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