Events & Issues

New Delhi, 11 August 2017

Health Providers

NEED RECOGNITION & REWARD

By Dr.S.Saraswathi

(Former Director, ICSSR, New Delhi)

The month-long strike by nurses in Kerala has exposed the miserable state of the nursing profession described as “the finest of fine arts” by Florence Nightingale.  Strike by nurses has now become an annual event performed in some part of the country necessitating resort to Essential Services Maintenance Act (ESMA).  But law and regulations pertaining to hospitals, medical care, labour,  contract  law – all of which have a bearing on Nursing as an occupation and are undergoing reforms – have not removed the genuine grievances of nurses in India.

Nurses have partially succeeded in achieving their demand for pay hike this time, but other problems faced in this profession have not been removed.  Nor is it possible to remove them by strikes in view of certain common notions about  personal  service in India.

The strike, called by the United Nurses Associaltion (UNA) and the Indian Nurses Association (INA) was opposed in Kerala High Court by Health Care Providers (India) on the ground that health services in the private sector would come to a grinding halt. The State was indeed going through a period of fever epidemic creating  tremendous  pressure on hospitals.

The Kerala High Court asked the State government to apply ESMA in public interest  to persuade the nurses to withdraw  the strike.   The Court even went to the extent of passing an interim order prohibiting the strike.

The WHO has stated that “Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all setting”.   It also “includes promotion of health, prevention of illness, and care of ill, disabled, and dying people”.

Strike by nurses can affect the entire healthcare system and the functioning of hospitals and nursing homes.  Besides small services to patients, it would seriously  affect intensive care unit and surgical departments and laboratories and  bring their work to a standstill.  They  all  depend  on nurses to carry on their work.  Private hospitals face even the prospect of closure if nurses go on strike.

Nurses are as important for doctors as for patients.  They provide the link between the two.  Nursing is no longer a simple “calling” as designated by Nightingale over 150 years ago differentiated from a “profession”.  Medical science has advanced so much taking along many other auxiliary services that once remained   moral services.  Professionalism marks every segment of health providers and nursing involves good academic exercise in the area and sound on the job training.  It combines necessary knowledge and skills required in the treatment of patients at all stages.

Nursing fulfils the main criteria required for recognition as a profession like well developed academic course, scope for using  judgement  in work,  professional organisation, acknowledged social worth,  significant contribution to human wellness, and special knowledge and skill.  Different countries may emphasise different factors, but nursing has definitely grown as a separate profession and has earned recognition in the world of work.

What it needs in India is social recognition, ending aloofness from the general public like certain other uniform-wearing service personnel like the police. Studies in some western countries reveal that there prevails an idea that low status given to nursing generally is due to predominance of women workers  in this sector.  Gender bias  is active in India too.  Male dominance by number in medical practitioners stands as a sharp contrast to female dominance in the number of nurses.

Strike by nurses is known in all countries including those where  working conditions are far better than in India.  In May this year, nurses voted in favour of a nation-wide  strike called  by the Royal College of Nursing  in the UK.   In June, all hospital work was paralysed and services were suspended in Kenya.

France is renowned for quality healthcare service, but the condition of nursing professionals  is wanting in many respects.  Towards the end of 2016, it gave rise to an “unprecedented movement” across the country to raise the quality of healthcare profession.  A wave of suicide of nurses was believed to be related to intense job stress.  In several other European countries, low pay has led to prolonged strike by nurses.

The strike in India  ended in the last week of July with the Kerala government agreeing  to  implement the Supreme Court directive to fix the minimum salary of nurses in the State as Rs. 20,000 per month in government hospitals and to extend this to private hospitals with less than 50 beds. It was decided to appoint a committee to fix salaries in  hospitals with more than 50 beds.

Nurses  constitute the largest group of professionals in the healthcare system.   In many countries,  nursing is considered  an independent profession   but in India it depends on doctors and hospitals heavily though nurses are indispensable for them. Even nurses in home care services depend on organisers and placement agencies.  Nurses have little bargaining strength to fight for status and reward.

There is no  strong all-India labour union for nurses in India.  Established unions  like CITU  take up common labour issues affecting large labour  population, but not so much specific problems of particular professionals.

According to WHO estimates,  the country needs 2.4 million nurses.  Nurse-population ratio in India  is said to be lower than in many developing countries in Asia.  Low professional and socio-economic status , gender issues, lack of political  support,  and unregulated private sector are said to be the reasons for  scarcity of nurses in number and their low quality.  Nurses themselves largely come from poor families – a factor that easily leads to exploitation in many ways.   All these are compelling reasons for  the society to  take up their case earnestly.

In many developing countries, information on human resources available in the health sector is incomplete and unreliable to help workforce management and planning.  According to WHO estimates, nurses account for about 30.5 per cent of health workforce in India.   In some States like UP, Bihar, and Haryana it drops below 20 per cent.

Still, large-scale migration of nurses to Middle East and European countries take place not so much by pull factors, but by push factors  like  very low salaries and difficult working conditions.  Estimates suggest that Indian nurses constituted the biggest group among those recruited from non-EU countries into Britain’s National Health Service between 2009  and 2015.  Those who have stayed behind are tempted to go on strike to force improvement in working conditions.   It is common knowledge that nurses from Kerala are working all over the world and have earned appreciation.    

The diverse kinds of work entrusted to nurses demand different types of abilities and expertise.  Western countries have developed  nursing degrees like Master’s Degree in  neuro-vascular  problems, cardiac problems, burns, etc., and also in nursing education and administration.  Similar  advanced courses have been started in India also from Auxiliary and Midwifery Course to Ph.D. Degree.  To establish more nursing colleges and to  make these courses popular, the profession of nursing has to be made attractive for both boys and girls from all economic strata.

In brief, nurses and other health providers  need recognition and reward.  It will go a long way in directly  improving our health index.---INFA

(Copyright, India News & Feature Alliance)