Drawing on their research into gender disparities in Indian medical culture, Julie Davies, Emily Yarrow and Kamal Gulati argue that for Indian medical training and practice to become safe for women, more focus should be placed on training staff in organisational and systems thinking so they can drive through required changes.
On 9 August 2024, a 31-year-old second year woman trainee doctor was raped and murdered at the R G Kar Medical College and Hospital in Kolkata as she was sleeping in a seminar room after working a 36-hour shift.
Immediately following there were doctors’ protests nationally and over a million doctors took part in a 24-hour strike on 17 August. The Indian Medical Association (IMA) stated that the murder was barbaric and wrote to the Minister of Health and Family Welfare insisting on special security measures for doctors. The incident highlighted the lack of security for doctors and safe spaces for women. In response, the Indian Supreme Court has set up a national task force, with state level promises for the tightening of doctors’ safety in state-run hospitals.
India is the world’s fastest growing economy with ambitions for universal healthcare and to be the third largest economy by 2027. President Modi’s Vision of Viksit Bharat@2047 is for India to be a developed nation by 2047. As part of this vision, the Government of India’s Nari Shakti policy of women-led development is committed to improving women’s lives in the country. A key principle of World Health Organization’s global strategy on human resources for health: workforce 2030 is to eliminate gender-based violence, discrimination and harassment.
There has been limited success in India realising these goals for women’s empowerment. The World Economic Forum Global Gender Gap Report 2024 ranked India 129 out of 146 countries. Endemic gender-based violence in India indicates the country has a long way to go to either in terms of the quality of life for its citizens, or the UN Sustainable Development Goals, the success of which depends on India.
Will we see any real action and implementation of legislation to protect women? In 2013, the government passed the Prevention of Sexual Harassment (POSH) of Women at Workplace Act, which defined sexual harassment, established a complaints process, and outlined employers’ responsibilities for ensuring safe work environments for women including rest facilities. However, this has had little impact. In 2019, a Healthcare Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill was drafted to protect healthcare workers and hospitals, but it was never enacted.
Our experiences working on gender disparities in leading medical schools in India and UK business schools and most recently on a joint project researching the impact of these biases on physicians in India and UK gives us a particular insight into these challenges. What does it tell us about the working conditions of doctors, and attitudes towards women doctors, when their life expectancy is shorter than that of the general population? Why is legislation designed to protect women not strictly applied? What can doctors and their representatives do to achieve decent working lives to support universal healthcare and gender equity?
Our suggestion is to integrate medical leadership throughout medical school training and doctors’ working lives to equip them with an understanding of the need for systems leadership and skills to change the systems they are operating in. This requires addressing short term issues in working conditions, but also building a system that can better regulate itself.
Medical elitism in India
Kiran Kumbhar, who practised medicine in India and is now a historian in the University of Pennsylvania, talks about doctors in India having a “unique victim mentality, with the accompanying elitism and entitlement.” The medical profession is seen as high status and desirable. However, public discourse has focused on corruption amongst doctors. The lack of investment in public health and huge demand has resulted in violent attacks on doctors and tough working conditions. Zero tolerance policies similar to those in the UK’s NHS should be adopted to improve doctor–patient relationships and mitigate causes of frustration and anger which lead patients and their families to attack doctors verbally and physically.
Diverse leadership
Our research on doctors in two leading medical schools and hospitals in India has confirmed the challenges of huge patient loads and relentlessly demanding working conditions. Despite healthcare management training programmes, hospitals are mainly headed by male doctors who have not had formal leadership training. The result is that there is a lack of strategic thinking and implementation and a focus on clinical expertise and academic medicine. Moreover, as in many parts of the world there are more women than men students in medical schools, who are taught by fewer women professors. Women are also mainly excluded from decision-making in boardrooms and medical leadership positions, a situation that can weaken representative policy making and improved gender equality in higher education.
Development through organisational learning and leadership
If doctors’ working lives, particularly the lives of women doctors, many of whom are too frightened of the consequences of speaking out, are to be improved as part of India’s goal to be a developed country, then formal medical leadership development training and involving doctors meaningful in managing organisations are vital. This could be achieved through closer links between business schools and medical schools and between social sciences and medical sciences, such as the study of medical leadership in India and England. A renewed interdisciplinary focus on research projects and collaborations centred on the UNSDG five (gender equality) and eight (decent work and economic growth), perhaps under the auspices of the UK-India Education and Research Initiative (UKIERI) could also drive developments in this area.
We hope that an effective law to protect doctors is in sight. We will read with interest the report due to be published on plans to improve doctors’ safety, working conditions, and well-being in India. Ultimately, current workplace regulations are insufficient and need to be bolstered by effective and robust legislation, as well as sectoral attitudinal change, in order to ensure a holistic approach to worker protection.
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Shocking 😮 story but violence is so normalised. There’s so much hope in India still, though.