Traditionally, our response to laws failing to arrest healthcare violence has been to simply increase the quantum and severity of punishment the next time.
By Soham D Bhaduri
The government’s promulgation of an ordinance to punish violence against health personnel by amending the Epidemic Diseases Act, 1897 is welcome. Maharashtra, Punjab, Odisha, West Bengal, and Telangana already have similar state-level acts which make violence against healthcare workers cognizable and non-bailable. In mid-2019, spurred by a spate of violence on junior doctors, the Union health ministry proposed a nationwide law with an enhanced imprisonment quantum of up to 10 years, which was put on the backburner due to opposition from the home ministry. Earlier in 2019, a private member bill seeking the same was tabled in Lok Sabha. The fresh ordinance appears to be another simple knee jerk response.
Considering the grave situation, where the health workforce can face rapid attrition due to fear of violence in addition to the disease itself, we must think of strong pre-emptive instruments in addition to the ordinance.
A long-standing demand of doctors has been to deploy armed personnel in hospitals. However, their sheer number – with more than 10,000 hospitals just with the government – has hitherto rendered it infeasible. Considering that Covid-19 dedicated facilities are a manageable number deploying armed personnel in such violence-prone settings is both feasible and warranted. It is crucial to extend the same to ambulances, and depending on capacity to lower-level facilities.
Armed personnel accompanying field workers into the community can greatly jeopardise trust and community cooperation. To address this would require an examination of how healthcare violence during the pandemic differs from healthcare violence in normal times.
Deficient (public) or extortionate (private) health services incapable of meeting acute needs of an ordinary patient is the commonest aetiology for healthcare violence. This leaves little room for effective communication. In the case of the current pandemic, a distorted perception of risk posed from the visiting health worker, and the possible tribulations of being isolated or quarantined, are major drivers of violence.
The current pandemic has seen unprecedented efforts at risk communication across the levels of governance. IEC strategies to deter healthcare violence, which also address distorted ideas about risk from health workers and assuage fears about corona management, will need to be conspicuously integrated into our overall Covid-19 risk communication machinery. There is every reason to earmark funds for anti-violence communication within the budget for risk communication.
Traditionally, our response to laws failing to arrest healthcare violence has been to simply increase the quantum and severity of punishment the next time. The current ordinance is of a similar nature and does not address the critical question of effective implementation. There has been little consciousness about laws even among police personnel.
Apart from creating widespread awareness of the ordinance and its provisions, the most important measure for empowering the ordinance will be to set glaring precedents by speedily trying malefactors. Apart from greatly amplifying the deterrence power of the ordinance, it would instill confidence among health personnel.
The author is Mumbai-based doctor & editor of the journal ‘The Indian Practitioner’