जनता का स्वास्थ्य

Friday, 17 July 2015

Can McDonald';s reach a health facility? Jul 13, 2015

Shiv Charan Mathur

Vibrancy in the practice of a discipline draws curiosity of its practitioners, more so in a field like Public Health where stakeholders are many and multiplying fast!

It is to understand the dynamics of public-private-partnership (P-P-P) in primary health care, I attended the "Health Summit 2015" organized in a five-star hotel of state';s capital last week. Executives from well known brands like Philips and Vodafone discoursed on ';access and affordability';. Chains like Fortis and Manipal in the open market-place displayed glossy posters and distributed pamphlets of services provided by them. Honorable Minister was taken around the displays like a laboratory-on-a-mobike providing more than 70 investigations at any stop!

We were informed that out of more than 2,000 Primary Health Centers of Rajasthan, around 90 (overheard that in first instance 30 only!), have been handed over to WISH which seems to be a new private partner with Government of Rajasthan. Many in the audience were expecting from the private players - who solely controlled the dais throughout the day - to provide transparency to the transactions transpired so far. But they seem to be adding excitement to the game!

Going in the history of P-P-P, private player have joined the health field only when they could elicit the cost from the government. How far these new giants arriving on the carpet of Health sector would dole out from their corporate social responsibility is a matter which health activist might be vigilant to watch. Speculation is rife that budget allocated to health facility will be transferred to private players who in turn would add to the quality and effectiveness of the service delivery from the public facilities. How these facilities would be driven will be the matter to be included in the memorandum of understanding between public and private systems. Since the entrepreneurship of private players has a great potential, with increasing infra-structure of the state, no wonder if we can find something like a drive-in outlet of McDonald in a public health facility within a couple of years. Let it happen and accept it only if it is preceded by universalizing the access to affordable primary health care in a state where so far human development is a matter of concern.

Sunday, 14 June 2015

JAN SWASTHAY ABHIYAAN FREE HEALTH CHECK UP CAMP AT SAMAIN VILLAGE ON 14.6.2015

Sunday, 7 June 2015

जन स्वास्थ्य अभियान
अखिल भारतीय जनवादी समिति एवम
हरयाणा स्टेट मेडिकल एंड सेल्ज रिप्रेंजेंटेटिवज यूनियन (H.S.M.S.R.U)
के तत्वाधान में सूरत नगर फेज -२ गुडगाँव में स्वास्थ्य जांच शिविर का आयोजन किया गया जिसमें
शल्य चिकित्सा विशेषज्ञ Dr R.S.Dahiya,
सामान्य रोग विशेषज्ञ Dr O. P.Lathwal,
स्त्री रोग विशेषज्ञ Dr Sonia Dahiya,
शिशु रोग विशेषज्ञ Dr Narender Monga,
दन्त चिकित्सक Dr Raj Kumar व Dr Batra ने मरीजों का निरिक्षण किया । 180 से अधिक मरीज कैंप में आये । इसमें शुगर टेस्ट , B.P check up,ECG आदि टेस्ट भी मरीजों के किये गये. सभी डाक्टरों
को आयोजको द्वारा मोमेंटो देकर सम्मानित किया गया । दिनेश अवस्थी जी ने सबका धन्यवाद किया ।

Saturday, 9 May 2015

Rural health inequities: data and decisions

The Lancet

DOI: http://dx.doi.org/10.1016/S0140-6736(15)60910-2

Article Info

70% of the world's 1·4 billion people who are extremely poor live in rural areas. A new report released on April 27 by the UN International Labour Organisation (ILO), Global evidence on inequities in rural health protection: new data on rural deficits in health coverage for 174 countries, presents the first global, regional, and national data on the extent and major causes of rural–urban inequities in coverage, and access to health care. 56% of rural residents worldwide are without legal health coverage (defined as protected by legislation or affiliation with a health insurance scheme)—compared with 22% of the urban population. 83% of Africa's rural population have no entitlements to health care, yet the most extreme rural–urban inequities in legal coverage occur in Asia and the Pacific. Reflected in the context of equity and universal health coverage (UHC), the report abruptly reminds us that the global community, despite all good intentions, are still doing too little too late for the health of rural populations.

