After the Supreme Court of India, on September 9, issued an ultimatum on the protesting doctors in West Bengal to resume duties by 5 pm, September 11, or be met with disciplinary action from the state government, the protesting medicos have not yielded to the order, and are continuing their agitation.
Resident doctors in the state initiated a sit-in protest outside the Swasthya Bhavan, the headquarters of the state’s Health Ministry following the order, and are showing no signs of stopping. They expressed their disappointment in the Supreme Court’s order and said they would continue their cease-work until the central government meets their demands.
One of these demands is the introduction of a central Bill to protect healthcare workers against violence.
While this was a long-stated demand from various medical associations in the country, it gained further urgency after the rape-and-murder of a postgraduate trainee (PGT) doctor at the RG Kar Medical College and Hospital, Kolkata on August 9.
“We are pushing the central government to introduce this bill as the violence against healthcare workers is seeing no signs of stopping or reducing,” says Dr Paramita Thander, a junior resident doctor at RG Kar, who is also a part of the protests.
She adds that the healthcare workers in RG Kar, especially, have been more susceptible to violence, which is the reason for the continuation of the protests. “Nobody wants to go to their workplaces fearing violence, or even death,” she laments.
This is the second time in recent memory that demands for this legislation have been raised by the medical fraternity in India. Following the murder of Dr Vandana Das, a medical intern by a patient in Kerala on May 10, 2023, various medical associations in India demanded that the Central government introduce legislation to protect healthcare workers against the violence.
In 2019, the Ministry of Health and Family Welfare (MoHFW), Government of India released a draft legislation titled The Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2019, and invited suggestions and objections from relevant stakeholders, prior to its finalisation.
However, a recent response to a Right to Information (RTI) by the ministry stated that the Centre will not be enacting a separate bill to prohibit violence against healthcare workers.
A reluctance to enact the bill?
This RTI, filed by Kerala-based activist Dr Babu KV on August 17, enquired about the status of the draft notification and sought copies of any communication between the Ministries of Health, Home Affairs and the Prime Minister’s Office (PMO) regarding the draft bill of 2019.
The ministry also refused to provide said copies of the communication, as they were exempt from the provisions of the RTI Act, 2005.
Speaking to EdexLive, Dr Babu said that he filed the RTI query after JP Nadda, the Union Minister of Health and Family Welfare, responded positively to the delegation of the Indian Medical Association (IMA), which met him and ministry officials to demand the central bill, and assured them of action.
“It is disappointing that the Union government is not willing to address a long-standing demand of the medical community even after nationwide protests,” he said.
This is the third time Dr Babu filed an RTI enquiry on the status of the draft bill — and was met with this response.
In 2022, the responses to his RTI applications, which were dated July 5 and September 12 informed him that the Ministry of Health decided not to “pursue” the draft legislation, and no further action or communication with the Home Ministry took place.
When asked about why the Central government might not be moving ahead with the legislation, Dr Babu says that the centre might not want to introduce a separate legislation just to protect members of one profession from violence.
Further, the lack of adequate spending on public health is also a contributing factor to the lack of a central law to protect healthcare workers, says a public health researcher, on the condition of anonymity.
She points to the fact that many medical colleges and healthcare institutions are strapped for funds to implement basic security measures. “For example, recent guidelines from the Health Ministry direct public medical colleges and hospitals to increase the number of CCTV cameras and security guards on their premises, among other things. However, when they are short of funds, how can they implement these measures?” the researcher explains.
Moreover, the lack of a clear implementation strategy or direction from the central government also poses a problem for the proper implementation of these guidelines.
Central act necessary for parity
However, the public health researcher says that a well-drafted, well-defined central legislation could help reduce violence against healthcare workers.
“In India, 25 states and union territories have laws to protect healthcare workers against violence. In fact, Kerala and Karnataka have amended their existing legislation to make them more stringent, and encompassing of all healthcare workers,” she explains.
However, the lack of central legislation makes it difficult to ensure that acts of violence against healthcare workers are not redressed or punished effectively.
“For example, we found through multiple RTI enquiries that the conviction rates for violence against healthcare workers have been low. Moreover, different laws in different states would mean that the same crime would have varying degrees of punishment,’ she explains.
Therefore, a central act could ensure proper redressal and consequences for the punishment of violence against healthcare workers, and ensure that their basic Right to Life is protected, she says.
Structural changes needed
However, the prevention of violence against healthcare workers cannot be solved through legislation alone, argues the researcher.
Making the case for a “multi-pronged approach”, she says, that violence faced by healthcare workers usually depends on variables like their gender, designation, and level of seniority.
“While all healthcare workers are susceptible to violence, the degrees of vulnerability vary. For example, a junior doctor is more likely to face violence than a senior doctor. A female junior doctor is more likely to face violence than a male junior doctor. A female nurse is more likely to face violence than a female junior doctor,” she explains.
In addition, violence against healthcare workers often reflects the gendered, casteist, or bigoted nature of violence that exists in the society at large, she adds.
Elaborating on this, Dr Parth Sharma, community physician, public health researcher and founder of Nivarana, a public health information and advocacy organization says that the RG Kar incident is nothing but an extension of the oppression and violence faced by women every day.
“We cannot just reduce the incident to a case of violence against a healthcare worker. This is the extension of societal misogyny, and we cannot overlook that” he says.
He adds, “The act would only protect doctors as long as they are under the jurisdiction of their hospital. Once they are outside, normal law applies to them, and they are vulnerable to danger. This is especially true for women.”
Further, he opines that violence against healthcare workers is a symptom of much larger issues: an apathetic and underfunded healthcare system and a morally declining society.
“Successive governments have not prioritized public spending on healthcare, with only around 2 per cent being allocated to the health sector with the expenditure hovering around 1.3 per cent. This systemic underfunding is adding to the suffering of both healthcare workers and patients,” he explains.
It is also important to centre patients in any law that protects healthcare workers, as they are also vulnerable against this apathetic healthcare system, both researchers say.
“Following the examples of China and Taiwan, the act should include both the measures to protect healthcare workers, as well as patients,” says the researcher.
Therefore, an increase in public spending for healthcare (at least the targeted 2.5 per cent of India’s Gross Domestic Product) and more empathetic management could also be useful to prevent violence against healthcare workers. The moral decline of our society, which makes its presence felt in incidents of violence against healthcare workers, requires a social reform through education that instills good values, he says.
In addition, the inclusion of female doctors, nurses, and other cadres of healthcare workers in all spheres of decision-making, right from the core committees and delegations of medical associations, as well as in the policy-making sphere would facilitate creation of better policies which could help create better workplaces for women in particular , he says.
“Our research found that from 1943 to 2020, only 11 per cent of the membership among 23 national health committees were women. This lack of a gender balance was also recently highlighted in another healthcare decision making body in India. For more inclusive policies, diversity of representation needs to be urgently addressed,” he adds.
Lastly, hospitals must be treated as designated safe spaces as per International Humanitarian Law, and must be kept safe from violence, says the researcher. “When hospitals are safe, healthcare workers do not need protection,” she says.
