Statement Condoling the Deaths of Children in Muzaffarpur and Condemning Governments’ Failure

Jan Swasthya Abhiyan (JSA)  is deeply saddened at the horrific deaths of over 100 children due to Acute Encephalitis Syndrome (AES) over the past few days at the Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar. We  express heartfelt condolences to the families of the young children who have lost their lives.

JSA demands that the Government initiates immediate measures for the treatment and prevention of AES to prevent further deaths. We also demand that concrete and long term steps be taken to ameliorate and strengthen the public health system instead of pushing the country towards privatisation and insurance-based model of healthcare. 

to read full statement, click here

JSA statement on violence against doctors in West Bengal

Jan Swasthya Abhiyan expresses shock at the grievous assault on junior doctor, Dr Paribha Mukherjee in NRS Medical Hospital at Kolkata on 11th June 2019 and condemns, in the strongest terms, the escalation of violence, communalization of the issue, and attempts at intimidation of junior doctors by the government that have ensued in West Bengal in the past 48 hours, in the aftermath of the protests by junior doctors.

To read full statement, click here

Peoples Health manifesto-2019 by JSA

As the General Elections-2019 are fast approaching, Jan Swasthya Abhiyan activists are pushing the political structures to address the issues plaguing people’s health by releasing a ‘People’s Health Manifesto-2019’

The manifesto demands increasing the public expenditure on health to 3.5 per cent of the GDP in the short-term and absorbing the Ayushman Bharat health insurance scheme—based on the discredited ‘insurance model’—under a strengthened, well-funded public health system and a right to health act which includes a patients charter.

Click here to read and download the People’s Health Manifesto-2019 in English

Click Here to read and download the People’s Health Manifesto-2019 in Hindi

JSA-RTF statement on eviction of tribal communities and forest dwellers

Jan Swasthya Abhiyan and Right to Food Campaign express solidarity with tribal communities and other forest dwellers in their fight under the Forest Rights Act. As health and nutrition experts and activists, we demand that all involved State Governments immediately file an appeal against this order that we believe will further increase existing health inequities between the tribal and other populations and also endanger their food security. We expect the Central Ministry of Tribal Affairs to also intervene in this case as well as take urgent action for the implementation of the FRA Act guidelines and PESA. We appeal to the Supreme Court to use its powers to ensure that constitutional safeguards for the tribal population are enforced instead of participating in a misuse of the law against them.

Click here to read/download the complete statement

campaign against privatisation of health services in Punjab

JSA Punjab organised a meeting in Chandigarh with like minded rights based groups to launch a campaign against privatisation of health services announced by the Punjab government recently. The CM and Health Minister gave vague statements in the media after opposition to the same. However, it seems that they are going to continue with the same.
Today, the Chandigarh UT announced that they are mulling over a decision to privatise public schools. The campaign group, consisting of various organisations, that met today decided to join the two issues and launch a joint campaign.

Press Release on Ayushman Bharat

PRESS RELEASE

Abandon the AB-PMJAY scheme based on the discredited insurance model

The recent announcement regarding the launch of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme has raised expectations that the scheme will somehow address the extremely urgent needs regarding healthcare in the country. Expectations have also been raised because of the labeling of the scheme as the ‘largest health protection scheme in the world’ and the promise that beneficiaries will receive Rs.5 lakhs as cost of hospitalization.

The Jan Swasthya Abhiyan wishes to point out that the mere assertion that the AB-PMJAY is the largest health protection scheme in the world, does not make it so – in fact it is entirely misleading. The Government’s own National Health Mission has an outlay of around Rs.35.000 crores, many times more than the Rs.2,000 crores allocated for the scheme in the 2018-19 budget.

Download press release here.

