Winding up of the CGHS:
THE Union Minister of Health and Family Welfare of the UPA government, Dr. Anbumani Ramadass categorically declared in a press conference at Chennai on 1st June ’05 that the government of India had planned to wind up the Central Government Health Scheme (CGHS), which benefits 50 lakh beneficiaries, and that it had also been decided to introduce in its place the “Health Card” scheme.
On 20th April, 05 the State Minister of Health and Family Welfare, Srimati Panabaka Lakshmi, placed her answer before the Lok Sabha to the unstarred question No. 4017 on the abolition of the CGHS raised by Sri. Bachi Singh Rawat, an MP. The essential point of the answer was as follows: The Planning Commission has completed its Mid-Term Appraisal (MTA) of the Tenth Five Year Plan in respect to major sectors of the Government. The chapter on health has drawn attention to several reports commissioned by the Ministry of Health and Family Welfare. These have reported on the low satisfaction level with the CGHS. The MTA further suggests that the concerned ministry could consider several options for the reform of the CGHS. The MTA suggests that the current and new CGHS subscribers may be given the option to shift to a system of health insurance.
On 6 May ’05, the Ministry of Health and Family Welfare issued an order to set up a 5-member committee under the chairmanship of Sri. P.K.Kaul (former cabinet secretary) to look into the functioning of the CGHS scheme and give recommendations for making it financially more viable and cost-effective. Interestingly, the order also said that the proposed committee also suggests conversion of the CGHS organization into a corporation on the lines of the ESIC.
The CGHS was established in 1954 with the objective to provide comprehensive healthcare to the central government employees. Later the scheme was extended to pensioners and various government personnel. At present this scheme is operating in 24 cities through 246 dispensaries, 19 polyclinics, 18 laboratories and 86 ISM units. More than 7000 employees are attached with this CGHS. Never before a question was raised on the very relevance of the scheme itself. Unfortunately, at present a perverse move has been advanced by different organs of the Central government to wind up or convert this crucial health service in qualitative way. And for making this move rational and justified, suddenly the question of examining the level of satisfaction of the subscribers has been posed. But, if the concern of the subscribers or consumers of the health service is the real agenda of the government, why not focus on the improvement of the functioning or the professional performance of the service? Why it is being proposed that the cost of ‘better’ service is to be imposed on the consumers themselves?
The question of financial viability and corruption has been raised by the Union Health Minister as the government has to spend Rs.500 to 600 crores per year on the scheme. However, categorically refuting the baseless allegations made by the Minister, the national president of All India C.G.H.S. Employees Association, Mr. Ram Kishan, rightly said, “the scheme was introduced as a welfare scheme to provide very cheap health service to a section of employees and so it can never be judged on profit-loss basis or level of expenditure of the government. If corruption or irregularities are the real concern, then why the Minister does not come out with a “White Paper” unearthing the factors behind it, and thus work out ways and means to improve the system, instead of conspiring to dismantle C.G.H.S”.
During the last decade, irrespective of the colour of the govt., crucial sectors like education and health have been undergoing fundamental changes. The main components of ongoing restructuring are reduction of financial support of the govt, drastic reduction of workforce in these sectors, growing contractualisation and penetration of corporate houses and MNCs. In this backdrop, the proposal for the winding up of the CGHS is a concentrated expression of the onslaught on the health sector. The real question is not whether the existing employees would be retrenched in a crude manner or offered a ‘graceful’ exit; rather it would abolish thousands of posts “and further shrink the scope of employment and pave the way for all-out contractualisation of the employment, including in the appointment of doctors.
Some liberal ideologues may argue as to what is the harm in winding up a particular health scheme when it is being replaced by some alternative arrangement. But it is amply clear that the proposed alternative is essentially meant for withdrawal of the government role in healthcare and throwing it to the mercy of the corporate houses or MNCs. The Union Health Minister himself has admitted that this arrangement of “health card” would be on an experimental basis and in case it succeeds it would be expanded further.
The CGHS employees are organized into a single all-India association with a glorious tradition of militant agitations, which ensured them many economic gains and dignified working conditions. Recently, they went for a one-day token strike on 7th June, 2005 throughout the country on issues like timely supply of quality medicines, expansion of the CGHS services, promotion of employees, and filling up of vacant posts etc. They are organizing conventions at major centers all over the country. On Sept. 14, a national convention is proposed to take place in New Delhi which will be preceded by an all India strike on August 29-30.
– DP Buxi