Extreme inequality in access to health care services and the
poor living conditions of a majority of the people are responsible for the poor
conditions of health in India. While people who can pay are able to receive
world class treatment facilities, for most people in India a major illness in
the family plunges the family into extreme poverty and destitution.
Not only are healthcare facilities out of reach for most
people, routine public health measures to protect our people are denied to a
majority. India continues to figure among the bottom in global estimates regarding
deaths among infants and young children and among pregnant women. India lags
behind most countries, including many much poorer than us, even in providing
routine immunization to children.
India is also currently experiencing a ‘multiple burden of
disease’. Several preventable infectious diseases are growing unchecked,
nutrition-linked health problems (gross under-nutrition coexisting with a
rising trend of obesity) continue to affect millions, while chronic health
conditions are rising substantially.
Every family in India dreads a medical emergency. When a
family member falls ill, we pay from our pocket – often by selling our assets
or by borrowing. Thus the poor are either denied care because they cannot bear
the expenses or the family gets pushed to further poverty and destitution. As
families cope with health shocks the vicious cycle of poverty and ill-health
continues. Poor health services in the country are a tale of deep apathy of successive
governments towards the suffering of a majority of the poor and the vulnerable.
Those in power have contributed to the systematic neglect of the public health
system on one hand and to an aggressive expansion of unaffordable, often
unnecessary, unethical and low quality private health services on the other.
In this booklet we
highlight some of the key issues pertaining to health of millions of Indians
and raise some of the key demands for improvement of access to quality health
care.
Poor
Conditions of Health
One-fifth of
world’s children who die before their fifth birthday are born in India, while
the highest number of mothers who die while giving birth are from India. We
perform poorly in comparison to most countries in the world, including most
developing countries. Even in our region, only two countries lag behind India.
See Box 1 to understand how we continue to be one of the worst performing
countries in the world as regards healthcare and health outcomes. A survey of
179 countries across the world shows that India is among the least safe countries
to be a mother (Save the Children, 2015). High undernourishment prevalent among
women in the reproductive age group, coupled with low coverage of care during
pregnancy (ante natal care – ANC) make women vulnerable at the time of delivery
and lead to complications. Millions of children die every year from preventable
diseases because they are not immunized and from hunger and malnutrition. Over
one-third of our children do not get enough food, a rate that is comparable or
worse than some of the poorest countries in Africa. Children die routinely from
common diseases like diarrhea and pneumonia because of lack of access to safe
drinking water, lack of sanitary facilities and absence of free public
facilities for treatment.
Surveys show that only 68.7
% of women have received three antenatal check-ups, only 26.3% of pregnant
women have consumed more than 100 iron and folic tablets and only 61% of
children (12 -23 months) have been fully immunized.
|
·
India ranks 119thof 169
countries in Human Development Index (HDI)
·
India ranks 140th of 179 countries as
the best place to be a mother (State of World’s Mother 2015)
·
India is placed at 67thof 84 countries in Global Hunger
Index (GHI)
·
More than a fifth of under five
deaths per year, take place in India – the highest anywhere in the world; a majority of these deaths are
preventable
·
More than 100 million children under
five are undernourished, and 8.5 million suffer from severe acute
malnutrition.
·
Only half of children under five receive routine immunisation (National
Family Health Survey III)
·
Only about half (52%) of deliveries are safe: (National Rural Health
Mission)
·
Only one-third of children having diarrhoea receive ORS (State of
the World’s Children, UNICEF, 2011)
·
Pneumonia: 69% taken to hospital and only 13% receive antibiotics
(SoWC, 2011)
·
Only half of the pregnant women receive 3 or more check ups before
delivery
|
Box 1: Where do we stand in protecting our people’s health?
