Unless government puts its house in order through good governance, equity and probity, it is anathema for people to subscribe to fundamentally flawed decisions
The signs are not good. The country seems more and more topsy-turvy. Decision making by ministers or by the top brass of the government Establishment require special managerial acumen. This is not a job for greenhorns. The presence of a Minister Mentor in government (himself a former Prime Minister and President) was presumably meant to mentor and groom the greenhorns and neophytes in the cabinet into the subtleties and well-honed skills required to be able to exercise the art of government. Nearly eight months later the outcome leaves much to be desired on so many fronts germane to the welfare and better well being of the people such as the standard of good governance, accountability, merit based employment, a strict oversight on public spending to eliminate waste, economic growth, economic fundamentals, widening inequalities and the erosion of the standard of living of mainstream Mauritius. The quality of policy decision making is a yardstick of the competence and ability of government to handle and manage complex issues bearing in mind the public as well as the people’s interest. Every policy decision must be carefully thought out after a holistic examination of all relevant elements and facts and a due process of consultation. The growing perception is that too often government policy decisions have been botched provoking legitimate exasperation and protests.
The government decisions to introduce a shift system in the public health service and to controversially hike the prices of gasoline and diesel are two recent cases in point. The medical profession is not like any other profession. It is a special calling. Policy decisions relating to the profession have to take into consideration its specificities and the Hippocratic Oath taken by physicians before they start practising. This oath includes inter alia commitments to treat illnesses to the best of their ability, to preserve the patient’s privacy and to teach the secrets of medicine to the next generation. An efficient public medical service and the professional caring of patients by doctors require a warm human touch. It cannot therefore be organized on a shift system as in a textile factory. Is this approach being scripted by the 2017-18 budget proposals to recruit 624 personnel including specialists in our hospitals? Similarly, any political interference into the sacrosanct independence of the Medical Council is just not on.
Oath to treat the ill
Given the special nature of the profession, any reorganization of the medical service must necessarily be effected in consultation with the representatives of the medical profession. It is therefore not surprising that the recent proposals to reorganize the medical service provided in our hospitals on the basis of a shift system has been opposed by doctors and has led to protests. Health care is one of the key pillars of our welfare state. In the 2017-18 budget proposals, it benefits from an allocation of Rs 11.6 billion, the third highest after those of Social Security and Education. In addition various projects in the health sector such as in e-health, the construction of a new ENT hospital or mediclinics are funded under the Indian Financial Assistance envelope.
It is therefore vital that any attempt to reorganize the medical service should primarily improve the quality and standard of professional health care provided to patients as well as offer better conditions of work to the medical and para-medical staff. It must be highlighted that free health care means that the latest medical treatment available as well as diverse costly devices such as stents for heart bypass surgery costing some Rs75,000 each in the private sector are provided free of charge. An improved healthcare therefore also means a more rigorous, efficient and judicious use of the substantial Health care budget for the benefit of patients.
Patient centric health care
Doctors know that the nature of their profession and their oath of caring towards patients require that they have to be on night duty at least once per week depending on the number of doctors affected to each service. The more doctors there are in each service, the night duty responsibility can be better shared, thus improving the conditions of night duty. This system allows a better coordination and follow-up of urgent and critical cases. The specialists on call can thus liaise with the doctors on night duty and more closely monitor all the cases requiring a special and more diligent attention. Specialists therefore deal with fewer doctors than in a shift system to monitor the cases requiring close follow ups such as in casualties, cardiac units, intensive care units, surgery or maternity. This enables a more efficient treatment and caring of such cases. In contrast to a shift system, a well planned roster of night duty also allows the general practitioner to spend more weekends with his family in a month.
