IMA, NCERT and Existing Inequalities – Issues Around Availability and Accessibility of Health Care: Sarojini N. B. and Deepa V.

Guest post by SAROJINI N.B. and DEEPA V

[A story appeared on 11 July 2015 in some newspapers about the Indian Medial Association demanding deletions from a class VII NCERT textbook. An immediate response appeared in Kafila to some of the issues raised by IMA.

This post, whose authors Sarojini and Deepa were centrally involved in the writing of the textbook in question, here put certain things in perspective. They present this as an initial clarificatory response to the news report. ]

We are writing regarding an article “Docs oppose ‘negative’ portrayal by NCERT” that appeared in the front page of The Hindu on 11 JUly 2015, Delhi edition by Bindu Shajan Perappadan. The article refers to the chapter “Role of the Government in Health” in the NCERT’s social science textbook on Social and Political Life-II for Class VII students. The article reports that the IMA has written to President Pranab Mukherjee, Prime Minister Narendra Modi and the Ministries of Health and Education, pointing to the “objectionable description” of private healthcare services. The IMA has also demanded “immediate remedial action” stating in their letter that the “matter should be taken seriously and the NCERT should be directed to delete or re-write this chapter”.

In 2007, several NCERT text books were developed, including the textbook in question Social and Political Life-II for Class VII, through a consultative and contributory process in which many of us were involved. The process led by NCERT was a progressive attempt at reviewing and developing content on a range of subject areas and issues in the country, in order to generate knowledge that is as contemporary and comprehensive as possible, and encourages critical and analytical thinking on the part of students.  While the issues were complex, authors / contributors as a group attempted to develop chapters that would reflect an understanding that is rooted in social, economic and political realities, while making them interesting and comprehensible for class VII students. The chapters foreground existing inequalities and discuss the issues around availability and accessibility of health care – including some key characteristics of the private and public health sector.

The purpose of the Chapters in the Unit in question (Role of the Government in Health and How the State Government Works), was to build an understanding about the State / Government through Health. The chapters foreground existing inequalities and discuss the issues around availability and accessibility of health care – including some key characteristics of the private and public health sector. The objections raised by the IMA, covered in the The Hindu on (11 July 2015), comes 8 years after the text books were developed, and on issues that are well established. Given the current environment that encourages the privatization- indeed corporatization- of health, such objections are neither isolated nor surprising. According to the IMA, the story  board on pages 22-23 depicting the “difference in treatment” in government and private hospitals is a “wrong depiction”. “They have shown that the cost of treating the same illness is Rs.3,500 in private sector and Rs.150 in government sector,” said Dr. K.K. Aggarwal, honorary secretary general, IMA and Dr. A. Marthanda Pillai,  national president, IMA. “The message which will go to the students is that private sector fleeces money.”

However, it is a known fact that private health care is unaffordable for the vast majority of Indians. Indeed, out of pocket expenditure on health in India is one of the highest in the world, and health care costs contribute to indebtedness for a significant portion of our population.

According to World Health Organisation (WHO), India National Health Accounts (NHA) data for 2013, show that ‘Out Of Pocket’ (OOP) expenditure is 86% of Private Health Expenditure in the country. As per recent  71st round National Sample Survey Office (NSSO) report, on an average, a much higher amount (four times) was spent for treatment per hospitalized case, by people in the private as compared to public hospitals.  The case of cost of hospitalization for child birth is even more revealing. The average cost of hospitalization for child birth in rural areas is Rs. 1587 in public hospitals, while it is ten times more in private hospitals (Rs. 14778). The average cost of child birth in urban areas is Rs. 2117 in public and Rs. 20328 in private hospitals.

While the NCERT is yet to respond, the IMA’s demand to direct the NCERT to “delete and rewrite the chapter” must be challenged.

Sarojini N and Deepa V work on Health issues and can be contacted at sarojinipr@gmail.com and deepa.venkatachalam@gmail.com respectively

6 thoughts on “IMA, NCERT and Existing Inequalities – Issues Around Availability and Accessibility of Health Care: Sarojini N. B. and Deepa V.

  1. Aditya G

    Why are they complaining 8 years later?
    The only reason I can think of is that with a friendly government in place the private sector is on the offensive. It has already won the economic debate now it wants to conquer the ideological battleground.

    I shall be following this story closely. Kafila should also keep us updated.

  2. The text in question is available at http://www.ncert.nic.in/NCERTS/textbook/textbook.htm

    Class VII Social Science — gess302.pdf

    Classification of rich & poor is given more importance in that chapter. The comic strip makes it more evident. The poor boy in the bus and the rich in the car.

    Some insinuations could have been avoided. A profit must be made for the private sector to survive. That is not a crime. The authors getting a pay from exchequer conveniently forgot that.

    Sunshine and air is given to all equally. Why some prosper and others perish in that environment is the will of the God. May God bless all.

    1. Aditya G

      Will of God? That’s the best excuse I’ve heard so far. And if everything is down to God’s will, a passage in a school textbook should not annoy you.

  3. Dr. R. D. Dubey

    Most of the things written by Ms. Sarojini NB and Ms. Deepa V. are correct. In India out of the pocket expenditure for health is one of the highest in the World. At the same time health budget in our country is one of the lowest in the World. Regarding inequality, 75 percent of the total health expenditure is on 25 percent people and rest 75 percent Indians have to depend on 25 percent expenditure. But that does not justify the depiction of doctors done in the said chapter. Are doctors responsible for this inequality ? Are doctors responsible for lower health budget and excessive OOP ? IMA’s objections have not been properly responded to by the authors. The particular para which IMA has objected, says that private service providers find doctors who write unnecessary injections and saline for the diseases which can be treated by tablets. By planting these types of stories in the raw minds you are creating hatred in them against doctors to whom they will have to go through out their whole life. Every time they consult their doctor they will feel that whatever treatment doctor is giving is unnecessary and only for flinching money. Is it a correct attitude ? Moreover, Government hospitals and private hospitals can not be compared. Government hospital are run by the money provided by the Government and they are supposed to provide free treatment to all patients.

  4. Pankaj

    Inspite of being a private practitioner,
    I find that most of the chapter(90%) is written well without any malice towards private practitioners, with intent of creating awareness in the students regarding the rights of people and duties of state(Govt.) in a democracy, in context of health.
    The only thing which the chapter fails,to highlight and make clear,is that just like most patients,opting for private practice is not always a CHOICE but often a compulsion for most doctors too. The inevitability of private options ,for both patients and doctors IS where the government is failing its people.A (brief,if not detailed) discussion about why doctors,many of them unwillingly,opt for private practice would make the chapter not only fair,but also complete/comprehensive.
    Your views are awaited.

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