Table
1: A cross country comparison
of key health outcomes and outputs
|
|
Brazil
|
Russia
|
India
|
China
|
South Africa
|
Thailand
|
Sri Lanka
|
Bangla desh
|
|
Physicians per
1000 population
|
1.76
|
4.3
|
0.7
|
1.94
|
0.8
|
0.4
|
0.7
|
0.4
|
|
Nurses per 1000
population
|
6.4
|
8.5
|
1.7
|
1.85
|
4.9
|
2.1
|
1.6
|
0.3
|
|
Hospital beds per
1000 population
|
2.4
|
9.7
|
0.7
|
3.8
|
2.8
|
2.1
|
3.6
|
0.6
|
|
Institutional
delivery
|
97%
|
99.7%
|
73%
|
99.8%
|
91%
|
99.5%
|
98.6%
|
32%
|
|
Maternal mortality
ratio per 100,000 live births
|
69
|
24
|
190
|
32
|
140
|
26
|
29
|
170
|
|
Life expectancy
|
73.6
|
70.5
|
66.2
|
75.1
|
56.1
|
74.2
|
74.1
|
70.3
|
As we can see
from Table 1, India fares poorly in comparison to even developing countries,
including our immediate neighbours Sri Lanka and Bangladesh.
The state of
public health is clearly depicted by the fact that we are not able to protect a
large number of children from vaccine preventable illnesses. Childhood
vaccination is regarded as one of the most cost effective interventions to
prevent child deaths. A third of the un-immunized children
across the world are in India. Large inequalities in immunization coverage
persist in India, across and within states and according to wealth, caste,
religion, location etc. Children from the richest wealth group are 2.5 times
more likely to be immunized than their poorest counterparts. It is distressing
to note that states which had performed
well earlier (as per data available in 2005-06) have slipped back over the last
ten years, including Tamil Nadu, Haryana, Uttarakhand and Maharashtra (Fig 1).
Most significant is the decline in TN. From being among leading states in terms
of full immunisation coverage, the state has experienced a dramatic 11.2
percentage point decline. The major reason for stagnation or decline in overall
immunisation coverage is decline in coverage in urban areas. Most noteworthy is
the decline in Haryana (from 82.2 to 57%), Maharashtra (68 to 55.8), Tamil Nadu
(83.7 to 73.3) and Uttarakhand (67.2 to 56.5).
Figure
1 Children below 23 months fully immunized (Total) (%)
Source: National Family Health Survey
2015-16, State Fact Sheets.
Health of
Women and Girls
Discrimination faced women and girls have a lasting and tragic impact
on their health status. Data from National Family Health Survey (NFHS) shows
that child deaths rates for girls are 61 per cent higher than those for boys
after the first month, all the way up through age four. Among 15-19 year olds
in the country, complications during pregnancy are the leading cause of death.
As many as two out of three adolescent girls living in India’s backward
districts have experienced sexual violence.
Maternal death rates continue to be very high (at 190/ 100,00 live
births, one of the highest rates in the world). Maternal deaths are highest amongst young
women, while girls continue to be married off before the legal age of marriage.
Too many girls become pregnant before tyhey are old enough and before their
bodies are ready for pregnancy. This combined with malnutrition and anemias
ensure that young women, many still in their teens, die during pregnancy. Women also continue to die around child birth
because health facilities in many parts of the country are not equipped to
provide emergency care to them when complications arise, the quality of care during
pregnancy available is inadequate, and safe abortion services in the public
sector are inaccessible for the majority of women. Quality contraceptive services as are not
provided according to what women need. Instead women are targeted for
hysterectomies to achieve family planning camps. Horrendous accounts surface
periodically of how women are herded into unhygienic and under staffed
hysterectomy camps.
The burden of communicable, non-communicable diseases and mental
distress is also seen more in women. Sexually transmitted diseases amongst
women remain undiagnosed, and when diagnosed can have drastic social
consequences for them. Heart attack and stroke are more lethal for women, and
depression twice as common. Women over
the age of 60 years have greater disability and suffer more from ill health
than men of the same age-group, due to delays in or lack of health-seeking,
mismatched care provision (as women are under-represented in health care
delivery systems and in research, particularly related to chronic diseases).
Gender-based violence is extremely high, with as many as 40.3% of women
reporting at least one instance of physical abuse. There seems to be an
epidemic of sexual violence against women in recent years. Mental and physical
consequences of violence against women need to be addressed by the health
sector.
