Medical practice in India faces a range of challenges and criticisms and there are growing calls to turn away from commercialised models of care. Here, Dr Arun Gadre, discusses the origins of the Alliance of Doctors for Ethical Healthcare movement, and their inaugural conference in Delhi this week.

Ethical healthcare

The book “Dissenting Diagnosis”, which I co-authored with Dr Abhay Shukla, was published by Penguin India in 2016. It contains testimonies from doctors about malpractices and the stark commercialisation of private healthcare in India. The book struck a chord with growing dissatisfaction amongst many doctors from across India, and the calls for change has brought us together as an informal network which we called the Alliance of Doctors for Ethical Healthcare (ADEH).

Most ADEH members are practising doctors. We are all disturbed by the downwards spiral of ethics in the private healthcare sector. We are sad that adversarial relationships between patients and doctors have led to financial insecurity and threats (in some cases acts) of violence towards doctors. The rising incidents of malpractices, irrational investigations, unnecessary procedures and surgeries, and kickbacks have engulfed private practice; young doctors entering the field are practically under threat for survival unless they succumb to malpractices.

Drifting towards commercialisation

Basically the scenario is a result of government policies since the 1990s, from when the government gradually abdicated its responsibility for providing free accessible quality healthcare to millions of India’s poor; and has retreated from its commitment to creating a social welfare state. It has pushed for passive privatisation by making the public healthcare system malnourished and tactically supporting the private healthcare sector. The privatisation has helped create medical colleges which charge millions of rupees for medical education; theses private colleges are now nearly equal in number to the government medical colleges. Following decades of neglect and lack of political will the public healthcare system has become bureaucratic and inefficient. Nearly 60% of in-patients and 80% of out-patients have to rely on the private healthcare system, even if they can not afford private care. Approximately, 40 to 50 million people are pushed below the poverty line in India every year due to catastrophic out-of-pocket expenses.

The private healthcare on which the government is leaning for provision of healthcare is mostly unregulated, unaccountable and driven by commercial interests. The cost of healthcare has escalated. Unindicated procedures, surgeries and investigations are fast becoming a norm. There is no grievance redressal mechanism for genuine complaints. We as a medical profession have failed in self regulation. The track record of regulatory institutions like Medical Council of India has been dismal in ensuring ethics in medical practice and giving justice to the aggrieved patient. Entry of corporate hospitals registered as an industry and hence basically looking towards satisfying their shareholders by perpetually increasing profit has muddled the rot still more.

The seething anger of thousands and millions of patients due to the nontransparent, exorbitant cost of healthcare is a volcano around us, which erupts many times irrationally and without justification, with brute horrible violence.

Time for change

As ADEH, we stand for measures to check corporatisation of Health care; we want rationalisation of fee structure in private medical colleges, regulation of the pharmaceutical industry, equipment and consumables industry and honouring of patients’ rights. We want a Clinical Establishments Act that protects honest and ethical doctors rather than corruption, and that brings corporate hospitals under the control of a National Medical Commission.

Since its inception, ADEH has been active in advocacy and awareness among doctors as well as the public at large. We welcomed the government move to cap stent prices; we gave our petition before the parliamentary standing committee regarding the National Medical Commission draft. We are engaged in raising the voice of rational, ethical doctors. We have a dream to bring universal healthcare to India, a system wherein private practitioners would be paid from public funds on the principle of ‘standard payment for standard care’ and hence doctor-patient relations would not be based on market forces.

In order to realise our objectives, ADEH is organising the first National Conference on Ethical Healthcare on the 21^st and 22^ndof April 2018 at the All India Institute of Medical Sciences (AIIMS), Delhi. This conference is the first of its kind in India to focus on ethical healthcare and will consider:

1. Challenges faced for rights-based / ethical healthcare in the national and global context
2. Corporatisation and commercialisation of healthcare and their impact on doctors
3. How to move towards universal healthcare in India
4. Challenges faced by young doctors for upholding ethical, rational practice

We will be commending those doctors who have bravely fought for pursuing ethics in healthcare, and will be joined by representatives from other ethical healthcare movements including ‘Right Care’ (USA) and ‘Slow medicine’ (Italy and Brazil), as well as a doctor from Abu Dhabi. The movement for non-commercialised and humane healthcare is picking up momentum across the world and we hope our inaugural conference marks the beginning of a new chapter in the fight for accessible, quality healthcare as a basic human right.

Arun Gadre is Coordinator at SATHI-Pune India and a member of the Alliance of Doctors for Ethical Healthcare. More information on ADEH and the National Conference on Ethical Healthcare can be found at: http://www.ethicaldoctors.org/