It is therefore imperative that any reorganization of the medical services is done in full consultation with the medical staff and all the stakeholders bearing in mind the nature and oath of duty of doctors towards their patients and the overriding object of providing a world class medical service and standard of patient care to the people. It is however equally important that the hospital and the ancillary health care services are staffed and manned by competent personnel imbued with the highest standards of professional ethics. Rigorous benchmarks and recruitment guidelines must assure that new doctors recruited have the clinical and professional skills to observe, correctly diagnose, consult with colleagues and aptly treat patients within a team working in a particular service. The hospital work place must also be a congenial hub of learning and sharing experience where young doctors learn from their seniors. In short, revamping the health care service means putting the patient at the centre of the health care system in the country, keep him regularly apprised of the state of his health and ensuring that he benefits from the best professional medical care and treatment possible.
No to unfair treatment
Last week’s government decision to hike gasoline and diesel prices in a context when the Brent oil price, which serves as a major benchmark price for purchases of oil worldwide, has fallen from some S58 per barrel in January 2017 to about $52 per barrel presently has caused widespread ire and protests.
For too long, successive governments have burdened vehicle owners with a whole range of indirect taxes and levies which have nothing to do with the actual price of oil and the oil price stabilization fund. Various taxes and levies covering contributions to the Road Development Authority, Rs 4 per litre to the Build Mauritius Fund, the MID Fund and subsidies to support the price of cooking gas, rice and flour represented 61% and 51.7% respectively of the prices of gasoline and diesel at the time of the last price rises of these commodities in February 2017.
It is estimated that these discriminatory taxes and levies on vehicle owners contributed a whopping Rs 14 billion to the State in 2016. The inequity of these levies is evidenced by the fact that billions of Rupees from the Build Mauritius Fund are inter alia being used by government to finance various water projects and the replacement of public sector buses under the Bus Modernization Scheme. Why should vehicle owners be arbitrarily penalized and singled out to finance such government investments?
The current price of oil is lower than that prevailing in February 2017. All things being equal, the present additional rise of Rs 2.20 and Rs 3.45 per litre in the prices of gasoline and diesel in a context of lower world oil prices means that an even higher proportion of these prices are paid as taxes and other levies to the State. It is not rocket science to know that the rise in gasoline and diesel prices has an adverse spill over effect on the economy and a direct impact on the transport industry triggering calls for a rise in bus and taxi fares, the price of bread, etc.
It is obvious that this second increase in the prices of gasoline and diesel in the space of six months is totally unjustified, the more so as an even higher percentage of the enhanced prices represent diverse taxes and levies imposed solely on owners of vehicles and two wheelers used by workers across the country to commute to their place of work.
This price rise is also unacceptable in a context of wanton dilapidation of public funds and generous government largesse in favour of the coterie, cohort of advisers and political appointees placed in cushy fat cat jobs. Under such circumstances, the vehicle owners of mainstream Mauritius cannot be asked to bear the brunt of additional taxes and unfair levies in a context of systemic erosion of their purchasing power. Government should have adjusted the unfair burden of taxes and levies solely borne by vehicle owners instead of again hiking the prices of gasoline and diesel at a time when world oil prices are lower and more stable.
Such government policies and levies selectively and iniquitously imposed on a subset of society are questionable. Such a warped logic also motivated the 2012/2014 government decision to pass on the burden of the recurrent annual costs of the dock workers’ pensions which was borne by the sugar industry producers amounting to more Rs 100 million per year to the local consumers of sugar through a levy of Rs 3.70 per kg on domestic sales of sugar, under the nose of ACIM. The largest sugar producers as opposed to the small planters whose individual production is quite small are the principal beneficiaries of this galling and unfair measure. The air ticket is similarly burdened by diverse levies and taxes representing between 40% to more than half the air fare.
Governments must govern by example and in a manner which is rigorously fair to all parties and certainly not partial to the very well endowed. Unless government puts its house in order through good governance, equity and probity as well as rigour in managing public funds, it is anathema for people to accept such an iniquitous hike in fuel prices or subscribe to fundamentally flawed and contentious government decisions. The people are united in loudly saying no to growing mayhem and inequity.
* Published in print edition on 11 August 2017
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