The state health assembly were organised at Gandhi Bhavan Bhopal on 30th August 2018, this was attended by around 90 participants from the 27 districts Shadol, Badwani, Datia, Tiakmgarh, Bhind, Vidisha, Khandwa, Mandla, Jabalpur, Damoh, Harda, Dhar, Jhabua, Singrauli, Alirajpur, Bhopal, Rajgarh, Sheopur, Chhatarpur, Katni, Satna, Chhindwara, Hoshangabad, Indore, Rewa, Anuppur and Narsingpur. Assembly started with introduction of all the participants and inaugural lecture by one of the most active member of the Jan Swasthya Abhiyan Madhya Pradesh Mr S. R. Azad, he started with the revisiting the Alma Ata declaration 1978 of ‘ Health for All by 2000’ AD, to which India was also a signatory. It is almost two decades since the goal year has passed but there is no sign of the realization of the declaration. In fact, India is following the undesirable path of introducing the private sector in health care. After that he added major activities and campaign carried out by the state JSA like PIL filed in the case of privatisation of public health institution district hospital Alirajpurand Jobat CHC, Monitoring of National Health Mission, Botched eye surgery, Silicosis and many more.
In the next session Dr. Anant Bhan who is working on the issue of medical ethics has delivered his speech on the subject “challenges in health sector in India with special focus on PPP, Insurance, and Privatization”. He said that health became a political agenda before the election year and government is focusing on the privatization or public private partnership in health care services. He also added that accessing health care services is leading cause of indebtedness. He shared some of the current government health schemes.
Ayushman Bharat claims that 40% covered population is of SC/ST. This scheme provides for health insurance rather than direct health services. This has shifted the financing of health care from a public (tax-sourced) model to an insurance – based service.
The government buys insurance on behalf of the beneficiary population from a third party (insurance agency) where the benefit cover is of ₹5 lakh with 1350 ‘cashless’ medical packages. There is no cap on the family size.
There was a soft-launch of the scheme on the occasion of 15th August 2018, while the full-fledged operations are yet to be rolled out. A 24×7 helpline has also been launched.
There are multiple issues regarding this scheme, some being-
Source of funding is uncertain-while the central and state governments are to spend 60% and 40% respectively, but the corpus has been determined on the basis of the 2011 socio-economic caste census, and the population has been increasing at a steady rate ever since.
Few stated like Odisha have refused to adopt the scheme since they have their own schemes with coverage upto 7 lakhs.
Ayushman Bharat focuses on in-patient treatment while OPD remains largely ignored.
Out of pocket expenditure on health, especially primary health and post-operation palliative care pushes thousands of families into poverty and debt.
The Medical and allopathic medicine lobby is adamant against bridging courses for nurses, ASHA workers, since it fears loss in revenue. Contrast this with the reluctance of certified doctors to go to rural and interior areas.
Cases like the Johnson and Johnson hip replacement recall shows how the regulatory laws favour private agencies rather than people. In India, only those who have complained of complications are getting a corrective surgery, there is no direct compensation for all victims.
The recent controversy of the ban on oxytocin production, vaccination rows, is also issues of public health concern.
Private hospitals get massive subsidies like land leases for a pittance because they are supposed to be working for social benefit. A particular ratio of beds is to be reserved for BPL patients, but these profit-driven entities will never work for social benefit since their driving objectives are contradictory.
Dr. Anat Bhan also shared some of the good examples of privatisation of health services. Mohalla clinics in Delhi, where private practitioners are incentivised to run a few hours of service, are a good example of how the existing private stakeholders can participate.
Cross subsidising is an option where people who can afford pay more than those who can’t.
Another issue raised was of sterilisation camps, malnutrition and consequent deaths, and their impact on marginalised communities.
In the next session Mr. Aulya Nidhi talked about the Major Health Issue of Madhya Pradesh. He started with the explaining the basic ideology of Jan Swasthy Abhiyan is that JSA is a voluntary network, and all members are in agreement with the People’s Health Charter.
