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Access to basic health care should be a fundamental right available to every human being. The western world has long been grappling with the cost of healthcare and the need to expand access.

While some European countries have state-run healthcare programs, the US has a largely free market health care system driven by special interests from the pharmaceutical and insurance industry. Neither of these systems has been found to be widely satisfactory.

A developing country like India, where 27.5% of the people are well below the poverty line, has little choice other than a government-provided health care system for its large population. The good news is that we already have a state-run healthcare system; the bad news is that it’s a hopelessly inadequate one. A visit to the nearest government hospital will more than confirm this.

A few of the problems besetting state-run hospitals are:

Inadequate number of Doctors and Nurses

Primary Health Centres, dispensaries and hospitals are woefully short of doctors, nurses and other staff. Recruitments are done at state level. Even if staff is urgently needed in a Primary Health Centre (PHC), the PHC incharge can only write to higher ups. The letter gets lost in bureaucratic maze at higher levels. As a result, the people suffer.

It would be best if Gram Sabha is empowered to recruit new staff whenever needed. Depending on local cultures and resources, they would also be best suited to decide whether to recruit ayurvedic specialist or a homeopath or a local mid-wife etc. They would also be able to do so at much lower costs than being paid by state Government. Such staff recruited directly by Gram Sabhas would be treated as Gram Sabha employees and Gram Sabha would be their appointing authority. They would have the powers to hire them and proceed against them if they do not work properly.

The power to appoint new staff should be given to Gram Sabha and not to sarpanch because sarpanch may turn corrupt and take bribes in return for recruitment. Gram Sabha may set up a committee to shortlist names. The final decisions may be taken in an open meeting of Gram Sabha. For district level hospitals, this power would be enjoyed by Zilla Panchayat, who could be held accountable by Gram Sabhas of that area.

Assigned Doctors and Nurses don't bother to perform their duties

What can a poor and ordinary citizen do if the doctor does not turn up for work, if the nurse misbehaves? Nothing. At best he writes a complaint to higher officials in medical department, who do not respond. This is a clear case of lack of accountability. The medical professionals at these hospitals are answerable to their supervisors, who in turn report up the chain of command. Ordinary people have no control over them.

Once again, this is best addressed at the level of Gram Sabhas. If any medical professional does not perform, the Gram Sabha should have the power to summon him before the open meeting, question him/her and withhold his salary or impose penalty against him, if needed. For the staff employed directly by Gram Sabha, Gram Sabha would also have the power to fire him.

Ill-equipped hospitals and shortage of medicines

Government hospitals are always short of medicines and equipment. Purchases are mostly done at state level. Even if a hospital does not need a particular drug or equipment, they are saddled with it but the drugs actually needed are not provided. For instance, in GTB hospital of East Delhi, drugs for dog bite are never in short supply because it is one of the most expensive drugs and there seems to be a nexus of the supplier with purchase department.

Let the purchases be decided locally for all drugs and equipment and funds for the same should be provided by Gram Sabhas. Let the hospital administration place its requirements before the Gram Sabha meetings, who may pass it or get it vetted from some expert. The Gram Sabha may even go for some ayurvedic or homeopathic medicines rather than going for only expensive allopathic medicines. This would ensure that not only would medicines be available to people but would also save costs on buying medicines and equipment not needed by them. If there is an outbreak of an epidemic the issue is bound to be raised in the local Gram Sabha and Gram Sabha may be able to take immediate steps, unlike present system, wherein the administration takes months to respond, by when several people have already died.

Looking Ahead

If the Gram Sabhas are empowered, where does that leave the purveyors of the 60-year old centralized command and control edifice? The reality however is not one of a zero sum game. A more powerful Gram Sabha does not mean a weakening of the central authorities. It simply frees those at the top to be focused on strategic long term initiatives that ensure the optimal functioning of the distributed network of hospitals under various Gram Sabhas addressing their needs, ensuring better communication, and leveraging the best practices of all their clients (the Gram Sabhas).