Nobel Laureate Amartya Sen on Friday said it would be wrong on the part of West Bengal government if it gave too much emphasis on private healthcare delivery system and did not focus on public infrastructure since the bulk of healthcare needs of the masses was met by the latter.
"It (the government) would do wrong if it thinks that the private system can provide all answers to people's healthcare problems, one has to first put the basic public infrastructure in place before thinking of expansion of private healthcare," Sen said, responding to a question if West Bengal's focus on private healthcare operators was justified.
Speaking to reporters after presenting an investigative report compiled by the 'Pratichi Trust' set up by him on the healthcare scene in two districts West Bengal (Birbhum) and Jharkhand (Dumka), Sen said 68 per cent of people covered in the report opted for private healthcare in the absence of a 'functional' public infrastructure.
"Though the study might not be representative of Bengal or Jharkhand, it does show that there is a dramatically high proportion of private practitioners, 29 per cent of whom are quacks in Birbhum and 62 per cent in Dumka. All this because the public health centres were either closed or without doctors in most places," he pointed out.
"There are far few sub-centres than the demand and those existing mostly don't function. They just exist on paper. This is a classic failure of responsibility of public health servants," Sen said.
Asked about his views on the raging debate on failure of the healthcare system in West Bengal, Sen said the problem did not lie as much in the 'financing' aspect of the public system as in the delivery and inspection.
"However, that debate was mostly focussed on the urban centres. We are dealing with a problem which is rural, with relative have-nots as opposed to relative haves. The rural picture is one of considerable disquiet, immensely more in Dumka than in Birbhum," he said.
The final report, to be published in February, would try to trigger a public discussion to revive the public health services as well as a regular inspection mechanism, he said.
The main findings of the study, conducted between October 2002 and August 2003 in 432 households of 24 villages in six blocks of these two districts, were non-functioning of sub-centres and PHCs, non-availability of basic services like medicines of testing for malarial parasites in the predominantly malaria belt, exploitation and medical deceit by private practitioners.
"One result of the non-functioning of public health services and the limited range of services offered is the wide use of private practitioners, to whom the patients -- even very indignant ones -- are forced to go, sometimes sent by public health servants themselves. In some cases, the public servants prefer seeing patients for money in private," Sen pointed out.
The eminent economist said prevalence of quacks and diversion of patients from the state-run system to expensive private care was found to be ruining families of ill people economically in many cases as they were forced to go into indebtedness and sell assets including land.
"The high charges of the private practitioners, qualified and unqualified, strain the poor families economically sometimes for services falsely claimed to be curative, like giving saline injections to deal with malaria!" he exclaimed.
Discussing the policy changes required to streamline the system he said alongside a steady inspection system, the state needed to exercise much greater control and supervision of the activities of government doctors.
"But the root of the problem lies in the limited coverage of public health services, combined with the non-functioning of designated centres. Much will depend on the ability and willingness of the state sector to provide basic medical services needed by the poor," Sen contended.
