The armed forces like other central agencies have been created with a specific purpose. Their mission, aims and tasks are oriented towards security of the nation. These tasks spread across a spectrum of activities from provision of aid in disaster relief and enforcing law and order when other agencies have failed to battle insurgencies and militancy.
The forces’ primary role remains that of ensuring territorial integrity of the nation from external threats. The structure is based on perceived threat and tasks. Since maintaining an armed force is costly, its resources are limited and remain at a premium. Employing these at the central level without considering the long-term impact would result in shortfalls when required for fulfilment of the primary mission.
Every government, especially when elections are around the corner, seeks to win over masses by announcing schemes for which they are either unprepared or aware that they cannot be logically implemented, hoping the announcement itself would win them support. The Ayushman Bharat Yojna, also called ‘Modicare’, the world’s largest health care scheme for rural areas, announced by the government recently, is an example. The scheme was announced with much fanfare and aims to provide Rs 5 lakh health cover per family in rural areas for secondary and tertiary care hospitalisation.
Despite government attempts, no private hospital has volunteered to join the scheme. The reason as stated by Dr Parthiv Sanghvi, Secretary of the Maharashtra branch of the Indian Medical Association, was that the rates are ‘unrealistic’. He added, “the hospitals have collectively decided that unless the package is revised, they will not get empanelled.” Since no private hospital was willing, the government adopted the easier route, compelling railways, armed forces and other central agency hospitals into the scheme. It never considered revising rates or enforcing participation of private hospital chains.
The government is compelling the military to involve military hospitals into ‘Modicare’ without evaluating capacities, workload and infrastructure of such hospitals. This act by the government stems from its fear that the scheme would be criticised by the opposition during electioneering as just another announcement. It is evident that the government is jumping to garner support without being adequately prepared.
Military hospitals have a specific task. In war, they are redeployed in forward locations to cater for casualties. In peace, they are tasked to provide health care facilities to soldiers and their families. Veterans are only considered for treatment in case of free capacity, which is almost always unavailable.
In remote areas of J and K, North East and Uttarakhand, locals visit nearest army facilities for basic treatment. This treatment does not include prolonged stay as these hospitals lack capacity and specialisation.
Armed forces hospitals are limited in number and have capacity to cater for the anticipated strength in their locations. Increase in strength of the military has not resulted in enhanced bed capacities of hospitals mainly due to shortfall of doctors, lack of funds and space constraints. In every case military hospitals remain overcrowded. Most of the staff is overburdened.
To reduce pressure on military hospitals, the government introduced ECHS (Ex-servicemen Compensatory Health Scheme) for veterans. Under this, veterans proceed to their own clinics for primary health care and for specialised treatment to affiliated private hospitals. This is because military hospitals cannot cater to them.
Expecting these overburdened hospitals to now provide access to the general populace will possibly ensure that this functional system also collapses under the weight of excess patients. The doctors, already under intense load would now be compelled to handle far more patients than their capacity. Hospital treatment and care meant for soldiers would be diluted. Veterans have already been discarded, soldiers’ families would be next.
The idea behind ‘Modicare’ may be unique and aimed at benefitting masses but implementing this without a detailed analysis and evaluating capacities of military hospitals is ensuring that not only ‘Modicare’ but even these hospital facilities collapse under excessive weight.
Bureaucrats implementing ‘Modicare’ should have realistically aimed at improving health care services at the grass roots level, rather than compelling patients from villages, who are the main beneficiaries, to travel large distances to military hospitals in cities. It would add to their problems as they would neither have a place to stay nor be sure of availability of doctors.
There have been many instances in the past few years where the government has acted to deride the functioning of many central organisations, the armed forces being the biggest loser. Military hospitals are the latest target.
The armed forces exist for the nation, comprise of masses from the nation and have a responsibility towards its populace. They have institutions which are essential for their functioning. To ensure their collapse under increased load, only to provide additional brownie points for the ruling party in elections, is inexcusable.
It is surprising that this government despite its much-hyped power has either failed or is unwilling to force private players to join ‘Modicare’. Every private hospital has a Corporate Social Responsibility (CSR) component, which should be exploited. Ignoring it, seeking the easiest way out by forcing the military to open its resources, without sparing a thought on its impact is clearly short-sighted.
The government should develop healthcare facilities across the country and compel private hospitals to join the scheme. After all they too are part of the nation and have a social responsibility. Do not exploit military hospital facilities without assessing their capacities resulting in their collapse. If you wish to do so, then build their infrastructure and capacity first.
The writer is a retired Major-General of the Indian Army.