Draft People’s Health Manifesto, 2018

The Jan SwasthyaAbhiyan staunchly upholds the Right to Health and Health Care for all people of India.We are opposed to anti-people steps being taken by the current Government in the health sector. We strongly oppose various negative policy trends such as:

  • the recent national health budgets being reduced in real terms,
  • downgrading of public health services;
  • various retrograde steps concerning the National Health Mission;
  • launching of the ‘Ayushman Bharat’ scheme based on the discredited ‘insurance model’ despite massive evidence against the effectiveness of such insurance based schemes involving major participation of the private sector in service delivery;
  • moves for privatisation of district hospitals and other public health services;
  • continued refusal to ensure effective regulation of the private medical sector,allowing this sectorto continue massive profiteering at the cost of patients, especially by corporate hospitals;
  • lack of comprehensive price control for all essential medicines and unwillingness to regulate unethical marketing practices by the pharmaceutical industry;
  • ongoing exclusion and marginalisation of wide sections of the population related to health services

All these steps point to an ominous direction. We oppose the trend of pushing neoliberal policies in the realm of health care, which weakens public systems and leads to rampant marketisation of health services. To realise the right to health for all, requires ensuring a wide range of social determinants of health, along with universalising health care, where a strengthened, accountable, democratized public health system acts as the backbone and leader.

In this context, we propose the following policy actions, especially in the context of various upcoming state assembly elections, and parliamentary elections likely in 2019, to be acted uponby all political parties and candidates. This is with the expectation that the parties which come to power should implement these policy measures, and those which serve in the opposition should continue to raise these proposals and demands in all available forums within and outside elected bodies. The Jan SwasthyaAbhiyan will concurrent mobilize and campaign among different sections of the people to build a consensus around the urgent actions we propose.

  1. Make the right to health care a justiciable right through the enactment of appropriate legislations both at Central and State levels. Such legislations should ensures universal access to good quality and comprehensive universal health care including the entire range of primary, secondary and tertiary services for the entire population. This must be accompanied by a public health legislation which ensures people’s access to a range of health determinants and protection from health harming influences. These should contribute to the process of making Health and Health care fundamental rights in the Indian Constitution.
  2. Increase substantially the public expenditureon Health, financed primarily through general taxation, to 3.5% of GDP (this would be annually around Rs. 4,000 per capita at current rates) in the short term, and 5% of GDP in the medium term, with at least one-third being the contribution from the Centre. Since health is a state subject, and the contribution of states is at the centre much higher than the central contribution, all states should establish a system to monitor expenditure and implementation of activities supported through the state health budget. Further ensure that out of pocket spending on health, which is currently obnoxiously high, is rapidly reduced and becomes less than one-fourth of total health care expenditure. Because of the centralization of fiscal powers at the Centre states have serious financial constraints and this must be addressed by much greater decentralization of fiscal relations between the Centre and States. For example, contrary to claims, an additional 1200 crores has not been allotted for the Health and Wellness Centres and this amount will be deducted from the budget for the National Health Mission, and states will have bear the additional financial burden for these proposed centres.
