(Recently, health workers across the country united to form the All India Health Employees and Workers Confederation, and have launched a spirited struggle to defend the public health sector against privatisation and contractualisation. Chandan Negi interviewed Comrade Ramkishan, seasoned leader of health workers and Convenor of the Confederation.)

Q. The Central Government has implemented the Sixth Central Pay Commission (6th CPC) report with great fanfare. In fact, the UPA government is projecting it as its one of its major achievements. But health employees in the government sector are on the streets on the issue of Pay Commission. Why is that?

The hard truth is that the 2.5 lakh health workers of this country are feeling betrayed by 6th Central Pay Commission and have decided to launch a struggle. From 23 February onwards, all health services in the country will come to a complete halt.

Q. How would you characterise the 6th CPC policy framework?

It was a strike notice by Central Government Employees including the Railways and Defence Employees which forced the government to constitute the 6th CPC, though the Government was legally bound to constitute the CPC and it was already overdue.

Up to the 4th Pay Commission, prior to the neo-liberal New Economic Policy (NEP) phase, the orientation of the recommendations tended to be more pro-employee, favouring mass-employment, self-reliance, strengthening and expanding government responsibility in the social sector, and including some provisions for employees at lower ranks. In the NEP phase, since the 5th CPC, the Government started withdrawing from the social sector and privatization became its ‘mantra’. The 6th CPC has created a much wider gap between the lower and the higher grades. It has promoted contractualisation of labour by abolishing the entire Group-D cadre and opening the door for outsourcing the work of group-D staff. It has tried to make government services least attractive by ignoring group-C and group-B cadres in most of the departments and making the Civil Services officer-centric.

Q How has this framework had an adverse impact on the health sector?

In the Health sector, the 6th CPC has taken care of only two cadres i.e. of Staff Nurse and Medical Officer. We are happy that the cadre of staff nurse has been upgraded and has been awarded their long-due share this time, though their grievance of pay-fixation still remains unresolved. 6th CPC have axed all paramedical cadres like Pharmacist, Laboratory Technician, E.C.G. Technician, Laboratory Assistant, Dental Technician, Sanitary Inspector, Yoga Instructor, Radiotherapy Technician etc. and placed them in the P.B.-I (now pay scales are determined by Pay Bands with grade pays), which is the pay band for upgraded group-D.

The Pay Commission has abolished the HPCA/PCA, and the Government of India decided to stop this allowance of the health employees from 1.4.2009, accepting the recommendation of the 6th CPC to replace the same by Risk Insurance Scheme. The 6th CPC while recommending abolition of this allowance, gave justification for it in its recommendation No. 3.6.17, which says that “Commission is aware that this would still result in some pecuniary loss for these employees. The loss, however, would be more than compensated in respect of existing group-D employees who will be upgraded to group-C. This loss for group C employees should be compensated in form of Performance Related Incentive Scheme (PRIS)”.

The Commission’s remark is an attempt to divert attention from the real issue. We all know that the upgradation of the group D staff has been done for the group D staff of all ministries and not only of Health sector, so where does the question of compensation of HPCA/PCA arise! The Commission remarks that HPCA/PCA in respect of group C staff will be compensated by PRIS, whereas the same commission recommends to cover only 20% employees of one cadre in an institution under PRIS. What will happen to the 80% remaining Group C staff?

Moreover, the HPCA/PCA was not sanctioned to health staff as a risk allowance. This allowance was created and paid to the Group C & D staff of the health sector at the rate of Rs.80/- & Rs.75/- way back in the year 1987 on the basis of recommendations of the 4th CPC which has suggested to form a committee to consider the payment of Risk Allowance. The Ministry of Health and Family Welfare constituted a committee of the Medical Superintendents of various Hospitals, which recommended that Risk Allowance and Night Weightage Allowance being paid to the Health Staff at that time may be merged. Not only this, the Committee had further recommended that health staff need additional support to take care of preventive and nutritional needs as they are exposed to a highly infectious environment loaded with highly virulent and drug-resistant bacteria. The recommendations of the Committee were accepted by the Ministry of H& FW and forwarded to the Cabinet with their recommendations. Hospital Patient Care Allowance was sanctioned to the Hospital Staff w.e.f. 1.12.1987 and later on it was paid retrospectively from 1.4.1987. There was an upsurge of agitations of the Health Employees in the year 1998 as the demand of Non Practicing Allowance of Health Employees was denied by the 5th PC. After a month-long agitation including a 11-day strike, a negotiated settlement was made under the guidance of a ‘Group of Ministers’ and the HPCA & PCA was enhanced to Rs.700/- Rs.695/- and Rs. 690/-. This allowance was also extended to six more institutions, which were not getting it earlier.

