Jan Swasthya Abhiyan, Rajasthan registered protest at Vidhan Sabha today against the decision of the state govt. to hand over various health care facilities into private hands. JSA alleged govt. of washing away its hands from its fundamental responsibility of delivering quality health care services to people and affirmed that by handing over primary and secondary health care facilities to private bodies, the govt. is pushing already crumbling health care system towards a state of disaster. About 200 abhiyan representatives from all the corners of the state got together to demand that the government immediately revokes its decision of privatising public health facilities in the name of PPP.
A delegation of five persons was invited by the State Health Minister, Sh. Rajendra Rathore to discuss on the demands. The issues were discussed thoroughly with the Minister and senior Health Department officials including Dr. Neeraj K. Pawan, Additional Mission Director, National Health Mission, and the following demands were agreed upon:
1. The government admitted that the list of 300 PHCs issued under the call for proposals for handing over of PHCs to private bodies has serious anomalies and that the PHCs enlisted therein do not meet the criteria of being remote and backward. The list therefore will not be considered and a more rational list of backward and remote PHCs will be developed.
2. The government would experiment with PPP in PHCs with a small number of backward PHCs first and would escalate the idea only after evaluating its outcomes at the end of a year. Thus, PPP would not be implemented in 300 PHCs but only a handful to begin with.
3. The clause in the RFP wherein the private operators were given the liberty of providing additional services (apart from those which are mandated under IPHS) for which they could even charge patients will be removed completely. The clause was dangerous as this would have opened doors for the private operators to make huge money by exploiting patients by prescribing unnecessary tests and diagnostics.
4. The government agreed that any health facility which registers protest by the local community on handing over to private bodies will not be considered for PPP. This includes CHC Sanganer (located almost within the city of Jaipur and one of the better functioning CHCs) where the local community has been relentlessly objecting to the idea of its handing over to a private medical college.
Background and the major demands that were put forward by the campaign:
There are two modes of hand over happening in the state. One is where if any private sector organization is willing to provide these services without any government support, then without following any tender process, health facilities would be handed over to them by simply signing MoU with these private sector organizations. Under this process, Rajasthan has handed over three community health centres; two of these are in Jaipur which have been handed over to NIMS private medical college and one CHC in Barmer is handed over to CRD Health Care Private Limited. Apart from this, 30 Primary Health centres and about 150 Sub centres have also been handed over to an organization named WISH Foundation which has further subcontracted other organisations to run these PHCs. Giving primary health services in the hands of private medical colleges and private limited companies is utterly concerning since there are quite a few types of treatments where profit can be earned by performing unnecessary surgeries on patients in the name of free health care services. Moreover they are not seeking any financial support from the government which raises questions about the accountability and responsibility of these private sector organizations.
The other process of handing over these facilities is through tendering process under which any not for profit, profit making, any individual MBBS doctor or any other competent entity can bid for the tender. Request for proposal to bid for these facilities had been released on the website of health department, Rajasthan. While earlier the government made a pretense that only 90 PHCs, from utterly backward regions and difficult to serve areas would be brought under PPP mode, the released RFP suggests a list of 300 PHCs from across the state for which tenders have been invited. After handing over these health facilities to private sector, government would remove its staff from these centres but the infrastructure and equipment would be completely handed over to private bodies to run the facilities.
One of the most perturbing condition that RFP document talks about is that PHC operators can also provide additional services than what are quoted in the RFP document, for which patient will be charged. This gives the window to the private bodies to offer additional services and also it could be a way for them to earn extra money from the pocket of people. What could be these additional services is not mentioned explicitly, but the additional services may include ECG machine, sonography machines, Xray machines, services of specialists which are otherwise not part of the mandated services of PHCs as per the IPHS. These services are provided free at the community health centres and above. Thus if certain services are required and certain tests are needed to be done instead of referring the patient to the CHCs and elsewhere private parties will be permitted to charge money from the poor persons who are sick. This would often result in over medication and huge payments. Charging the poor for health care services in the public healthcare system is violation of the fundamental rights of the citizens and hence this clause must be removed from the RFP immediately.
It was said that services could not be provided in rural and particularly remote areas and this rationale was also part of the argument made that PPP was intended to improve the public healthcare system. However, a careful look at the 300 PHCs proposed to be privatised shows that a majority of them are either in the urban areas or within a reasonable distance from an urban area. Thus, it is not the remote areas that are being brought into the scheme but the urban areas where the incomes are marginally higher and where persons going to the PHCs can be charged money for the services rendered therein which services are supposed to be provided free. This leaves huge space for the private parties running the PHCs to exploit the poor and vulnerable at times of their illnesses. The list of 300 PHCs ought to be handed over to private bodies therefore stands completely unacceptable as they fail to meet all the grounds based on which government had been advocating for PPP.
While some of the above demands have been accepted by the government today, yet JSA Rajasthan would continue advocating against privatisation of govt. health care facilities until govt. executes what it has promised for. JSA would also be keeping a close eye on the health facilities run on PPP mode.