  3. Stop all forms of privatization of Public Health Services. Expand and strengthen the public health care system to ensure quality and availability of health care appropriate to primary, secondary and tertiary level, entirely free of user fees. Ensure that no private practice is undertaken by government doctors at the time of their work as part of public health services.
  4. Build and actively promote a predominantly public health system based framework for Universal Health Care(NOT ‘Coverage’). Major expansion and strengthening of public health services could be combined with some in-sourcing of regulated private providers, as an interim mechanism, to cover the current gaps in provisioning.  While doing so the goal would be to maximize the extent and reach of public provisioning over time, while socializing and majorly transforming involved private providers, who would be individual, small and charitable providers, and not corporate hospitals. The direction would be of selectively using private health care resources to strengthen public systems, contrary to the approach of the proposed Ayushman Bharat program of indiscriminately using public resources to strengthen private health care providers.
  5. Abandon plans for the ‘Ayushman Bharat’ scheme based on the discredited ‘insurance model’. The projected annual outlay of Rs.12,000-50,000 crores, as per different estimates would be much better utilized by investment in expansion of public facilities and creation of permanent public assets. Absorb existing publicly funded health insurance schemes (RSBY and different state health insurance schemes) into the public health system, supplemented by selective in-sourcingof private providers for filling of service gaps.
  6. Regularise all Health Scheme workers and ensure that they receive protection from the entire range of labour laws. All levels of public health system staff shall be provided with adequate skill training, fair wages and placement and all provisions of social security and decent working conditions.
  7. Formulate and implement a comprehensive policy on occupational health and safety. Ensure accountability and stringent action against violations. All projects by corporations that can potentially affect health should first receive a ‘health clearance’.
  8. Increase public investment in education and trainingof the entire range of health personnelto ensurecapacity building in government run colleges. Establish a well-governed and adequate public health workforce by creating adequate numbers of permanent posts. Put in place stringent mechanisms for regulation of all existing private institutions, such as medical and nursing colleges, in a transparent manner and place a moratorium on the establishment on new private medical colleges.Overhaul the Medical Council of India and the Nursing Council of India along democratic lines to eliminate corruption and unethical practices.
  9. The Government of India, with active involvement of all State governments, should without any delayguarantee access to all essential and life saving medicines and diagnostics in all public facilities across the country. The scope and coverage of this scheme should be no less than the ongoing schemes in Tamilnadu, Kerala and Rajasthan, which would ensure free access to thefull range of essential medicines and medical investigations provided through all levels of health facilities. Revive existing public sector units and establish new public sector drug production units towards self reliant medicine production in the country. Provide adequate funding to all public sector medicine research institutions.
  10. Bring all essential medicines under price control through a system of price fixation based on manufacturing cost.Ban all irrational medicines and irrational combinations. Effectively regulate and eliminate unethical marketing practices by Pharmaceutical companies. Promote opening of generic medicine outlets in adequate numbers.The government should prepare a generic medicine policy and make mandatory use of generic names in prescriptions while ensuring easy availability of generic medicines.Use the public health safeguards in the Indian Patent Act to promote access to medicines, and actively promote indigenous manufacture of most drugs and devices. Protection should be provided against patent misuse and Compulsory Licenses should be for local manufacturer of needed medicines.

