Based on the discussion above, the following steps are urgent
and necessary:
Act on the Social Determinants of Health: This would
include promotion of food security by universalisation and expansion
of the Public Distribution System. It would also include providing safe
drinking water, sanitation facilities, full employment to all, education
for all and decent and adequate housing.
Address the Gender dimensions of Health: Guarantee
comprehensive, accessible, quality health services for all women for all
their health needs which includes but is not limited to maternal care.
Abolish all coercive laws, policies and practices that violate the
reproductive, sexual and democratic rights of women, including
coercive family planning measures.
Immediately reverse Caste Based Discrimination: Take
immediate and effective steps to entirely reverse all forms of caste
based discrimination, which is one of the most important social determinants of ill health. Immediate ban on manual scavenging should
be implemented.
Enact a Right to Health Act which assures universal access to
good quality and comprehensive health care for all for the entire range
of primary, secondary and tertiary services, and that makes denial or
non-availabilityfor reasons of access, affordability or quality a justiciable
offence.
Increase Public Expenditure on Health to 3.6% of GDP
annually (Rs 3000/- per capita at current rates) with the central
government’s contribution being at least 1% of GDP (Rs 1000/- per
capita). All public health expenditure to be tax financed. Progressively
increase public health expenditure of the government to at least 5% of
GDP.
Ensure quality and assured availability of health care:
Quality of care to be ensured in all health facilities. Public health facilities
to be entirely free of user fees and the entire range of services to be
provided directly by government run facilities and not through Public
Private Partnerships (PPPs).
Stop both Active and Passive Privatization of health care
services: Necessary measures to stop active privatization in the form
of transfer of public resources or assets to the private sector. Measures
to stop passive privatization (where private facilities fill the gap left by
inadequate public facilities) by increasing investment in public health
facilities.
Training of Health workforce: Increase public investment in
education and training of the entire range of health personnel. Ensure
that government run colleges to train a range of health workers, nurses
and doctors are located in areas where they are needed most.
Well Governed, Adequate Public Health Workforce: Create
adequate posts for the entire range of health personnel in the public
health system. Regularize contractual employees and provide ASHAs,
ANMs and all levels of public health system staff with adequate skills,
salaries, and decent working conditions.
Secure access to quality assured essential medicines and
diagnostic services in all public health facilities, free of charge.
Reverse Exploitation by private hospitals practitioners: The
national Clinical Establishment Act should have provisions for:
observance of patient's rights in all clinical establishments; regulation
of the rates of various services; and elimination of kickbacks for
prescriptions, diagnostics and referrals.
Absorb, over a period, existing publicly funded health
insurance schemes (RSBY and different state health insurance
schemes) into an expanded public health system publicly financed
through general taxation.
Ensure access to essential and safe Drugs & Devices: Costbased
price-control of all medicines need to be re-established. Measures
are also necessary to ensure banning of all irrational medicines and
irrational combinations.
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