Although inequities in health protection are recognised within UHC debates, data about the rural–urban divide are weak and fragmented, with a complete absence of disaggregated data within countries, regions, or globally. Policy makers tend to respond to what is presented to them. The absence of disaggregated data influences decisions on national resource allocation, and in turn perpetuates the neglect of systematic planning for rural populations in many countries. This report is the first step to rectify the gap in evidence by using five proxy indicators, measuring key dimensions of coverage and access to health care: legal coverage, staff access deficit, financial deficit, out-of-pocket spending, and the maternal mortality ratio (MMR).

The report highlights that virtually all rural–urban differences in health staffing, financing of services, and legal coverage occur in rural populations. Health worker shortages are unsurprisingly extreme in rural areas worldwide. Although half of the world's population live in rural areas, only 23% of health workers globally are deployed there, with an estimated seven million health workers missing globally in rural areas compared with 3 million in urban dwellings. 63% of the world's rural population do not access health care because of underfunding of global health financing, compared with 33% of the urban population. Out-of-pocket payments inequities are, at first glance, relatively smaller globally in rural populations, with lower out-of-pocket payments in rural than in urban populations in Africa, Latin America, and central and eastern Europe. Yet the lower out-of-pocket payments in many countries indicates an exclusion of rural populations from access to health care. The harsh reality in rural areas is that what does not exist (eg, health workers, clinics, transport) cannot be paid for, and therefore no cost accrued.

Across all regions except Europe and north America, rural MMR is at least double urban MMR, with Africa reporting the highest MMR regional level of 55 deaths per 10 000 livebirths. Country case studies from Cambodia, Mexico, Nigeria, and Zambia report using the same five indicators to highlight the main challenges to improve health coverage and access. In Nigeria, the country's rural population fares worse than the urban population on the indicators of staff access deficit, financial deficit, and maternal mortality. This situation exists despite rapid urbanisation and a high but inequitable supply of human resources for health relative to other countries. Zambia, with a largely rural population and an urban population reliant on private sector services, has higher out-of-pocket payments in urban than in rural areas. Mexico, with a mostly urbanised population, also reported higher out-of-pocket payments in urban areas—both illustrations of when services remain limited or completely inaccessible for rural populations. Cambodia performed better than the other countries on the MMR indicator, reflecting maternal health efforts.

The ILO report leaves no doubt that the urban–rural gap in access to health care exists. The question is more about the size of the deficit and what can be done. The conclusion that only a comprehensive and systematic approach can address these inequities cannot be overstated, and must be acted on. No single action focusing on one of the indicator areas is enough to achieve UHC. A country's approach must systematically and simultaneously address legal coverage and rights, health-worker shortages, extension of health-care protection, and quality of care. Only then can equitable access for all be fully achieved.

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Sven Torfinn/Panos Pictures

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Wednesday, 6 May 2015

Doctor - Patient Relationship, Rights And Responsibilities

Medico Legal

Votes(1) Comments(73) Viewed 3293 Times

Well....how many of us honestly practice this or how many of us have displayed the following in the waiting area of our clinics, Nursing Homes, Tertiary Care Specialty Hospitals, Medical Colleges, Charitable Trust hospitals, Polyclinics etc?. These are not rules and regulations but common sense practice which has to be incorporated in our behaviour and must be reinforced in the behaviour of our patients only then our society will be reconditioned towards respecting our, time, knowledge, skills, chargeability, etc and only then our long lost status of Demi Gods will be reinstated.