 

  1. Eliminatecorruption in the Public Health System through transparent policies for appointments, promotions, transfers, procurement of goods and services and infrastructure development through a Transparency Act, and institute robust grievance redressal systems, which are adequately financed and managed with certain autonomy from the systems involvedin implementation of programs and policies.
  2. UniversaliseCommunity based planning and monitoring of public health services at all levels to ensure the accountability and responsiveness of public health services. Over time, move towards a democratised, community driven health system, and a framework of health care that takes into account diverse community needs and perceptions.
  3. Expand and Strengthen the ESI system. Ensure inclusion of a comprehensive system of health care protection for workers in the unorganised and organised sectors, linked with the expansion and rejuvenation of the Employees State Insurance (ESI) Act, 1948. Specifically include workers in the unorganized sector and the agricultural sector, who are currently not covered by any form of social protection mechanism.
  4. Effectively regulate the Private medical sectormodify theNational Clinical Establishment Act-2010to ensure observance of patient’s rights; regulation of the rates and quality of various services; elimination of kickbacks for prescriptions, diagnostics and referrals; and grievance redressal mechanisms for patients. All states must adopt the National Act or a state specific act which incorporates all the features of the national Act. Establish a publicly managed admission system, and regular referral between government hospitals and charitable trust hospitals, to effectively utilise beds for patients from economically weaker sections in trust and private hospitals who have been given lands at highly subsidised rates and tax concessions in purchase of equipment.
  5. Various types of ‘PPPs’ which weaken public health services should be eliminated. Instead, where essential to fill gaps in public provisioning, regulated private providers (especially smaller and not-for-profit facilities) should be in-sourced at standardized rates, in such a manner that they serve the larger public health goals.
  6. Support medical pluralismso that people have a choice to access non-allopathic systems of healing, including safe home-based birthing practices. Substantial encouragement must be given to research and documentation related to non-allopathic systems.
  7. Ensure thatvulnerable sections and sections with special needs enjoy access to health care at all levels. Vulnerability could be due to social position (e.g. women, dalits, adivasis), health status (e.g. HIV status), occupation (e.g. manual scavengers), ability, age or any other cause. Guarantee comprehensive, accessible, quality health services for all women and transgender persons for all their health needs.
  8. Recognize gender based violence as a public health issue and ensure access to comprehensive health care for survivors. Adopt measures to ensure access to entire spectrum of equitable, quality health care for women from all backgrounds and in all situations.
  9. Universalise Maternity benefits for all pregnant and post natal mothers, including contractual Workers, Daily Wage Workers, all workers in the Unorganized Sector and in the Agrarian Sector. Provide Crèche & Rest room for mothers small children in all work places.
  10. Take immediate and effective steps to eliminate all forms ofcaste based discriminationand any discrimination or deficits based on tribe or ethnicity, in the health care sector and beyond. Take immediate steps to eliminate the heinous practice of manual scavenging.
  11. Ensure rights based access to comprehensive treatment and care ofpersons with mental illness through integration of the revised District Mental Health Programme with the National Health Mission.
  12. Eliminate the interference by multi-lateral and bilateral financing agencies and corporate consultancy organisations (such as the World Bank, USAID and Gates Foundation, Deloitte and McKinsey etc.) from all health policy formulation.
  13. Implement strict regulation of approval and conduct ofclinical trials. Ensure that the CDSCO and the ICMR monitor the conduct of clinical trials at the trial sites. Ensure fair, timely compensation for trial participants who suffer from adverse events. Develop a justiciable charter of rights of clinical trial participants.
  14. Promote appropriate health research, significantly upgrade and build capacity of department and centres for health research, so that monitoring and evaluation of health programmes can be scientific and representative. Findings of such evaluations should lead to generalisable recommendations, rather than review missions which have poor scientific rigour and limited insights.
  15. Systematically plan to deal with both the traditionalsocial determinants of health like food security and nutrition, sanitation and the newer determinants like environmental pollution, occupational health, road safety, addictive substances like tobacco, alcohol etc. and violence.
  16. Universalize and expand the ICDS programmeto effectively cover under-3 children and universalize community-owned CMAM (community based management of malnutrition) programmes.
  17. Remove requirement for mandatory Aadhar link to access health services from all health care related schemes.
  18. Integrate action on public health with broader defence and expansion of democracy and secularism at all levels.Review the health policy and existing systemsto ensure that these prevent any type of majoritarian fundamentalism, discrimination against minorities, denial of care in conflict situations, and stigmatization or denial of care for persons labeled as ‘others’ or ‘outsiders’. Ensure that health systems at all levels are maximally inclusive and equitable, and strongly project messages to propagate an ethos of democratic inclusion, secularism, humanity and peace.

We appeal to all political parties and aspiring candidates to give highest political priority to people’s health in their agenda. In the 40th year of adoption of the Alma Ata Declaration of ‘Health for All’, as a nation we must revive the concepts of inter-sectoral action and community empowerment as being central to health. In this spirit it is imperative to prepare and implement people based plansat various levels to ensure food security, education, water supply and sanitation, land justice and agrarian regeneration,community control of natural resources, livelihood security, gender and social justice – all linked with environmentally sustainable and equitable development – which are essential for the general well being and health of the people of India.

Please send your additions/changes, if you have any by 5th October. The Manifesto will be finalised based on your inputs.

AP State Peoples Health Assembly

Nellore, the Mecca for Peoples Health Activists of Andhra Pradesh hosted Andhra Pradesh Peoples Health Assembly. The assembly was held on 16th September 2018 at Dr JS Vignana Kendram, named after Dr. J. Sesha Reddy, who was a dedicated peoples doctor, a passionate health activist and the architect of Dr. PV Ramachandra Reddy Peoples Poly Clinic. This assembly was held along with Dr. J. Sesha Reddy 10th annual memorial seminar.

