanced by the strategy of price negotiation, pooled procurement, and mutual exchange of information regarding the prices.

SONGSOPTOK: Do you think that adopting the Social Security model implemented in a lot of countries in Europe which ensures primary health coverage to all citizens and is financed by the totality of the working population can be relevant and efficient in all countries?

SANTOSH BAKAYA: Yes, I think that the Social Security model, although bedeviled with many problems, can be relevant in all countries, however, it is important that it should be according to that country’ socio- political needs.  The economists, Amartya Sen and Jean Drize talk of two aspects of Social security – protection and promotion. Protection against a fall in living standards through ill-health and accidents and Promotion focusses on enhancing living conditions.  The countries need to protect the health of their citizenry and promote good living conditions.  Social security which developed after the Second World War around the globe and was later enshrined in the 1948 Universal Declaration of human rights, has become a very important part of the different countries now. Although , still the centre of debate , it has been accepted with its flaws and advantages .


We sincerely thank you for your time and hope we shall have your continued support.
Aparajita Sen

(Editor: Songsoptok)


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