Neglect of
public health system
In most countries
where people have near universal access to health care, it has been achieved through
a well-functioning public health system. Here we may note that while a well
functioning system to provide universal access to care is a necessary condition
for good health outcomes, it is not sufficient on its own. Good health is a
result of better nutrition, safe drinking water and sanitation, universal
access to education, gainful employment and equitable and inclusive
development, better working and living conditions, control over addictions as
well as environmental pollution and an end to various forms of discrimination.
Reduction in poverty itself contributes immensely to improved health outcomes.
A strong,
comprehensive public health system is the most efficient way to provide
appropriate health care. It creates a separation between health care needs and
people’s ability to pay for healthcare. It also allows much stricter control of
health care costs, serves as an effective check on unregulated growth of the
private sector and helps prevent unethical practices in the private
|
Figure 2: Government
Hospital Beds per 100, 000 people
|
India’s poor
investment in health care translates into a failure to create the necessary
health infrastructure, or to build a health workforce, or to ensure
availability of necessary equipment, diagnostic facilities and medicines. We
are just not adding enough beds in public hospitals or enough doctors and
nurses to make public services effective.
After the
introduction of some public health measures under the NHRM, some improvements
did take place. Services of close to 23,000 doctors, 35,000 nurses and 70,000
ANMs and 10,000 management staff were added under the NRHM. However as compared to the government’s own
Public Health Standards, this is less than one-third of the total number of
public health workforce that is required. Further the terms of engagement of
these staff were extremely adverse -- almost all of the additional staff under
NHRM is contractual, with remuneration packages often less than half of the
regular staff that does the same work, and with no security of tenure.
There continue to be
substantial shortfalls in the number of Sub-Centres (SC), Primary Health Centres
(PHCs) and Community Health Centres (CHCs) across states. Nationally, there are
only 0.16 facilities for every 10,000 persons, and there are approximately 5.5
government beds for every 10,000 persons. Outpatient visits have nearly doubled
from 55 per 1,000 persons in 1995-96 to 100.7 per 1,000 in 2014, with more
marked increases in urban as compared to rural areas. Inpatient episodes
increased nearly three-fold in the same period, from 15 per 1,000 persons in
1995-96 to 44 per 1,000 in 2014. Yet the number of beds in the public sector,
per 10,000 population has remained stagnant since the 1980s.
For SCs, nearly 21 states had shortfalls ranging from 4.4% in Jammu and
Kashmir to 50.6% in Delhi. Uttar Pradesh (33.9%), Jharkhand (34.5%), Meghalaya
(46.6%) and Bihar (47.7%) also have high shortfalls in the number of SCs. For
PHCs, the states of Uttar Pradesh, Delhi, Bihar, Madhya Pradesh, West Bengal
and Jharkhand had shortfalls ranging from 28.6-69.8%. For CHCs, states with
shortfalls above 30% included Madhya Pradesh, Maharashtra, West Bengal, Andhra
Pradesh, Karnataka, Sikkim, Assam, Tripura, Uttar Pradesh, Bihar and Delhi.
Nationally, the shortfall was: SCs, 20.1%; PHCs, 24.1%; and CHCs, 37.9% (GoI,
2011). More than three quarter of
Sub-centres (76.4%) do not have any water supply. Piped water is not available
in a majority of PHCs (63.3%) and CHCs (54.6%). Almost a third of PHCs (32.5%)
do not have a functional labour room for conducting deliveries. Seven out of
every ten CHCs (70.9%) do not have regular power supply (Concurrent evaluation,
NRHM, 2011).
One of the most
important reasons for underutilization of primary health care facilities is the
lack of the full range of required primary care services. Most sub-centers and
PHCs provide little beyond immunization services, some ante-natal care and at
best care for normal delivery. Most treatment of chronic illness like
hypertension and diabetes is referred away and so is the treatment for most
infectious disease except some of those on the national programmes. This would
accounts for less than 20% of all health care needs. Along with expansion of
infrastructure and filling up vacancies of human resources, quality of care
delivered at public health facilities need immediate attention.
