SONGSOPTOK
INTERVIEW WITH SANTOSH
HEALTHCARE – A
RIGHT OR A PRIVILEGE?
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.
SONGSOPTOK: What 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 .
SANTOSH BAKAYA: AN ACADEMICIAN –POET –ESSAYIST –NOVELIST, HAS WRITTEN
ABOUT TEN BOOKS , THREE MYSTERY
NOVELS FOR YOUNG ADULTS, A COLLECTION OF 58 ESSAYS - FLIGHTS FROM MY TERRACE
PUBLISHED BY SMASHWORDS AND HER POETIC
BIOGRAPHY OF MAHATMA GANDHI , BALLAD OF BAPU ,
PUBLISHED BY VITASTA PUBLISHERS , DELHI WERE CRITICALLY ACCLAIMED . HER LATEST BOOK IS A
COLLECTION OF PEACE POEMS, WHERE ARE THE LILACS?
We sincerely thank you
for your time and hope we shall have your continued support.
Aparajita
Sen
(Editor:
Songsoptok)
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