Kerala's 'ambulance baby' spectacle shows private players, aided by govt, are taking over public healthcare system

G Pramod Kumar
Nothing wrong in seeking the help of a super-speciality private hospital with world-class amenities and experienced doctors and surgeons, but it did puncture the healthcare claims of the Kerala government.

Kerala witnessed an unusual spectacle Tuesday: an ambulance rushing from Kasargode at the northernmost tip of the state to Thiruvananthapuram in the southernmost tip with a 15-day-old critically-ill infant for a heart surgery.

In a state notorious for its accident-prone roads and a lack of highways, where a 100-kilometre road trip takes three hours, this was bizarre. But everybody, including Chief Minister Pinarayi Vijayan, oblivious of the foolhardiness of the act, made it appear like some outstanding feat.

Many blindly participated because they were kindhearted: they shared the details on social media feeds, and TV channels spread the news wide so that people on congested roads volunteered to step aside for the ambulance. The state police also chipped in to make the the trip as quick as possible.

Even while facilitating the drive, or at least sympathising with the family of the child, some people asked the obvious question: Why the hell were they taking this risk of travelling 600 kilometres on such terrible roads instead of using an air ambulance? If the extraordinary journey was to save time, why not fly?

But very few asked the more critical question: Why did the doctors and parents of the child have to go all the way to Thiruvananthapuram, passing through 12 other districts, that too, in a case that even the chief minister was aware of? The real and most fundamental question: Where are the other hospitals?

Probably, when notified by some sensible folks, the state health minister asked the ambulance to cut short the trip and go to a private hospital in Kochi. She also promised the family of the child that the state government would take care of the cost of the surgery.

It was encouraging that the Kerala government realised its folly midway through the strange road trip after participating in it for a sufficiently long time without any application of mind. Still, when it intervened, it took refuge in a private hospital, thus veritably admitting there were no government institutions capable of paediatric heart surgery in the seven districts of central and northern Kerala. Even in Kochi, when it stopped the ambulance and offered to help, it was not with the support of a government institution.

While there is nothing wrong in seeking the help of a super-speciality private hospital with world-class amenities and experienced doctors and surgeons, it did puncture the healthcare claims of the Kerala government. Where were the teaching hospitals in other districts, how come not a single government hospital en-route was capable of handling paediatric heart surgery, which often happens under emergency conditions? Does every child in such condition have to travel such long distances? If the care is offered through the private sector, what exactly is the role of the public sector, that too in a state ruled by a "Left" party?

In January, Congress president Rahul Gandhi in a speech criticised Kerala's healthcare sector. Health Minister KK Shailaja hit back with wounded pride by saying that the state had world-class hospitals and treatment facilities and it was even attracting people from across the globe. She also listed the schemes and achievements of her government in healthcare.

However, what she hid behind in her statement was the fact these world-class facilities were a property of the private sector. The crazy ambulance ride on Tuesday and her reliance on a private hospital to save the child was an obvious admission to this reality. It was also a clear indication to which way the state's healthcare is moving.

The child is now being taken care of by the government at Amrita Hospital, reportedly under a scheme called "Hridyam" which offers free treatment of children with congenital heart disease. A look at the hospitals listed under the scheme shows why a sick child had to be transported under risky conditions this far, and why a single government facility was unable to handle it.

Of the seven hospitals empanelled, only two are in the government sector: the Kottayam Medical College and the Sree Chitra Thirunal Institute in Thiruvananthapuram, which is a government of India establishment. Obviously, the state government has outsourced the surgeries to private hospitals instead of equipping its facilities and human resources which essentially strengthens the state's intellectual and technical assets for common public good.

This points to a disturbing trend in Kerala's healthcare: its public health infrastructure, which once contributed to the state's unique global brand of Kerala Model of Development, is now giving way to the private sector. The state, which for several decades, starting with the princely states of Travancore and Kochi, invested heavily in public health and achieved health standards comparable to industrialised nations, now has one of the most privatised healthcare sectors in India, which various studies peg between 65 and 90 percent.

A 2014 state government report (Twelfth Five Year Plan Expert Committee Report) citing the National Health Accounts said the share of the private sector in the state's healthcare was as high as 90 percent. It also said that 12 percent of rural and eight percent of urban households had been pushed into poverty because of high healthcare bills. The state has one of the highest out of pocket expenses on healthcare.

The present government is accelerating this transition by promoting health insurance €" which essentially helps the private sector get more business as a study in Tamil Nadu had indicated €" and outsourcing many of its responsibilities to the private sector. Instead of universal healthcare, which bilateral organisations such as World Health Organisation advocate, the state is pursuing an insurance-driven model.

In other words, the government is facilitating the irreversible takeover of the healthcare sector jointly by insurance companies and private/corporate hospitals. This is the same model that has ruined America's healthcare sector and made it inaccessible to millions of people.

A study in Tamil Nadu, which embraced insurance earlier than Kerala, has shown that such a move will only help the private sector and will even affect the availability of personnel for the government hospitals.

As the private sector gets bigger and bigger, which the government seems to be facilitating, the public healthcare sector will even struggle to get well trained doctors and surgeons, as the "Hridyam" outsourcing model suggests. It's ironic that such an accelerated transition is happening during the rule of CPM, apparently a Marxist-Leninist party.

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