He speaks about the various major health issues of Madhya Pradesh like –
- Unethical clinical trials– Due to unethical clinical trials hundreds of victims died and thousands are suffering from severe adverseeffects. He added the recent example of Cases like the Johnson and Johnson hip replacement recall shows how the regulatory laws favour private agencies rather than people. In India, only those who have complained of complications are getting a corrective surgery, there is no direct compensation for all victims.
- Privatisation of health services and institutions – State Government is trying to privatise the health institutions. JSA intervene via public interest litigation (PIL) in one of the incidence of Alirajpur district hospital and CHC Joabt, where department had carried out an MoU with Deepak Foundation. Presently the process is on hold but we have to be very conscious about this type of steps and need to intervene timely.
- Health and wellness centre- Another important issue was of the newly proposed ‘Health and Wellness Centres’ replacing sub centres across the country, and alarmingly, vision documents talking about the updatation of sub centres but Madhya Pradesh health department is trying to convert PHCs in health & wellness centres. Due to this step the demand for two doctors at Primary health centre will be in grey area.
- Ethics in medical field- Ethics in medical education is one of the critical issue in th estate. VYAPAM scam is one the example but there are more practices in this fields to be addressed.
- Occupational Health issues- Occupational health is one of the major issues of Madhya Pradesh. Presently the issue of Silicosis identified in several districts of state like Alirajpur, Dhar, Jhabua, Shivpuri, Vidish, Panna, Chhatarpur, Mandsaur, Ratlam etc but till date government has not any poicy for the betterment of the workers at risks. He also address the issue of scrapping of 29 labour laws and their merger into 4 labour courts, and further impacts on issues of occupational health were discussed.
- Botched eye surgery – Faulty eye operations in government hospital were done in recent past. JSA took promptly steps in the matter and victims of the botched surgery get the compensation in the case of district hospital Badwani but in other places still things to do.
- Health impacts of thermal power plants – In the many thermal power projects are established and many more are in the line but there is lack of monitoring of environmental pollution and health impacts of these plants.
- Rajya Bimari Sahayata Nidhi – There is serious irregularities in the implementation of the scheme, JSA deal the various cases where concerned hospital demands more amount then sanctioned under the scheme. In one of the case of Indore Government has suspended the license of one of the hospital for demanding the more amounts.
- Mentoring Group on Community Action – MGCA is an official body of under the National Health Mission and many active members of Jan Swasthya Abhiyan are the members of MGCA. He requested to participated that like we should take this opportunity to raise our concerns.
Apart from these issues he also speaks about the distribution of 10 lakh pairs of footwear to tendu patta worekrs allegedly contaminated with carcinogenic substances.
His major concern in whole presentation was on the health policy is promoting the privatisation and health is became a ‘industry’.
Presentation from Networks/ Organization and associate members of JSA-Discussion on the following issues took place, where people from various districts of MP spoke of their experiences-
Sachin Jain – Roji Roti Abhiyan
Food security and its impact on health- if food is being taken out of the PDS, and money is being transferred instead, it means the government would no longer need to buy food grains.
Dinesh Rai Singh – Silicosis Peedit Sangh
Water is so inadequate in some areas in Jhabua that people are consuming contaminated water. There are no doctors or nurses at primary health centres.
Smriti Shukla – Maternal Health Rights Campaign
She spoke on maternal health as a collective investment of a community and not just in isolation. Sterilisation, particularly in unaware communities and the dangers associated with the same- for instance in Sheopur, out of 12 maternal death cases only one was investigated.
Ramji Roy – maternal Health Rights Campaign
Ramji Roy from Datia spoke of the maternal health rights campaign, the quarterly magazine published by MHRC to inform people about issues relating to maternal health.
Another shocking sterilisation camp case was of 66 operations happening in 1.5 hours, a complaint of which was forwarded to the State women’s commission.
Sapna Sisodiya – Rahat mahila Resource Centre
She spoke of domestic violence and its impact on women’s health, particularly psychological health, of which women unaware of their rights were victims of.
Mahesh Sharma – Jindagi Bachao Abhiyan, Anuppur
He spokes about fly Ash causing air and water contamination on the environment and the health of the people living in the vicinity of the Moser Baer thermal power plant.
Ganesh Sharma of Anuppur
He described the contamination of the Khirna Nala and fly Ash getting drained in the Son River, causing health issues not only in people but also animals and farms.
