Doctors’ strikes in multiple Indian states are hitting public and private hospitals alike.
A strike by private doctors in Uttarakhand is forcing many patients to turn to government hospitals for treatment. The week-long strike has resulted in public health facilities becoming overburdened by a sudden spike in demand. The issue has come to the attention of the Uttarakhand High Court, following a public interest litigation (PIL) filed by Gurvinder Singh Chadha, a Haldwani-based activist.
“Due to the strike, patients are suffering,” said the petitioner’s counsel, Dushyant Manali. “Beds in the government hospitals are fully occupied. Many government facilities lack infrastructure and staff.”
“The High Court is calling on the state government to propose solutions to the crisis, such as recruiting additional doctors…already doctors at government-run hospitals, community health centres, and primary health centres are being asked to work overtime”
The High Court is calling on the state government to propose solutions to the crisis, such as recruiting additional doctors to alleviate the pressure on overstretched staff. Already doctors at government-run hospitals, community health centres and primary health centres are being asked to work overtime, according to Dehradun’s chief medical officer (CMO) Dr S. K. Gupta. Doctors are also being instructed to not to take leave until the crisis is resolved.
The private doctors’ grievances stem from objections to the Clinical Establishments (Registration and Regulation) Act, 2010. The Act regulates privately run medical facilities to prevent overcharging of patients and ensure minimum quality standards of patient care and services dispensed by private healthcare providers.
The Uttarakhand unit of the Indian Medical Association (IMA) objected to the legislation, which has yet to be implemented in the state despite its passage by the state government in 2016. They call for different legislation – the Uttarakhand Health Establishment Act. However, a legal challenge mounted by the IMA’s state unit failed last year. The legal suit protested a High Court ruling that noncompliant private facilities under the Clinical Establishments Act be sealed by the state government.
“Gurgaon, meanwhile, saw 615 striking workers sacked…[after being] on strike in the city since February 5th”
Gurgaon, meanwhile, saw 615 striking health workers sacked by the city’s Chief Medical Officer (CMO) after they refused to return to work. Employees under the National Health Mission (NHM) have been on strike in the city since February 5th. They have since been joined by more than 1,000 accredited social health activists (ASHAs), community health workers employed under the National Rural Health Mission.
The ASHAs’ joining of the strike reportedly leaves just 500 health staff – comprising doctors, nurses, and administrative personnel – to staff the entire district. NHM officials have directed beleaguered facilities to outsource staff to compensate for the absence of striking health workers.
“Health workers have gone on strike ten times in the last two years,” CMO Dr B. K. Rajora stated. This is despite, “bylaws to provide job security…dearness allowance, annual salary hike, among other benefits have been in force for last one year”. Dr Rajora has estimated the cost of these measures at around Rs 110 crore (US$15 million) per year.
“We have been trying to resolve the workers’ concerns but they continue their agitation,” the CMO added. “We once again request workers to call off the strike and join the work.”
Striking workers are unfazed, however. “Every time we protest, the CMO terminates us,” one NHM worker told the Times of India. “It is just a tool make us call off our strike, which we are not going to do this time unless all our demands are met.”
Striking health workers and ASHAs’ demands include job security, increased budget allocation, assurances against privatisation of health services in the district, and benefits such as paid maternity leave, travel allowance, paid overtime, and child benefits. They are also demanding equal-pay-for-equal-work.
“Proposed changes in legislation regulating the health sector have led to multiple incidents of strike action by doctors in recent years”
India is no stranger to doctors’ strikes, especially those involving workers under the NHM. Last year, the Bihar state government moved to terminate the contract of 80,000 striking NHM workers where similar demands for “equal-work-for-equal-pay” were made. The response only served to further stoke anger among striking workers. Some went so far as to threaten self-immolation.
Proposed changes in legislation regulating the health sector have led to multiple incidents of strike action by doctors in recent years. Last year saw the Indian Medical Association (IMA) call for countrywide strike action against proposed laws by the Centre. The IMA protested the National Medical Commission Bill, which would enact a number of changes such as replacement of the Medical Council of India with a largely unelected body. The Bill saw strike action called for in April, July and September, disrupting services at many hospitals.
Parallels can be drawn between the current situations in Gurgaon and Uttarakhand and past episodes of strike action. It is also clear to see why such crises are likely to occur again. Continued points of contention concerning new regulations and overburdening of doctors – exacerbated by shortages of doctors, especially those in specialist positions – are engendering a crisis of physician burnout caused by overwork and, oftentimes, low pay. Without ameliorating these issues, state and central governments alike can expect further strike action.