Dr.  P.  Ajay Kumar, Superintendent of Dr. PVRRPPC People’s Poly Clinic presided over the assembly. Mr. V. Balasubramanyam, MLC and senior leader of Jana Vignana Vedika inaugurated the assembly. He is the floor leader of Progressive Democratic Forum (PDF), a forum of five MLCs who won in the election with the backing of peoples movements. He made a very interesting observation; AP Legislative council is supposed to discuss on health sector in the forthcoming week. But the legislators were requested by the officials, off the records though, not to ask any questions on health issues, since there is no minister for health in the state and the officials are not in a position to give answers! He expressed his regret that at a time when the state is gripped by fevers and so many people were dying helplessly, we do not have a health minister. And then he remarked that since the legislative house is not in a position to discuss peoples health issues and solve the problems, it is appropriate to hold the Peoples Health Assembly at this juncture. He recollected a recent incident, where a nursing mother, who was recovering after delivering a baby, slipped from her bed in the over-crowded maternity ward of Government General Hospiital, Vijayawada and died. He doubted the reliability of morbidity and mortality data of the government of Andhra Pradesh. While the government claims that deaths due to malaria and dengue are very low in the state, doctors in their private conversations are denying the claim, observed the MLC. He gave a call to people, civil society groups and progressive political parties to build peoples health movement to strengthen pubic health systems and ensure Health For All. He expressed his willingness to raise the issues in the legislative council.

Mr. Indranil Mukhopadhyaya, from Jan Swasthya Abhiyan made a power point presentation on “National Health Protection Scheme: Peoples money, Private profit and the nemesis of public health system”. He started with explaining the basic concepts of healthcare financing and then went on to analyse how the existing social insurance schemes failed to bring down the out of pocket expenditure of the poor patients. With the help of rich data, he established that these schemes could increase rate of utilisation of private medical facilities and thus helped improving their revenues. With multiple layers of intermediaries, these schemes incur huge amounts of administrative costs, reducing the efficiency of healthcare delivery system. He reminded the audience of the instances of unnecessary  procedures and surgeries like hysterectomies, cataract operations etc. NHPS alias Modi care alias Ayushmann Bharat  is just going to be one such social insurance scheme, of curse at a larger scale, which only means that greater revenues for private and corporate hospitals. It provides a coverage upto Rs.5,00,000 per family per year. Ten crore families will be covered under the scheme. The fact that the scheme was rolled out n the final year of the tenure of the government and that a meagre amount was allotted for the scheme, speaks volumes about the intentions of the government, he observed. Most important problem with the private medical sector is that it is unregulated. Whatever little regulation exists, in the form of Clinical Establishments Act, it doesn’t regulate the prices in the establishments. Handing over huge amounts of money to unregulated private and corporate hospitals will only result in unethical and irrational care. Instead, this money should be spent on strengthening public hospitals. It is also important to improve the efficiency and accountability in public hospitals. Apart from bureaucratic regulation, community participation in monitoring and planning public health services is essential to improve functioning of Public Health Systems, he concluded. He extended his invitation for NHA-3 on behalf of JSA national secretariat the people and health activists of Andhra Pradesh.

Ms. Richa Chintan from Centre for Budget and Governance Accountability made a power point presentation on the plight of poor public health systems in India and observed that inadequate budget allocations are one of the most important reasons for this. She narrated how JSA and PBI came together to start a national campaign on strengthening public provisioning of health care in India. In the first phase, the campaign is started in six states, including Andhra Pradesh. She shared good practices and.  Important outcomes of the campaign. While improving the understanding of budget groups on peoples health issues, the campaign deepened the understanding of JSA on budget issues, she observed. She gave call to the health activists to take the issue of inadequate budget allocations to people. When the people understand that they have a right to health and right to access to medical care and that it is denied because of inadequate budget allocations to health, they will join the fight for ‘Health for all’.

Dr. V. Brahma Reddy, a veteran public health activist and popular science writer, spoke on the unethical and irrational medical practices. He observed that the governments are intentionally undermining public health systems and promoting private and corporate hospitals. People are being mislead by the dominant perception that only corporate hospitals can give the best medical care. He urged people not to fall into the trap of medical consumerism. He gave a call to all progressive forces to come together and work together against the commercialisation of medical care and undermining of the democratic spaces.

Mr. Y Srinivasulu Reddy, PDF MLC released a book titled “Vaidyaniki Susti” which means illness to healthcare. It is the Telugu version of ‘Dissenting Diagnosis’, authored by senior JSA leaders Dr. Arun Gadre and Dr. Abhay Sukla. It was translated by Dr. S. Suresh, Praja Arogya Vedika, AP state Convenor and was published by Prajasakthi Book House, the leading publisher of progressive literature in the state. Dr. Suresh introduced the book to the audience.