Low public spending and
consequently high burden of out of pocket expenses
Public Spending on
health in India is among the lowest in the world - when compared in terms of
share of GDP and per capita spending. There were only few countries in the
world which spent lesser proportion of GDP on health in 2014 (WHO 2016).
Governments in neighbouring countries like Sri Lanka, China, and Nepal could
mobilise more resources towards health than what is done in India. Per capita
public investment on health in India, is almost at the same level with the
average of the low income countries (LICs) and much lower than the average for low
middle income countries (LMICs). Countries like Brazil, Thailand, and South
Africa which have recently attempted to universalise have stepped up public spending
on health to 3-5 % of GDP over the period of a decade or so, while it
languishes at around 1% of GDP in India.
|
Box II:
Health care Financing
·
Public spending on health as a percentage of GDP
is among the lowest in the world (1.1%)
·
India is
among the most privatized health systems -- out of 100 rupees spend on health more
than 70 comes from people’s out-of-pocket expenses (OOPs).
·
Every year some 55 million people are pushed
below poverty line - this is more than the population of 177 countries in
the world
·
Expenses on medicine alone lead to impoverishment
of some 34 million people.
·
During
2004 (latest data available), nearly 30 percent in rural India and 20
percent in urban India who were ill but did not seek care because of
financial barrier.
·
Socio-economically
deprived groups tend to suffer greater impoverishment due to OOP spending
on health care.
|
In the absence of adequate public spending households are forced to buy healthcare services from the market – either in private facilities or through expenses they incur even in public facilities. What people pay directly while accessing care is called ‘Out of Pocket’(OoP) expense. In India the share of OoP in total healthcare spending is around 73% - which is one of the highest in the world. Thus in India, out of every 100 rupee spent on healthcare, the government spends only 27 rupees. Such a subsystem where access to care depends on ability to pay leads to inequality in access, untreated ailments and preventable deaths; and pushes people towards poverty and indebtedness. Numerous studies indicate that the poor in India are often required to borrow and sell off household assets to finance their health-care needs. The burden on OoP is largely on account of outpatient expenses but recently we also see a steep rise in hospitalisation expenses that are borne by patients. Recent National Health Accounts estimates show that the share of OoP has increased to 72.9% of total health expenditure, and public spending is a mere 1.1% of GDP.
Growing
private sector and expansion of public funded insurance
Over
the years, as economic policies have slashed expenditure on public services
like health and education, dependence on private sector for healthcare has
progressively grown. Dependence of people on private facilities for short
duration treatment was higher compared to public services, even in the mid
1980s. By the mid 1990s more than 80% of short duration illnesses were being
treated in the private sector. The public sector used to be the main source of care
requiring hospitalisation in the mid 1980s. By the mid 1990s there was a
reversal in the situation and the private sector became the main source of treatment
for hospitalized cases as well. In the next decade or so the spread of private
sector got reflected in even greater utilization of private facilities for
hospitalisation. By 2004-05 almost 60 per cent of total in-patient care
(hospital care) was covered by the private sector.
Table 2: Share (per cent)
of private sector in total hospitalized episodes and short duration ailments
|
Year
|
Hospitalisation
(in-patient)
|
Short Duration ailments
(out-patient)
|
||
|
Rural
|
Urban
|
Rural
|
Urban
|
|
|
1986-87 (42nd
round)
|
39.97
|
39.56
|
74.29
|
72.79
|
|
1995-96 (52nd
round)
|
54.71
|
56.93
|
80.29
|
81.65
|
|
2004-05 (60th
round)
|
58.39
|
61.76
|
77.72
|
80.83
|
|
2014 (71st
round)
|
58.1
|
68
|
71.7
|
78.8
|
Source:
Based on NSSO estimates, 42nd, 52nd, 60th and 71st round.
In the past decade a new trend has emerged, led by changes
in the government’s overall economic policies and priorities. The involvement
of the private sector in providing services while using public funds is being promoted
under the guise of improving efficiency in the delivery of health services.