DOCTORS’ Rights

To equal treatment and equal benefit of the law in all applications by and dealings with government, the private sector and others. Substantive equality means that family responsibility, rural areas, historic disadvantage, etc. are relevant factors.
Not to be unfairly discriminated against by any patient, medical scheme, medical faculty or school, government, employer or any other person or institution on the basis of their race, gender, origin or any other ground. Doctors have the right not to be harassed.
To have his/her life protected which includes the right not to be placed in disproportional life-threatening situations.
To freedom and security of the person which includes the right to physical autonomy and the right to be free from violence.
Doctors have the right to reasonable accommodation of their religious beliefs, short of undue hardship to others. Doctors also have the right to clinical independence.
To fair labor practices including fair dispensations of overtime, leave and working conditions and the right to have their grievances taken up at appropriate forums. Doctors have the right to be assisted in disciplinary enquiries, to state their side of the case and to an impartial chairperson. Doctors have the right to work in an environment that is not hostile in terms of sex, gender, sexual orientation or (presumed) race or ethnicity

Doctors’ Duties and Responsibilities

Code of Ethics

Principles of Ethical Behaviour are applicable to all physicians including those who may not be engaged directly in clinical practice.

Consider the health and well-being of your patient to be your first priority.
Strive to improve your knowledge and skill so that the best possible advice and treatment can be afforded to your patient.
Honor your profession and its traditions.
Recognize both your own limitations and the special skills of others in the prevention and treatment of disease.
Protect the patient's secrets even after his or her death.
Let integrity and professional ability be your chief advertisement.

Standard of Care

Practice the science and art of medicine to the best of one's ability in full technical and moral independence and with compassion and respect for human dignity.
Continue self education to improve one's personal standards of medical care.
Ensure that every patient receives a complete and thorough examination into their complaint or condition
Ensure that accurate records of fact are kept.

Respect for Patient

Ensure that all conduct in the practice of the profession is above reproach, and that neither physical, emotional nor financial advantage is taken of any patient.
Recognise a responsibility to render medical service to any person regardless of colour, religion, political belief, and regardless of the nature of the illness so long as it lies within the limits of expertise as a practitioner.
Accepts the right of all patients to know the nature of any illness from which they are known to suffer, its probable cause, and the available treatments together with their likely benefits and risks.
Allow all patients the right to choose their doctors freely.
Recognize one's professional limitations and, when indicated, recommend to the patient that additional opinions and services be obtained.
Keep in confidence information derived from a patient, or from a colleague regarding a patient, and divulge it only with the permission of the patient except when the law requires otherwise.
Recommend only those diagnostic procedures which seem necessary to assist in the care of the patient and only that therapy which seems necessary for the well-being of the patient. Exchange such information with patients as is necessary for them to make informed choices where alternatives exist.
When requested, assist any patient by supplying the information required to enable the patient to receive any benefits to which he or she may be entitled.
Render all assistance possible to any patient where an urgent need for medical care exists.

Continuity of Care

Ensure that medical care is available to one's patients when one is personally absent, when professional responsibility for an acutely ill patient has been accepted, continue to provide services until they are no longer required, or until the services of another suitable physician have been obtained.

Personal Morality

When a personal moral judgment or religious conscience alone prevents the recommendation of some form of therapy, the patient must be so acquainted and an opportunity afforded the patient to seek alternative care.

Patients’ Rights

Right to be treated with respect and recognition of personal dignity irrespective of cultural, Spiritual or religious beliefs.
Right to request any information about your condition.
Right to ask for and obtain copies of records pertaining to your medical care in the hospital. (You may need to pay copying fee, fill the approval form and get it signed by the hospital).
Right to ask for a second opinion or consult with any doctor or doctors in our panel without prejudice and interference.
Right to be informed about relief of pain which is an important part of care and to receive information about options to reduce, control and relive pain.
Right to refuse treatment. (However this decision will have to be taken by you at your own risk).
Right to complain against your treatment plan, Doctors, Hospital or any other health care personnel to the Nurse in Charge, Administrative Medical Officer (AMO) or Medical Director (MD)
Right to ask for information and clarity doubts about the particulars of your bill. You will be provided with a statement on scheduled basis which will detail the hospital charges as they occur. These may not include the Doctor’s fees.
Right to privacy and confidentiality.
Right to personal safety and security.
Right to know the identity of individuals providing service to you.

Patients’ Responsibilities

Responsibility for providing accurate and complete information about medical problems, Past illnesses, hospitalizations, medications, pain and other matters relating to their health.
Responsibility for following the treatment plan recommended by those responsible for their care.
Responsibility for their actions if they refuse treatment or do not follow the health care team’s instructions.
Responsibility for seeing that their bills are paid as promptly as possible and following hospital rules and regulations.

