Doctors' Strike: Has the Government Failed the Healthcare Sector?

Indian doctors have had to tackle problems caused by both the government and the people.

On 11 June 2019, doctors in West Bengal went on strike following an attack on two of their colleagues at Nil Ratan Sircar Medical College and Hospital. The doctors demanded that the government should take measures to ensure their security. However, not only did they not have the support of the government, who they refused to meet unless the meeting with the chief minister was broadcasted by the media, they also did not seem to have the support of the highest law–protecting institution, the Supreme Court, which made a statement, “We understand it is a serious issue but we can't provide security to doctors at the cost of other citizens. We have to look at the larger picture.”  This incident and the subsequent response  therefore opens up the doors for a wider debate,  which is: Who is on the side of doctors?

According to a 2015 study by the Indian Medical Association, 75% of Indian doctors have faced verbal abuse, while 12% of them have been subjected to physical attacks. The survey also states that 50% of violent incidents take place in the Intensive Care Unit (ICU), while in 70% of the cases, relatives of patients were actively involved. Apart from this, patients have begun to adopt a "litigant attitude." If treatments fail, doctors are sued or taken to the police. Doctors have had to speak up for themselves as they faced miserable conditions at work. For example, doctors in 2019 launched the “I am Overworked” campaign which involved demanding regulated working hours and standardised living and working conditions. Many of them stating working conditions such as 15 hour shifts with no break rooms, food or water.

Further, doctors have to function within a healthcare system that has several glitches. For example, there is a severe paucity of doctors in India. Studies reveal that there is 1 government allopathic doctor for every 10,189 people, 1 government hospital bed for every 2,046 people and 1 state-run hospital for every 90,343 people.  India faces a  shortage of an estimated 600,000 doctors and 2 million nurses. Primary health centres in rural India are short of more than 3,000 doctors. India’s healthcare expenditure per capita is roughly 32%, which is among the lowest in the world. 

This reading list explores how doctors that are an important interest group have had face several predicaments leading them to fend for themselves.

1) Regulation Is Necessary but the Government is Failing 

Doctors function within a fractured medical system that was opened up to trouble by the 1990 liberalisation policy of the Indian government. Anant Phadke  believes that neoliberal policies required the government to step in as a regulator. However, it failed to perform this task adequately. 

In India, the regulation of the medical profession and of hospitals has become more important after the adoption of the neoliberal policy framework from the 1990s onwards due to three interdependent factors which have influenced health and healthcare. First, especially during the last 25 years, unregulated marketisation under the garb of “economic growth” has been at the expense of the health of nature and of the people. Second, newer technologies and sub-specialties have emerged which have made healthcare more complex and hence needing more than ever, appropriate regulation to prevent misuse. Third, with the rise and domination of the corporate sector in healthcare, regulation of the medical profession and of hospitals has become far more important to protect the interests of the patients who become much more vulnerable ... The main problem in entrusting regulatory work to government bodies is the fact that the government bureaucracy continues the colonial tradition of a system which from the point of view of ordinary citizens, is unaccountable, high–handed and insensitive.

2) The Harsh New Code of Ethics

Indian laws end up putting doctors in precarious positions. In 2002, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations came into being. The new regulation for ethical medical practice was prompted by public concern about medical misconduct. However, K R Narayan points out alarming provisions stated in the code especially for doctors operating in rural areas.

The new ethics do not very much distinguish private from the public sector, except in a couple of acts. One of these targets the high absenteeism of government doctors in the rural healthcare institutions. If the physician posted in a rural area is found absent on more than two occasions during inspections by the chief medical officer of the district or the chairperson of zilla parishad, it will be considered as misconduct if it is recommended to the Medical Council.

3) The West Bengal Example

The medical healthcare system is endemic with problems that have persisted over decades. This can be illustrated by taking the case of West Bengal. Doctors went on strike in 1983 and in 2019 but ironically, the factors causing the strikes in both cases are very similar. In 1983, junior doctors in Bengal had gone on strike as they resented the fact that they were not given sufficient medical supplies to treat patients, subjecting them to violent attacks from the relatives. Again in 2019, doctors in West Bengal went on strike after the relatives of a patient brutally attacked two doctors, Paribaha Mukhopadhyay and Yash Tekwani. This ultimately culminated into a  nationwide strike by the doctor fraternity who complained about inadequacies in health infrastructure and that doctors were not being negligent. This goes to show that decades later, doctors are facing the same problems. This points out the inadequacies by subsequent governments to tackle issues of health care. Governments in fact have displayed high–handedness that  Biren Roy gives us some insight into, taking the 1983 strike as an example. 

The West Bengal government demanded a written explanation from the junior doctors about the circumstances in which they had abstained from duty during their cease-work in different government hospitals. It also decided to defer payment of stipends to junior doctors for September and issue of internship completion certificates to those who completed their training on or before 30 September. All the doctors' organisations were thus on the war-path against the Left Front government which also was not eager to settle the dispute. The government was bent on teaching the doctors a lesson. In the name of public resentment against the doctors movement, the Left Front, particularly the CPI(M) organised assaults on the doctors in different hospitals and even organised gheraos at the private residences of some doctors. 

4) The Positive Contributions of Medical Professionals and their Associations

Medical professionals and their associations have a history of being powerful interest groups, as Sanjay Nagra points out. Stating examples of such associations from around the world, he validates the contributions they have made to protect the public interest against government  high-handedness. Indian medical professionals, he believes, have also done commendable work. 

Historically in many countries, organisations of medical professionals have a formidable legacy of political and social interventions in public and healthcare policy. The American Medical Association (AMA) and the British Medical Asso­ciation (BMA) in addition to defending the rights of medical professionals have also successfully resisted attacks on public health like budget cuts. They often confront the state on political issues concerning healthcare and the BMA has a glorious history of resisting Margaret Thatcher’s attempts to dismantle the ­National Health Service. ( In India), a small number of professionals are deeply involved with academic medicine. There is also a signi­ficant number of medical professionals in India who have aligned themselves with non-governmental organisations (NGOs) working in community medicine and ethics. Many of them have done exemplary work at great personal sacrifice.

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