Divided over A Report

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The battlelines have been drawn up over the S. Balaraman committee report with nurses’ organisations seeking its immediate implementation and hospital managements threatening to shut down hospitals if the government makes any such move.

Health Minister V.S. Sivakumar said that the decision on implementing the report will be taken only after studying the report threadbare.

The minimum wage of a general nurse working in a hospital with 20 beds or less is a paltry `6,500 now, and that of a BSc nurse around Rs 7,500.

The Balaraman panel wants to increase this to Rs 12,900 (but without making a classification of hospitals).

The panel also recommended a minimum salary of Rs 19,470 for nursing superintendents and Rs 21,360 for nursing officers.

The Balaraman panel, formed by the government last February following agitations by nurses, confined its work to the study of the problems faced by the nurses.

The committee had no mandate to hear the managements or the public as such.

This is what the managements are questioning. According to them, the “one-sided” report will kill the health sector in the state. Some of them also question the legality of the committee to recommend a salary hike as it is not a statutory body like a minimum wages committee.

“If the report is implemented, it will lead to corporate giants like Apollo entering the state as small hospitals and clinics run by doctors will have to shut down, unable to meet the steep salary hike proposed for nurses,” said Dr R.V. Ashokan of the Hospital Board of India, working under the aegis of the Indian Medical Association (IMA).

“It appears more like a trade union document based on emotions. Nothing more was expected of a committee of nurses headed by a person having no understandings of the dynamics of the private sector. The committee overstepped its mandate in actually proposing a salary figure.

There seems to be no rationale behind the proposal. The committee’s proposal is not structured, unlike a minimum wages award. Nor did it receive representations from the private sector,” Dr Ashokan says scathingly.

He sees the matter entirely from the viewpoint of the hospitals and argues that smaller clinics and hospitals will have to close down and only corporate hospitals will survive. “In a state where 83 per cent of healthcare is out of pocket, the rise in cost will push people below the poverty line,” he said.

The Catholic Church, which is a major player in the health sector with around 400 hospitals in the state under it, said 75 per cent of them, especially those in villages, will have to be shut down.

“Hospitals run by the Church and other social organisations cannot transfer this cost to the patients, especially those in small towns and villages. The only option is to shut down the hospitals,” said Fr Paul Moonjeli of the Catholic Hospitals Association of India (CHAI).

The Kerala Private Hospital Managements Association has questioned the legality of the committee to make such a recommendation.

The committee did not hear the managements at all, it said.

But Jasminsha, president of the United Nurses Association (UNA) that successfully spearheaded a series of agitations by nurses in various hospitals, points out that none of the hospitals that effected a wage hike had to shut down.

“The Balaraman panel did a thorough study of the problems faced by nurses. The threat of shut down is a ploy as many of the hospitals have already raised charges for patients. If they can pay the doctors, what prevents them from paying a decent wage to the nurses,” he said pertinently.

The debate is sure to continue in the coming days and could lead to another showdown between nurses and hospital managements.

Lakeshore showing the way?

The debate over the Balaraman panel recommendations has suddenly brought the attention to Lakeshore Hospital, here, cited as a leading example of corporate excellence in medical care.

The hospital is paying the minimum wage of Rs 8,500 to all nurses as starting salary. General nurses who completed one year are eligible for Rs 11,500 and BSc nurses Rs 11,750. “Depending on experience, some of the nurses are drawing as much as Rs 20,000 here,” a spokesperson of the hospital said.

The hospital also boasts of 6-hr shifts and 1:5 ratio of nurses to patients. These are high standards compared to those recommended by the panel (8-hr shift and 1:9 nurse-patient ratio).

Private hospital managements pointed out that in a hospital like Lakeshore the cost to the patient there was much higher than hospitals run by church and other social organisations.