Physical Standards in the Private Health Sector: A Case Study of Rural Maharashtra
Several studies have brought out that the private health sector is the dominant provider of health care in India. The pro-private sector ideology is so strong that often it is assumed that the quality of health care provided therein is high. However, the fact is that there is hardly any good data on this topic available from anywhere in India. The need for such a study was strongly felt, more so in the background of the virtual absence of laws regulating and mandating minimum standards of care in the private sector.
The study focused on the physical standards of nursing homes (NHs) and hospitals in Maharashtra. For this a socio-economically average district (as per the CMIE index), Satara, was thus selected. A sample of 53 medical practitioners and 49 NHs/hospitals was drawn from the underdeveloped Patan and the highly developed Karad tehsils.. The tools used were a structured interview schedule along with an observation schedule and a checklist for equipment.
Moreover, since no institution in India, including the Bureau of Indian Standards, has evolved standards for hospitals having beds less than 30, we organised a one day workshop to prepare "Minimum Physical Standards for Private Hospitals and Nursing Homes". The participants for the workshop included researchers, government officials and doctors from the public and private hospitals in urban and rural areas. After extensive discussion, the draft for minimum standards was drawn up. This provided the cotext for analysing the findings of the study -
The study revealed some startling facts:
The Medical Practitioners:
- One fourth of practitioners are unqualified, and amongst the qualified, only 40% are allopaths while 52.5% from Indian Systems and 7.5% from homeopathy. Yet 79% of all practitioners in the sample were found practising allopathy.
- 62% of all practitioners kept no medical record of their patients. 38% kept some record that consisted mostly of medicines administered and charges to be recovered from patients. Thus, instead of being an actual medical record, it was more of a trade or a business record! Fittingly, such record is maintained in diaries and notebooks rather than on the medical record sheets.
- We also found that much of the basic medical equipment was conspicuous by their absence in the clinic of many practitioners.
The hospitals and nursing homes:
- Over 80% of them were established in the 1980s and 1990s. 91.8% of them were individual proprietorships. 80% of hospitals were run by doctor-owners and without assistance from any other doctor. Average bed strength was 11.
- More than 90% doctors running hospitals were males.
- Only 71.5% of doctors owning hospitals were trained in allopathy.
- Only three qualified nurses were found in 49 hospitals studied. Unqualified women, who were paid very low salaries, made up for the rest of the nursing staff.
- Almost all of the hospitals and nursing homes provided general medical care. In addition, 55% provided maternity and gynaecological services and 16% general surgery. Only 2% of hospitals were treating emergency cases and only 18% had facility for pathological examination.
- None of these hospitals were registered with any health authority.
- A quarter of them had uninterrupted power supply and of them, 24% had installed a generator. Only three fourths of them had a telephone and none had an ambulance.
- In only 28%, was the area of consulting room adequate. In 65%, there was no screen, curtain, or a separate room for examination of patients. A wash basin with tap was available in 59% of the hospitals, and of these in 49% there was no water available in the wash basin.
- In only 6% of the hospitals, the space per bed was adequate. The bed sheets and pillows were found to be dirty, in more than 50% of the hospitals,
- Most of them had an Operation Theatre (OT), but only 11% of them had adequate area. 71% had an OT table, 39% had a shadow-less lamp, 10% had ECG facility and only 65% had steriliser.
- In those providing Obstetrics and Gynaecological services, nearly a quarter did not have basic equipment. 52% had an oxygen cylinder, 74% had a delivery table and 81% had a suction machine.
- In those providing surgical services, 39% had an X-ray machine, 56% had an Oxygen cylinder, 39% had an Electro-coterie unit and none had a Boyles apparatus.
The study shows that the perception of high quality health care in private sector is an absolute fallacy, at least in terms of the physical and medical standards. It also makes a strong case for regulating the private sector for improving standards and for reducing exploitation of patients.
Supported by:The Research Project on Strategies and Financing for Human Development
Research Team:Sunil Nandraj,Ravi Duggal and Asha Vadair