This can be seen in the outsourcing of health facilities in states such as
Arunachal Pradesh and Karnataka; and outsourcing of various critical services
in public hospitals like diagnostics in Bihar and West Bengal. Insurance
schemes like the Rashtriya Swasthya Bima Yojana and Arogyasri are another
mechanism to pump public funds into the private sector. However, the dreadful
implications of this strategy on the public health system, quality of services
and access of the poor to health care services is slowly becoming apparent. Experiences
of outsourcing, like of diagnostics in Bihar, has shown that it has led to
decreased access to services and even denial of services for the poor,
increased out of pocket expenditure and decline in the quality of services.
Despite its rapid growth and large size, the private medical
sector in India suffers from a wide range of serious problems. It is widely
acknowledged that these arise due to its commercial interest to maximize
profits, along with an almost complete lack of effective regulation. This has
led to a huge urban-rural divide, massive wastage, exploitation due to
excessive/irrational medications, and frequent exploitation of patients by
overcharging and unnecessary interventions, major variations in quality and
overall substandard care, and violation of patients’ rights. This is compounded
by the exploitation by the drug industry through manufacturing and sale of
irrational medicines and irrational drug combinations, promotion of costly
brands, and overpricing. In addition, during the last 20 years there has been
proliferation of private medical colleges. Thus overall, barring some centres
of excellence, private medical care in India is substandard and unnecessarily
costly. There has been a complete failure of regulatory agencies like the Central
Drug Standards Control Organisation (CDSCO) and the Medical Council of India,
accompanied by a complete lack of
self-regulation by professional bodies like the Indian Medical Association
(IMA).
Despite these known problems related to the private sector,
public money is now being pumped into the sector in the name of providing
financial protection to the people. There has been an increase in the number of
publicly-financed insurance schemes floated by central and state governments,
with the stated aim of protecting the poor and the informal sector workers from
catastrophic expenditures on health. The Yeshasvini Health Insurance Scheme in
Karnataka in 2003 and the Rajiv Aarogyasri Scheme in Andhra Pradesh in 2007 are
the precursors to the Rashtriya Swasthya Bima Yojana (RSBY) launched by the
Ministry of Labour, in 2007 as a Central scheme. The schemes (state and
central) claimed to cover an estimated 302 million people in 2010 -- roughly
one-fourth of the population (as we shall see later these claims are inflated).
However, in terms of the benefit package available through these insurance
schemes, only limited secondary and tertiary level hospitalisation cover is
provided (with the exception of the much older Employees’ State Insurance
Scheme (ESIS) and Central Government Health Services (CGHS)).
Though these insurance schemes continue to remain popular
among policy makers and politicians, evidences suggest that impact on financial
protection has been minimal if not detrimental. As per the latest National
Sample Survey Organisation Survey on Health and Morbidity (2014) only 13%
population is covered under various government funded insurance schemes.
Coverage among the poorest sections, in both rural (10.6%) and urban areas
(8.6%) is even lower- leaving out huge sections of intended beneficiaries.
But what happens to those who are covered and access
hospitalisation services? In contrast to what is promised, free care is very
rare - only 3 out of 100 hospitalisation cases with coverage receive free care.
The actual benefits to those who do of facilities under these schemes is not
very high. Data suggest that on an average those who are not covered under any
insurance scheme spend around Rs.14,400 for one hospitalization episode
compared to the government funded insurance schemes where average cost is Rs.10,900
-- a far cry from the promise that these schemes would provide free care. Thus
the poor go to private hospitals, in the hope of free care and end up paying for
care that of dubious quality and which may not even be necessary (see Figure
3).
Figure 3: Average expenditure on hospitalization (in
Rs.)
Source: Business Line, 2016
Government funded insurance schemes cover only a select set
of in-patient procedures and surgeries while households spend two-third health
expenditure on outpatient care and particularly on medicines. In most states
more private than public hospitals have been empanelled for providing services
under such insurance schemes. These private facilities are concentrated mainly
in cities, with very few in rural, tribal and remote areas. Beneficiaries thus are concentrated in the
easier to reach villages and left out in the hard to reach villages or hamlets.
Further, these insurance schemes focus on specific treatment
procedures rather than on treatment of all illnesses, and therefore conditions
treatable at primary level end up being hospitalised (for example, for
uncomplicated anemia or diabetes) or transferred to secondary/tertiary levels.
