U.P. State Health Assembly, Lucknow

Report

“The time to make health and healthcare a fundamental right is Now!”

JSAUP organised the 3rd State Health Assembly on 8th September in Lucknow as an an event of mobilisation from different parts of the state as well as involvement and team work of member organisations of Jan SwasthyaAbhiyan. The assembly was attended by more than 200 activists, all the organisation heads also addressed the assembly and pledged support to the Abhiyan. Several new member organisations offered to become members of JSAUP which will be formalised after the NHA3.

Dr Sundararaman, Dean TISS Mumbai, the Keynote Speaker of the occasion, presented the framework of the movement and set the stage for a meaningful discourse. Hesaid that the public health sector is starved of funds and human resources and on the other hand, there is a growing commercial private sector which sees healthcare as an area for high return investment, and which is disconnected from all public health outcomes. He further said that even after 70 years of independence, India is way short of providing accessible and affordable health care to its citizens.. All through last three decades, state health systems were systematically undermined- by a complete slowdown in public investment in health, thus giving scope and opportunity to the pvt sector to grow. This period saw an overwhelming growth of the private sector and a huge rise in out of pocket expenditures on health care. Experience over the last two decades show that “Public Private Partnership” (PPP) has not only failed to deliver the desired outcomes but has in turn added to the weakening of public health facilities to the advantage of private sector.

Dr Sundararaman further said that International agencies were busy buying the big Hospital Chains in India and other developing countries to turn them to superspeciality hospitals and make profits through Medical Tourism. He warned that privatisation is no solution. In fact, it is the central problem. And a major cause of  Impoverishment due to increased expenditure on health is a major concern disproportionately affecting those who are marginalised and deprived.

Dr CS Verma, President JSAUP, presented the Health Status Report of Uttar Pradesh.He said that Uttar Pradesh is among the poorest states in India.The estimated proportion of people under poverty line is 39.8% or 809.1 million. The rural population is significantly poor than the urban population.However, the state has been witnessing a robust growth over the last decadebut it has also been iniquitous. The economic growth rate has been reasonable- an average of 5.5% per year .The reasons for the iniquitous nature of growth are many, but the one dimension of this phenomenon that this paper explores is the contribution that the health sector makes to this rising inequity. Dr Verma further said that the growing private health care industry of Uttar Pradesh may be contributing to both the high growth rate and the poverty. The service sector is the biggest contributor to UP’s economic growth and within this no doubt the growth of private sector in health contributes significantly. But the private sector in health grows at the cost of impoverishment of the poor- a case of robbing the poor to pay the rich.

Presenting the statistics of the state, Dr Verma expressed anguish at the state of affairs in the state. The state has 20976 Sub Centres, 3382 PHCs and 3581 CHCs, 10 sub district hospitals and 174 district hospitals as in January, 2017. However, the number of active facilities is a bit less than that. The gap between total facilities and active facilities has decreased during 12th plan period as compared to the 11th plan period, however it is still substantial. Dr Verma suggested that a comprehensive human resource policy, which lays down detailed guidelines for the state to implement strategies to address the shortage of human resources for health, is urgently needed. It is now widely acknowledged that for achieving universal health coverage (UHC), health human resources is the key factor.

RP Singh of  FMRAI said that the  Institution of genuine and efficient price control regimes is a long-standing demand of FMRAI. FMRAI demands of abolition of all types of tax regime on medicine. Recently, FMRAI is conducting movement with the slogan of ‘No GST on Medicines’. FMRAI demands of revival of Pharma PSUs and ‘free medicines for all ailing people’. He said that  FMRAI demands of government of India of immediate enactment of statutory code, with stringent punishment clause,  for pharmaceutical marketing practices so that unethical marketing by pharmaceutical giants (by giving freebies and bribes) and thereby selling inessential medicines at high prices,  can be checked and controlled.

RS Vajpai from CITU said thatThe current government spending on health care is a miserable 1.16% of GDP (2015). This is one of the lowest in the world (Rs. 957 per capita). The new health policy (Health Policy 2017) promises to increase public health spending to 2.5% of GDP by 2025,which will actually amount to Rs 2.83 lakh Crores( the current defense allocation) . While World Health Organization (WHO) recommends spending of 5% of GDP by the Nation States, Health Policy 2002 (drafted by A B Vajpayee Government) promised to increase the spending to 2% of GDP by 2010. But, it did not happen.

Shishir from Water aid said that the inclusion of innovative approaches in health programs will strengthen the health systems. He suggested the following point: 1.Integrate WASH in health care facilities. It should be a core component in health policies, programmes and strategies relevant to quality of care and universal health coverage.2. Review Kayakalp criteria, other tools for monitoring WASH in HCF, and the recently released Joint Monitoring Program indicators for WASH in health care facilities to arrive at comprehensive standards that allow classification of facilities in relation to WASH “service ladders” to monitor progress.3. Measure WASH in health care facilities routinely within health and national level surveys

Prof Raj Kumar, Vice Chancellor, Government Medical University of Health Sciences, Saifai presided over the session. In his address, Prof Kumar said that The collapse of the public health-care system costs enormous to the common people of the country as well as in Uttar Pradesh. This is the main reason of ever-increasing out-of-pocket health care expenditure. He also ridiculed over reliance on private sector for medical education and said that majority of private medical colleges had severe shortages of medical faculty.He also criticised the government run medical colleges where shortages of faculty and infrastructure persisted for years. He said quality education can not be imparted without quality teachers. Investment in helth sector was the only way he said.

Representatives of member organisations also shared their views in the sharing session. MadhuGarg and Seema Sharma (AIDWA), VK Srivastava (UPVM), RK Mishra (BGVS), Sanjay Rai (Aim), Ajay Sharma, VivekAwasthi (UPVHA), Dr Yashpal (MPH LU), Dr Manjur Ali (GIDS) Ranjana (Vigyan Foundation) also shared their views on the occasion.

Deepak Kabeer (DastkManch) did the coordination of the session, VivekAwasthi Convener JSA, welcomed the participants, and pravesh Verma, (Sahyog) gave vote of thanks.

— VivekAwasthi, Convener, JSAUP