After the acceptance of the 6th PC report by the Government, no Group D posts will be filled up on regular basis as all the present Group D posts with the incumbents have been upgraded to group C. All work related to Group D cadre will be done by the contractual employees. The 6th CPC has paved the way for outsourcing the work of entire group D staff. It is now clear to us that there will be no further recruitment of Nursing Attendant, Peon, O.T. Attendant, Cook, Mali, Dhobi, Stretcher Bearers, Aya, Midwife, Lab. Attendant, Ward Boy etc. Health institutions can not function with contractual workers who have no responsibilities towards the health-institution, and without the years of experience that the present employees have. Moreover there will be no control of the institution’s management over such contractual employees. Contractualisation of health services will push public health services towards total collapse.

The ‘health’ of health services in a country is a true indicator of its socio-economic progress and on this count, India stands with the least developed countries of the world. India has to increase the strength of its health workers many times over to attain a respectable level of health service, because the core of health service is its workers. But the policy-direction of the 6th CPC clearly indicates that the government is interested in shedding its responsibility of providing health care and is rather promoting “commercialization” of health care in a big way by facilitating the private sector on the one hand and ruining public health care on the other. Attacking the interests of the workforce is clearly a step in this direction. So, the issue is not only of the interests of 2.5 lakh employees, it is an issue of saving public health care in our country.

In a nutshell, if we summarize the recommendations of the 6th CPC in respect of health sector, it is clear that

• • 1. 6th CPC has cheated the Paramedical staff by keeping them in PB-I

2. HPCA/PCA, which health workers were getting for last 22 years, has been snatched.

3. Group D services have been contractualised, inviting privatization of the health sector which will seriously deteriorate the present public health services.

Q What are your demands?

We have three demands, namely

I. HPCA/PCA should be continued, should be at par with Nursing Allowance and may be part of the basic pay as being done in the case of NPA for all health staff including nursing personnel. It should be extended to all health institutions in country and all levels of health employees.

II. The pay scale of Paramedical services should be placed in PB-II instead of PB-I. We demand constitution of a Paramedical Services Council of India.

III. Outsourcing and contractualisation in any form and at any level should be stopped immediately in the Health Sector. Where contractualisation has already taken place, all the posts/works should be replaced by regular staff.

Q How are health sector workers organized to take forward their battle?

Health workers from all over India are organized under the banner of “All India Health Employees and Workers Confederation” which is an umbrella organization of health workers’ unions and associations, representing 2.5 lakh employees. On the initiative of Central Health Employees Federation (CHEF) a convention was held in Delhi on 10 December, 2008 to discuss the situation before health sector and the Convention unanimously decided to unite under the banner of a Confederation and to spearhead the struggle. All major health institutions of Central and Delhi Government’s Health Ministry, NDMC and MCD, Railway hospitals, Ordinance factories hospitals are part of the confederation.

Q What point has your struggle reached now?

The Government has brought health services to the brink of complete closure. Our confederation has exhausted every possible avenue of dialogue available to it. We petitioned the Health Minister and Prime Minister. On 16 January, the Confederation demonstrated before Parliament in thousands and also at local head offices outside Delhi. From 2 to 6 February, a relay hunger strike was carried out at every health institution. On 13 February, the Confederation led a massive demonstration before the Chief Minister of Delhi. On 17 and 18 February, employees organized partial strikes for 2-hours at their institutions. Surely any democratically elected government should have initiated talks after all this? Instead, the Government started its campaign of lies to mislead the public, media and judiciary. Now 2.5 lakh health employees from 86 institutions from all over India have begun their strike successfuly on 23 February. The Government is bent upon using strong arm tactics and threatening employees by invoking ESMA. But health employees have a history of struggle and this time also, we will fight until the Government is forced to accept our demands.