This also results in public funds being shifted from primary level care to
secondary and tertiary level care, or to private providers.
Patients also receive care of bad quality through the
insurance schemes. Many unnecessary procedures like hysterectomies (removal of
uterus) had been performed by the private sector hospitals in order to benefit
from the insurance money; thousands of such instances have been documented in
Bihar, Chhattisgarh and Andhra Pradesh. There is no real choice for the
beneficiaries in terms of which hospital they can go to; as it is the hospitals
that dictate what conditions and which patients they wanted to treat. Thus, while
private hospitals ‘cherry pick’ the most profitable conditions/procedures to
treat, public hospitals end up treating the more complicated and difficult
cases. In rural areas, especially remote places, public facilities are the only
ones available. The nest result of public funded insurance is that public money
is being transferred to private facilities, thus further depleting the already
meager resources available to strengthen public facilities. There is also a continuous
demand from the private sector to increase the reimbursement they receive for
providing care as part of the insurance schemes. Reports from Chhattisgarh and
Andhra Pradesh have shown that RSBY and Arogyashri schemes were facing
financial problems as demands from private providers for higher reimbursements
had increased and some hospitals had even stopped providing services.
Clearly, commercial and profit motives guide healthcare
provision, leading to unnecessary procedures, wastage of resources and no
improvement in health outcomes. Their
goal clearly is to profit from ill-health. Only a strong public sector can function as an effective
check on the vast unregulated private sector, where it is forced to compete for
quality of services with the public sector.
Access to
medicines
Access
to essential medicines is an integral, and often crucial, component of health
care. The World Medicine Report of the World Health Organization finds that
India is the country with the largest number of people (649 million) without
access to essential medicines. Given that India today is one of the largest
producers of drugs (by volume) in the world and exports medicines to over 200
countries, this is clearly an unacceptable situation. In an ideal situation all
medicines that are researched and marketed should enhance therapeutic goals and
should be available to all those who require these medicines. Unfortunately the
actual situation in the medicines market is much more complex. There are
several issues that need to be addressed in order to ensure access to all
medicines that people need.
The
drug industry is rapidly transforming with increasing mergers and takeovers by multinational
corporations. The government’s new policy of allowing 100% FDI in the drug
industry has become an instrument to acquire Indian companies. Without
investing anything for manufacturing or establishing any plants the MNCs are
capturing the existing Indian drug companies. While this may be in line with
the Government’s ‘make in India policy’ (where the only consideration is that
companies shift production to India irrespective of ownewrship of the companies
involved), it is starting to choke the domestic industry built and nurtured
over decades.
Medicine
costs are the major component of out of pocket expenses that we talked of
earlier. Changes in the Drug Price Control order in 2012 have converted the
price control of medicines into a cruel joke. Essential drug prices are now
fixed on the basis of their price in the market, which is inflated, rather than
on actual production costs. Many studies have shown that market prices of drugs
are often 10 or even a 100 times that of the production costs.
Patients in India are also
affected by a huge market, promoted by unethical marketing practices of drug
companies, by the marketing of irrational and harmful medicines. Doctors are
bribed by companies to prescribe such medicines. Following adverse comments by
the Parliamentary Committee on Health the government, in early 2016, issued notifications
banning over 300 irrational medicines. The medicines of many large companies,
including top selling products of multinational corporations were affected.
The major reason why people
in India cannot access medicines is that they are forced to buy them from the
market. Even public facilities often do not stock all essential medicines and
ask patients to buy them. A few state
governments have started free medicines schemes to supply all essential
medicines free of cost to patients attending public facilities. The schemes are
running successfully in a few states, notably Tamilnadu and Rajasthan. However,
most states are yet to effectively implement such schemes. Neither has the
central government lived up to an earlier promise to support such schemes in
all states.
Urgent measures to address the Health Crisis in
India
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: Cost-based
price-control of all medicines need to be re-established. Measures are also
necessary to ensure banning of all irrational medicines and irrational
combinations.
No comments:
Post a Comment