Report by correspondent of Mazdoor Ekta Committee
“Doctors and nurses working on contract are called upon to attend to hundreds of patients in all kinds of emergencies – yet they are themselves denied any health care benefits such as ESI facilities and are even denied maternity leave!” … these were the words with which Ms Swati Rane, an activist of the Jan Swasthya Abhiyan, described the condition of doctors and nurses working on contract in the health sector. She was highlighting the concerns raised by various sections of health workers at a meeting organised by Mazdoor Ekta Committee (MEC) on 26 October, on the Right to Security of Livelihood in the Health Sector.
The meeting saw the participation of a large number of regular and contract doctors, nurses and health workers of government and private hospitals, urban and rural primary health centres, National Health Mission (NHM) workers, ambulance workers, ESI Hospital workers, ASHA and Anganwadi workers, sanitation workers, security staff as well as working people from many other sectors, including IT workers, railway workers, electricity workers, trade union activists, teachers and students.
Shri Santosh Kumar, MEC; Ms Sasikala MRB Nurses Union, Tamilnadu; Ms Trishila Kamble, Municipal Nursing and Paramedical Staff Union, Maharashtra; Shri Kaushlesh Tiwari, Chhattisgarh NHM Karmachari Sangh; Shri Girish of Kamgar Ekta Committee; Shri Anandan, 108 Ambulance Workers Union, Tamil Nadu; Dr Karad, Maharashtra Samyukt Kamgar Kruti Samiti; Ms Swati Rane, Jan Swasthya Abhiyan, and several others presented their views.
The meeting was chaired by Shri Birju Nayak of MEC.
Shri Santosh Kumar of MEC emphasised that access to good health care at affordable rates is the right of every member of society. There should be adequate number of hospitals and health centres, in the cities, rural areas and remote corners of the country, with adequate number of doctors, nurses and other health workers, as well as the necessary medical equipment, facilities and medicines. The health care providers – doctors, nurses, para-medical workers and others – must have secure livelihood, safe working conditions, a dignified living wage, pension etc. However, the reality is very different.
While fancy private hospital chains – Apollo, Max, Fortis, etc. – promising state-of-the-art medical facilities, remain out of reach of the vast masses of working people, the endless lines, the lack of beds, medicines and equipment, the overcrowded wards and pathetic conditions in government hospitals speak volumes about the health care services there. We can well understand the terrible workload and hazardous working conditions of the doctors, nurses and health workers there. Health workers under various government schemes such as ASHA, Anganwadi, NHM, etc. provide health care services to the people in the remotest corners of the country, yet they are not even recognised as workers, they can be thrown out anytime, and they work for as low as Rs 6000-8000 per month.
Shri Santosh clarified that the source of all these problems is the existing capitalist system in our country. The capitalist class, headed by the monopoly houses, rules our country. The Indian state defends the rule of the capitalist class and every government, regardless of which political party heads it, implements the agenda of the capitalist class. While the illusion is spread that through periodic elections, people vote to bring in the government of their choice, the reality is that people have no mechanism to select the candidates, to hold the elected representatives to account or to recall them, or to initiate and amend legislation.
The sole aim of the capitalists is maximisation of profits. They have no concern for the well-being of the working masses. The use of contract labour means depriving workers of all their rights that they have won through long struggle. Increasing the number of contract workers is the method by which capitalists want to maximise their profits by reducing the wages of the workers to the minimum possible and denying them of all rights. Faced with the widespread resistance of the working class in the 60s and 70s, the Central Government had to pass the Contract Labour (Regulation and Abolition) Act on 5 September 1970. However, in the last 20 to 30 years this law has been made more and more flexible for the capitalists. Through a number of court judgments, various types of work such as security work, sanitation work and many other kinds of work of a permanent nature, including in the central and state government institutions, have been taken out of the purview of the Contract Labour Act. Contractors employing up to 50 workers have now been excluded from this Act. These workers are denied not only minimum wages, but also job security, ESI, Provident Fund, etc.
Today, doctors, nurses and other health workers are agitating for an end to contractual employment, job security, a dignified living wage, safe and humane working conditions, pension and other rights.
