Bhubaneswar: State People Health Assembly was organised at Redcross Bhaban, Bhubaneswar on 16th September 2018. The program was organised under the umbrella of Jan Swasthya Abhiyan (JSA) a part of Global Health Movement (PHM). Near about 150 participants from organisations working on health, activists, village leaders, academics, research organisations, legal-aid organisations, trade unions, patients’ rights groups, peoples’ movements, Adivasi and Dalit community leaders from all over the state attended and shared their experiences on the problems being faced to get the health services in both public and private facilities and prepared a status report on health to present in the national assembly to be held at Raipur on 22nd & 23rd September 18 as well as in the Global Health Assembly at Banglades on 15 November and mobilise action towards setting health as an important agenda prior to the upcoming general elections. Jan swasthya abhiyan want to make it clear to the Parties that we will hold them accountable and ensure that people’s issues should find prominent space in their manifestos of the 2019 general elections.
The issues like Inadequate Health Budget for Public Health, Highly Privatized Health Care System, access to Health Food & Nutrition insecurity, with double burden of Under nutrition & “mal “nutrition with junk Communicable Diseases and emerging antimicrobial resistance (AMR) High Maternal Mortality & Morbidity Need for Minimum standards & capping of Charges, Regulation of Clinical Establishments, non availability of free medicine are discussed in the assembly. Shortage of healthcare workers and services particularly in rural areas continue to have its negative impacts. Communicable diseases like TB, HIV, HCV and malaria continue to be a leading cause of morbidity and mortality even as non- communicable diseases (diabetes, hypertension, cancers, chronic Respiratory Diseases etc.) in urban and rural areas are showing an increase. The Gaps in RNTCP non-prescribing of Standard Treatment Guidelines and Rational Use of Anti TB drugs have resulted in emergence of MDR & XDR TB. Evidence of increased vulnerability of the undernourished people to TB highlights the need of ensuring additional nutrition, besides rational medicines and diagnostic facilities for early diagnosis of TB & MDR TB. Majority of the Hepatitis C inflicted do not have access to testing and treatment services. Despite stated free treatment for HIV, stock out of ARV drugs and CD4 testing kits, with restricted access to 2nd line treatment and no access to 3rd line continue. The Maternal Mortality Rate, Neo Natal Mortality Rate, Infant Mortality Rate and Under 5 mortality rate have declined but they still remain high in vulnerable populations and girls. Poor nutrition of women results in birth of LBW babies and high prevalence of anaemia in women of reproductive age. Quality care from pre pregnancy to post-partum and emergency obstetric care is still not accessible to a significant percentage of women. The Clinical Establishment Act 2010 was meant to regulate Private and public Clinical Establishments i.e Hospitals, Clinics, diagnostic Labs etc. setting minimum standards and ceiling prices for charges for various medical procedures to prevent exploitative medical charges. This Act has not been implemented. Lack of regulation of the private actors has driven up healthcare costs, led to inappropriate, irrational and exploitative medical diagnostic tests, medical treatment and procedures with costly catastrophic expenditure on hospitalization.
The members present also discussed how the government health insurance programme (RSBY and BKKY) further rename as Biju Swasthya Bima Yajana is the biggest privatisation initiative of the government which is leading to transfer of public funds to private sector and also resulting in catastrophic health expenditure for people seeking treatment in private hospitals. They narrated incidences of grave human rights violation and excessive charging of money in the private sector. Many participants shared their experiences of private hospitals withholding the dead body for money, how the private hospitals refused treatment by insurance card. It was also discussed how the government has been neglecting its own public health system through under-resourcing, not approving adequate regular posts and not making recruitments. This demotivates government health workers and results in denial of health rights and services. The few tertiary level public hospitals, like the medical colleges, are not able to cope up with the pressure and patient load as many cases that could’ve been dealt at the level of block or district, get referred here due to lack of services in districts. Numerous cases of violation of patients’ rights were shared. It was demanded that government should create regular posts and recruit local people for health centres and government labs. Private practice by government doctors emerged as another major issue plaguing and weakening the government health sector and ending in high expenditure or denial of services to the patients. Participants shared how in many cases doctors neglect their government duty and call patients to their private clinic for treatment. A charter of demands for election manifesto is prepared and ratified by the participants, to be submitted to the different political party. There was consensus that Odisha government should use public funds to strengthen the government health system instead of transferring funds to the private health sector through insurance schemes and public private partnerships which actually damage the public health system. A strong government health system can cater to all the people of the state, especially the poor, tribal and vulnerable populations more effectively. Further it was demanded that rates for treatment and medicines in private sector should be fixed and regulated by government. It was demanded that the state should invest more in crucial public services such as health, education and nutrition instead of retreating from it and handing over these critical services to the private sector. The Assembly came to a close on a collective call demanding that the Odisha government should immediately strengthen Public health facilities and services and show higher commitment to people’s health and to its own public health system.There is a grave problem of absence of regulation of the rates of diagnostics because of which, diagnostics account for an increasing share of out-of-pocket expenditure in both in-patient and out-patient care. The problem is being compounded in large private hospitals because they prey on patients by charging higher than market rates as well as adding on convenience fees. Though in state the diagnostics are free but the poor patients are unable to avail it as either the technician are not available or the equipments are not functional. So Government should streamline the free diagnostic facilities in public facility and put in place national regulated prices and a system of prescription audit for diagnostics. The government should act decisively to put an end to pushing peoples’ health over the edge and forcing families into economic ruin for the sake of protecting profits. Towards this end, Government should immediately take measures to impose strict price controls, especially on medicines, devices and diagnostic services related to healthcare as well as on the treatment procedures. Government has the policy space to take the lead in regulating healthcare charges and should put in place an institutional mechanism, backed by necessary legislation, to oversee the price regulation of all aspects of healthcare in a systematic manner to make them affordable. RECOMMENDATIONS• Increase public health budget to more than 2.5% of GDP with substantial investment in primary healthcare recognizing the double burden of Communicable & Non Communicable Diseases.• Recognize and protect the Determinants of Health (Food & nutrition) recognizing the poor nutritional status of the majority. • Ensure production & procurement, promotion, distribution of diverse, health promoting, nutritive food and regulate unhealthy poisons, toxins, chemicals in food and highly processed junk food as these are having negative health impacts.• Ensure Comprehensive Primary Health Care and Universal Health care which recognizes the state’s role in providing public health as a social good rather than a commodity for exploitative profiteering, further privatization and financial speculation.• Stop Privatisation and corporatisation of public health institutions, public sector vaccine and drug manufacturing units.• Enactment and enforcement of regulation of corporate and private sector health care to protect patient rights and prevent.• Address as priority the existing discrimination and structural marginalization of vulnerable groups facing multiple vulnerabilities (dalits, tribals, NT, disabled, poor, rural, urban slums dwellers, women, children specially girl child, adolescents, elderly, single people, disabled widows, homeless) in Health care services.• Ensure implementation of policies, programmes with adequate financial allocation and institutional arrangements to address occupational health concerns of those suffering from silicosis, involved in mining, sewage work, manual scavengers, working in hazardous industries with no labour laws and health rights and ensure safety.• Operationalize Comprehensive Mental Health policies and programmes with appropriate budgets and trained personnel and institutions, to provide mental Health Care and protect the rights of mentally ill.