Tuesday, 10 March 2015

HUMAYOON PUR

Sunday, 1 March 2015

Comments on Health Budget

Dear Sundar,

Why don';t you draft it? Let us send out a JSA critique as most papers have not reported this cut in health budget. I have copy-pasted below the key budget figures

As per budget paper 2015-16 : Expenditure on Health in Rs. crores
	Actual 2013-14	Budget 2014-15	Budget 2015-16	reduction
AYUSH	642	1272	1214
Pharmaceuticals	107	248	259
AIDS control	1473	1785	1395
Health research	874	1017	1018
NHM	18633	24490	18295	6195 (25.3%)	Page 168
	27145	35163	29653	5510 (15.7%)	Page 169 vol II
Plan outlay	22476	30645	24549	6096 (19.9%)	Page 169 vol II

Anant

On 1 March 2015 at 07:45, Sundar <sundararaman.t@gmail.com> wrote:

There are two important things about health sector in the 2014-15 budget speech. The first is the almost complete absence of mention of it- not even one full paragraph on it. Just a bland budget allocation line in one para, and then in another para as part of setting up different central institutions in all states a mention of AIIMS in a few states, then in another paragraph a proposal to give persons a choice to shift over from ESI to private insurance and finally in the tax proposals mention of increased limit for tax exemption for health insurance. All in different sites as part of different agendas- where health is very incidental

Secondly - there is a reduction in health expenditure even in nominal terms- let alone adjusting for inflation in budget allocation. The overall budget allocation reduces from 39237 crores to a 33152 crores. As related to expenditure of the last year- it stagnates in nominal terms but declines in real terms. Within this budget the decrease of NHM budget is much more. Also the addition of CGHS into this budget amount which was earlier placed elsewhere means that the decrease may be even more steep. Thus the central govt employees would have care at Rs 7000 per capita and the rest of the population at only about 900 per capita- about one tenth of the same, of which the central govt share is in the range of Rs 270 !!

One argument that is raised is that the health expenditure is being transferred to states through the 14th finance commission recommendations that have been accepted as part of moving away from centrally sponsored schemes. This claim has to be examined further. But even if it were so, the central committment both in line with 12th Plan and the govt';s own draft national health policy is to raise the central share also and this was urgently required in many areas of health systems strengthening. The complete disconnect with the National Health Policy 2015 draft is total- where specific central committment is stated as "this policy proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP. It also notes that 40% of this would need to come from Central expenditures. At current prices, a target of 2.5% of GDP translates to Rs. 3800 per capita,"

In other words though states would have to increase their expenditure, the central expenditure on health has to increase also to reach Rs 1520 per capita in three years ( at current prices). This budget puts the central expenditure at about Rs 276 per capita, which is less than one fifth of the target. The direction also is not of increase. Clearly the draft policy and all its proposal are reduced to just empty words.

The provision for AIIMS hospitals is also insubstantial and in 5 years only buildings will come up- and anyway it is not really the solution at all. None of the new AIIMS are operating at the level of AIIMS- they have just about begun outpatient care and a few admissions and have less services than the usual state medical college. It took them all of ten years to reach this stage. And a series of AIIMS are anyway no answer to the dismal situation in health.

Another aspect of the exemption in tax for those paying for medical insurance. The limit has been raised to Rs 25,000 per year. That is costly even by private medical insurance standards. And obviously this is trying to get the upper middle class and the rich to buy even costlier insurance. It has nothing to do with publicly financed insurance where the premium is only Rs 750 per year. By mentioning only insurance for the rich, yet another signal is being sent.

Nothing in nutrition or education or any other social sector.

All in all a terrible day for public health.

Equally dangerous was the way the TV media went on about the budget with no space for any views except that for industry representatives and their view point.

I think the contributions of Ravi Duggal, Anant, Amit etc have been useful and I only reiterate much of what is already stated. We must work on a quick statement - perhaps within the next couple of days. is that possible? Would be willing to help.

Greetings

Sundararaman

T. Sundararaman