Shri Santosh explained that the contract labour system is not only detrimental to the workers who work on contract, it is also detrimental to the society as a whole. The contractors often utilise untrained workers at lower wages, for work requiring highly trained and skilled employees – e.g. in rail, road and air transport, in the critical health sector, etc. – thereby increasing the hazards for the users of these services.
Shri Santosh concluded by calling upon all sections of the working class to unite on a common platform and take forward the struggle against their increasing exploitation and insecurity of livelihood. The aim of the struggle, he emphasised, must be to end exploitation, by replacing the existing capitalist system with the rule of the working class and all the oppressed.
Ms Sasikala said that in government hospitals and PHCs in Tamil Nadu, nurses continue to work on contract even after more than 10 years, at a mere Rs 15,000-18,000 per month. Even these wages are not paid regularly, resulting in immense hardship for their families. Many of them are called upon to handle more than 100 patients at a time, including maternity cases, and to put in 24-32 hours duty. Yet, these nurses are themselves refused maternity leave and are forced to quit their jobs. They have no pension, no insurance cover and they face all sorts of indignities including physical assault. She highlighted the struggle of the contract nurses to form their union and their demands to the government – to ensure regular employment for them, with all rights, as well as safe working conditions.
Shri Anandan spoke of the increasing use of contract work in the health sector and the miserable conditions of the workers. In the rural Primary Health Centers (PHC’s), district collectors use their power to regularly deny the health workers even their regular wages. Our experience shows that we cannot expect the courts to rule in favour of us, he said, and pressed for mobilising all health workers in the struggle for their rights.
Shri Kaushlesh Tiwari described the recent prolonged strike by nearly 16,000 NHM workers of Chhattisgarh, demanding regular employment along with other rights. The striking workers have demanded reinstatement of their union activists, who were suspended for leading the struggle. Citing the various promises made to the agitating NHM workers by the Chief Minister and other government authorities, Shri Tiwari categorically said that the state and central governments have no concern for either the condition of the NHM workers, or the health needs of the people. He demanded that the government increase the expenditure on public health, so that public health workers’ jobs may be regularised and better health services may be provided to the masses. Shri Tiwari stressed the importance of not relying on the government’s promises, but on mobilising the health workers in larger numbers and taking the struggle forward.
Ms Trishila Kamble vividly described the low wages, long working hours, huge patient load, denial of maternity leave and sick leave, etc. of contract doctors and nurses in the Mumbai Municipal Corporation hospitals. Patients are naturally angry and frustrated with the long hours of waiting and the poor health care services. Their anger has to be directed against the system, not the doctors and nurses who are themselves victims of the same system, she said.
Ms Swati Rane called for building the unity of patients and health workers, against the poor health care services and terrible working conditions of doctors and nurses in government hospitals.
Shri Girish spoke of the severe cutback in public health funds throughout Maharashtra. If doctors, nurses and health workers are themselves in constant fear of losing their jobs, how can they provide proper health care, he questioned. He called for regularisation of the jobs of the health workers and increase in the public health budget of the government, in order to make good quality and affordable health care available to all the working people.
Dr Karad said that health care cannot be made into a source of profit for the big corporate houses, emphasising the need for better public health services.
Shri Salvinder of Workers’ Unity Movement, UK, pointed to similarities between the deteriorating public health services in the UK and in India, which are a consequence of the capitalist greed for maximum profits, at the cost of the health of the working masses.
Shri Hanumam Prasad Sharma, Vice President of Lok Raj Sangathan; Shri Harishankar Sharma of TUCC; Shri Satish Pawar of AIUTUC; Shri Sukhendra Madaiya of the Centuries Mill Satyagraha Andolan; trade union leader Shri JP Dubey and several others also contributed to the discussion.
Summing up the participants’ views, Shri Birju Nayak, called for the workers in the health sector and in all other sectors to unite and come forward in the struggle to put an end to capitalist exploitation and slavery. For this, we have to replace the rule of the capitalist class with the rule of the workers, peasants and all oppressed people, and build a new society oriented to ensure the health, security and well being of the working masses, he concluded.