A few years ago, while inaugurating a cooperative hospital in Kerala, the chief minister said that like cooperative hospitals, private hospitals should treat patients with a human face as they were giving priority to commercial considerations. This proved true to some extent in the second wave of the Covid-19 pandemic at a time when the hospitals in many parts of the country were reeling under oxygen and bed shortage.
Amidst excessive commercialisation with the exploitation of people as a stark reality, it was felt that if India had a successful cooperative health model, like Amul milk model, then a big crisis in the health sector could have been averted to a large extent. Can such a model emerge as a strong alternative to public and private health model in the times to come?
Despite the government pumping in huge money and resources to promote private healthcare, the profit motive of the hospitals remains supreme. A healthcare system committed to provide ethical, reliable, high quality and cost-effective services based on care and compassion has failed to evolve, and the current wave of the Covid pandemic proved this point well.
The cooperative health model in Kerala with a strong service objective has emerged as a key alternative to the woes of privatisation in healthcare. The cooperative hospitals in the state last year during the time of lockdown were working non-stop to serve the poor and needy. Endowed with most modern facilities, they implemented systematic steps in combating the crisis by tracing the victims at the primary stage and providing them all facilities.
During the current crisis too, the cooperative health workers in Kerala were active in making sure that the slightest symptoms such as fever are tested for Covid-19. The cooperative hospitals were well-prepared to have an adequate supply of oxygen. If there were well-equipped cooperative hospitals in all parts of the country, then they would have definitely provided affordable healthcare and taken off the burden from the public and private sector hospitals which were grossly ill-equipped and badly managed to respond to the Covid crisis.
The present crisis has badly exposed the lack of sustainability of our healthcare system in the wake of challenges posed by an increase in demand for health services. The resultant rise in health expenditure as a result of this, placed much pressure on public and private health systems, affecting their sustainability. Rather than solely basing on profit, the cooperatives are sustainable organisations which are owned and run by their members. They come as a response to inefficiencies in serving the interests of people, such as where services and products are unavailable, or not accessible. While milk cooperatives emerged successfully in the villages due to inefficient and exploitative milk supply chain dominated by private players and proved their sustainability during the lockdown last year when supply was badly disrupted.
The government recently sought the help of the National Cooperative Development Corporation (NCDC) to provide crucial medical supplies to the health sector. NCDC showed its commitment to lend Rs 10,000 crore to cooperatives to set up new healthcare facilities, or to upgrade the existing ones under Ayushman Sahkar scheme announced last year. The Centre also asked states to cooperate with NCDC for creation of Covid facilities A little shift in the government policy favouring cooperative healthcare is noticeable here, but it appears this has come late, as it will take time to show results.
According to a cooperative health study, health cooperatives all over the world have grown in importance over the years as a reaction to the increase in demand for health services and growing difficulties faced by public authorities to manage rising public health expenditure. But, it is very strange that India has only 52 cooperative hospitals, and most of them are located in Maharashtra, Karnataka, Kerala and Andhra Pradesh.
As cooperatives have proved their sustainability time and again as compared to other enterprises, they can provide long-term, fairer health facilities to people as compared to commercial hospitals. The National Policy on Cooperatives, formulated in 2002, has outlived its utility. It must now be re-formulated to promote setting up cooperative hospitals and the policy must focus on creating youth entrepreneurs in cooperative healthcare. If Kerala’s recent Cooperative Policy talks of encouraging cooperative hospitals, then why not have such a similar approach in the National Cooperative Policy?
The National Health Policy talks only about promoting public-private partnerships, but it is silent on promoting cooperatives, even based on partnership model. The current crisis is a wake-up call for the government to give due priority to cooperatives in their health policies to evolve a sustainable healthcare system. If a cooperative healthcare structure in smaller countries like Italy, Spain, Japan etc was at the forefront in tackling Covid, then why can’t this happen in India, which boasts of the largest cooperative movement in the world? The cooperatives must not be discriminated instead they should be given a level playing field to prove themselves.
(The writer is Deputy Director, National Cooperative Union of India)