From Brain Storming to Nation Transforming
National Medicos Organisation (NMO) has always believed that action and service on the ground speak louder than words. So, when 43 chosen delegates and speakers from all over the nation received invites to participate in the first ever ‘Health Think Tank’ to be held at Deen Dayal Shodh Sansthan, Delhi on the 23rd of March, they were obviously curious as to how this event would unfold. The ‘Think Tank’ was formally inaugurated by Dr Manmohan Vaidya Ji by lighting the lamp alongside senior functionaries of the NMO. Dr. Yogender Malik, National Secretary NMO in his inaugural address explained that the need of a brainstorming session like this was felt to make sure that those dedicated to service to humanity and nation could also play a leading role in influencing the policies of the health sector at large. He further elaborated on the distinguishing features that made NMO stand out among fellow organisations, namely the spirit of putting humanity first, service next, followed by the nation and organization and the self last; encouraging prophylactic and preventive approach to health compared to a curative one and last but not the least, providing everyone from senior doctors to medical students an equal chance to put forth their voices.
The first session was focused on ‘Minimum Pay for Interns and Residents all over India’, an issue close to the hearts of members of the fraternity and the panelists were Dr. Dev Desai, AIIMS Delhi; Dr. Chintan Chaudhary, all India Coordinator, MediVision; Dr. Divyanshi Aggarwal, Bhagat Phool Singh GMC (BPSGMC), Sonipat and Dr. Raktim Tamuli, Assistant Professor, AMC, Dibrugarh Asssam. Dr. Desai brought out the wide disparity in pay of interns across various states and suggested a model of centre-state co-operation similar to the GST Council to work out a minimum, uniformly acceptable pay scale across India. Dr. Chaudhary asked why the pay standards could not be the same, if the admission process was the same for all students. He further came out with results of a survey carried out by MediVision India in which a minimum monthly pay of Rs. 25, 000 and Rs. 75, 000 was found to be acceptable by interns and residents respectively. Dr. Aggarwal highlighted the rage among the doctors over inadequate pay and shared the instance of medical students from a medical college in Haryana who launched an agitation supported by NMO to successfully get stipends revised. Dr. Raktim shed light on the roles and responsibilities of interns and residents and the need for ‘One Nation, One Salary for Government Employees’.
However, some of the most enlightening and compelling ideas came from amongst the audience members in the discussion that followed. Dr. Viraj Nevrekar, AIIMS Delhi brought to attention the fine difference in terminologies- ‘stipend’ and ‘salary’, which was used by the bureaucracy to trample upon the rightful demands of the medical fraternity. Prof. Ravi Kant CEO and Director AIIMS Rishikesh highlighted examples from other countries where internship was abolished and instead included in the first year of residency. He also suggested that the judgement of the Honourable Supreme Court on ‘NEET’ be studied in detail as it provides for central authority to supersede that of states in the field of health and medical education- a precedent that could be useful to the cause being discussed. Dr. Arupitchai Naryanan from Chennai shared memories from a successful strike led by him on issue of residents’ stipends led by him in 1970s in Tamilnadu.
The second session was on ‘Problems and Solution in Implementation of Ayushman Bharat.’ It consisted of a discussion among the panelists- Dr. K. Narsimha Rao, an orthopedic surgeon from Trichy, Dr. Dipak Shukla, CEO PSRI Hospital Delhi and Dr. M. Arupitchai Narayanan, followed by individual presentations by Dr. M. L. Bhatt, Vice Chancellor, KGMU, Lucknow; Dr. Aditya Batra, Holy Heart Hospital, Rohtak; Dr. Uma Garg, HoD ENT, BPSGMC and Prof. Ravi Kant. Dr. Rao gave the catchy slogan ‘Aadhar se Ayushman, Mera Bharat Mahan’ while talking about a technology integrated micromanagement model to make the scheme more useful in emergency situations. Dr. Shukla shared his exasperation as the CEO of a leading private hospital with the many bottlenecks being met with in the implementation of Ayushman Bharat. Prominent among them being- impractically low package pricing, delays in transfer of claim money and the possibility of misuse of the scheme for profiteering by fraudulent elements.
Dr. Bhatt praised the scheme for realizing the dream of ‘Svastha Vyakti se Svastha Rashtra’ (Healthy Individuals, A Healthy Nation Make) while pointing out that lakhs of Indians are pushed below the poverty line due to health-related expenditure. He however raised doubts about the sufficiency of human resources to ensure implementation of Ayushman Bharat Yojana in letter and spirit, especially in the under-serviced rural areas. Dr. Batra, in a detailed presentation, put forth problems faced at the level of beneficiaries, health care practitioners, state and central government and suggested solutions for the same. He made the audience aware that currently the scheme does not cover costs incurred in outpatient visits and investigations and confusion prevails over who would bear the cost if a procedure covered under the scheme lead to complications due to which the cost exceeded that approved under the package concerned. Dr. Garg asked whether upgradation of existing sub-centres to ‘Wellness Centres’ would actually translate in change at the ground level or remain merely a cosmetic exercise? Prof. Ravi Kant shared his experience at AIIMS, Rishikesh where he had managed to improve upon several provisions of the scheme to ensure maximum welfare of the patients. He also suggested a ‘Cross-Subsidy’ model to cover the entire nation under the ambit of health insurance, with the richer sections paying for it and the poorest availing the services for free.
The last session of the day was an ‘Open Session’, where audience members asked questions to the speakers about the Ayushman Bharat Yojana. This interactive session was very useful in clearing whatever doubts people had, as the speakers answered each question in detail with great patience. Broad consensus existed in the hall about Ayushman Bharat being a game-changer for the health sector in India which was off to a good and speedy start, if the sheer number of lives touched by the scheme within a few short months were to be taken as a barometer (as of March 2019- 14, 927 hospitals empanelled, 17,22,824 beneficiaries admitted and 2, 76, 21, 153 e-cards issued). Like any new initiative, it too had its share of teething problems, which seemed to be of transient nature and once addressed, would attract unprecedented health related investment in tier 2 and tier 3 cities. All in all, Ayushman Bharat would undoubtedly be a boon for the poorest strata of the society and would put an end to the vicious cycle of indebtedness and helplessness due to health-related expenses.
Dr. Malik summed up the entire day’s discussion in a crisp address and promised that soon the conclusions of this ‘Think Tank’ would be sent to the Central as well as State Governments. Seeing the enthusiasm among the delegates, he also broached the topic of holding more such events in the near future, which was eagerly accepted by the delegates and tentative venues and topics finalized. The delegates proceeded for lunch after the National Anthem, amidst cries of ‘Bharat Mata ki Jai, Vande Mataram’, with a newfound conviction of extending the spirit of nation service to the domain of policy matters as well.