Lakshmi – Asha Usha Asha Sahyogini Sangh
She raised issues on the role and functions of ASHA workers, lack of remuneration, dignity and their own health safety since they spend most of the time in contact with sick people.
The perception of ASHA for the patients as being reprentatives of the government, and of the government as them being ordinary people, puts them in a difficult position to carry out duties and also get remuneration for same. ASHAs need access to better primary health infrastructure so that secondary and tertiary care can become easier in the system. Training material in English also posed a hurdle in areas where hindi is the predominant language.
Nidhi – SOCHARA
The role of Sochara, CPHE fellows collective as a network for cooperation, raised issues of ASHAs having to spend out of their pockets to provide patients access to services, and the role of MGCA members.
Dr. Verma – Bundelkhand Zeevika Sangthan
He spoke of the relation between the Ken Betwa link and the 12 villages near the Panna tiger reserve being in its submergence zone which would lose access to healthcare. The gatekeeper of the reserve does not allow ambulances to pass, which have to take a 100-km detour. These are places where vaccination hasn’t taken place since 4-5 months and PHCs function only on 15th August and 26th January.
Vijay Veram – Nai Shuruwat
Heshared his own experience with the exploitation of the RBSY scheme and the exposure of which lead to the cancellation of the licence for the scheme of a major hospital in Indore.
Ramesh Pandey – Shahdol
He spoke of the workers in mines and the role of medical norms which prevented the diagnosis and reporting of silicosis due to unrealistic conditions like symptoms needed to be visible since 8-10 years. The impact of mining activities was not only limited to people but also water and vegetables in the region.
Anandi – Mandla
She spoke about the inaccessible PHCs during rainy season, lack of vaccination facilities, staff and diagnostic machines. Facilities that are supposed to be available at PHCs are not even available at the district hospital. In the case of child deaths, there was no audit or even committee or any information established.
Ganesh Kanade – Khandwa
He spoke of the hazards of fly ash from the thermal power plants in districts.
Dr. Umashankar – MP Vigyan sabha
He threw light upon the attitude of the World Bank, role of PPPs and the overall impact of globalisation on the environment–loss of bees, decrease in medicinal plants, key species, issues with lax environmental laws and the futility of EIAs. The exclusion of locally available varieties of grains, vegetables and sources of nutrition from PDS and reducing the role of SHGs to only providing food has made the incidence of malnutrition worse. He recommended conducting the family food audit to monitor consumption, and also questioned the low expenditure on health in the budget despite 2.5% annual population growth rate.
Sachin bhai concluded the session and with delivering the summary of the session –
The relation between health and food security is crucial. Social audit, including health and food habit is essential.
The mining districts are entitled to funds from the district mineral trust, commenced in 2010 to ensure that profits from mineral mining are shared with local stakeholders. 10% of the profit earned from mining minerals is to be used primarily for the health and education concerns of women and children. A corpus of ₹2000 crore was created, of which 580 crore were sanctioned and of which only 320 crore were used, and even that was used to build boundary walls and roads, and not for the communities as was the objective. Similar is the case with state mineral fund.
6 themes were designed to divide the members into focus groups to make recommendations regarding each issue to be presented at the national JSA convention in Raipur and to prepare peoples health charter for political parties.
The following themes in health were decided upon where people from various places working on various issues of health would contribute. Members are expected to send suggestions for each theme by 10th Sept.
Participation in National Health Assembly- Raipur
With the consent of all the members’ participation in NHA 3 was decided. Totally 130 participants from 33 districts are attending the National Health Assembly. Coordination will be done by the Rakesh Chandore and Ashish Pare.
International Health assembly – Dhaka
International health assembly will be organised at Dhaka, Bangladesh from 15th – 19th November 2018. Active members from each region can participate in this event. List will finalise later.
International Public Health University-
PHM is organising IPHU at Dhaka before the international health assembly, where a week long diploma course will be conducted on the issues of national and international health concerns.
It is also decided that the Amulya Nidhi and S.R. Azad will coordinate and do the follow up of all the decision taken in the assembly.
Vote of thanks given by the Ashish Pare of Madhya Pradesh Vigyan Sabha, Bhopal.