Mr. G. Srinivasa Rao, PAV Nellore District secretary welcomed the guests on to dias and introduced the background in which the state peoples health assembly is held. He explained about national and international peoples health assemblies to be held at Raipur and Dhaka respectively. Dr. MV Ramanaiah, PAV state convenor; Dr. B. Rajeswara Rao, PAV Nellore district president spoke. Representatives of all the organisations, that took part in organising the assembly gave their messages of solidarity.

Delegates from three districts presented the report of surveys conducted on public health facilities. They narrated the stories of denial of healthcare in public facilities. Surveys are still going on in many districts Detailed report of the facility and exit interviews will be prepared after completing all the surveys. About 350 delegates attended from across the state.

Report of State Health Assembly, Odisha

The State Health Assembly started with the welcome address of Sri Ajaya Tripathy eminent public health expert of State JSA. Gournaga Mohapatra, Convener JSA, Odisha presided over the inaugural session and briefly presented the objective of the Health assembly and how the JSA born and it’s journey from 1999 to till date. He also informed the participants about the activity undertaken by Odisha JSA to make health for all.  Dr. Madan Mohan Pradhan, Deputy Director Health, Government of Odisha the chief speaker of the programme who has been closely associated with Jan Swasthya Aviyan from the beginning requested to gave the keynote address and set the context of the assembly. He spoke about the initial days of public health movement why it came and how people voices need to raised for appropriate health care.  Government both centers and state have been focusing on schemes. They have been forgetting about comprehensive health care to all. NGOs are becoming project oriented. Projects and funds are necessary but it is not that when they don’t have funds withdrawn from the place saying we have no more funds. That’s like suicidal. In that way, NGOs are doing more harm to the people. NOGs are also working vertically they confined within their project and programme. If they haven’t see the health, education, environment, livelihood in an interrelated manner or never raise the voice in the proper manner and proper time then it will not be possible to stand health for all. Health is not confined with 3Ds (Dieses, Doctor, and Drug). NIRAMAYA needn’t considered as free medicine scheme of Government that is comprehensive health. Each people of the state should live with a healthy life physically, mentally and spiritually. To have that we as a group have to raise the felt health need of people before concerned authorities. For that a strong movement is required and for movement evidence is essential. If the free medicine scheme launched and there are sufficient medicines procured and supply we then have to understand why and how the chemists’ shops are grooming. There is the visible and invisible cause behind every outcome. So, if out of pocket expenditure of common men is increasing then we need to realize what happens underneath. For that, we need to study on that point. Its’ may take as one instance. Certainly, there are ‘N’ number of issues we need to work. India has the unique feature of fighting against growing NCD and communicable diseases those are not inclined to go away. So the double burden has the serious impact on the society as a whole. India is in the bottom line of countries investing in health which is merely one percent. And we can’t imagine with meager on percent the dream like health for all.

Tusharkanti Ray senior Public Health Expert told its’ contrary that we have been shuttling between the logic of preventive and curative health care without thinking about the determinants of health. When a small neighboring country can able to give own people the best primary health care and education why not India. WASH, education, road, communication, nutrition, livelihood, environment along with the drugs, doctor, and disease combined form health. So, health can’t think in isolation and we can’t close our eyes to the vicious circle of profit, corruption, exploitations in healthcare sector contributed an increase of poor to poorer population.

Dr. Rashmi Ranjan Satapthy, Joint Director Public Health, in his address told he is coming in a short notice and prior to this occasion. He is the State nodal office or non-communicable disease. Out of pocket expenditure increased in non-communicable diseases. Government is all set to introduce an AAP so that patient can know where the service facility is available. Very shortly population base screening will available at people’s point. TB and other lifestyle diseases will be identified in a early stage and treatment can be start immediately.  The timing and facilities everything can access by the patient. There is a huge information gap. In 22 urban PHCs of doctors, medicines and other services are available but people are keeping coming to Capital Hospital. In that way they are losing time, money in travel and increasing caseload in Capital Hospital also hampered the service. He promised for all king of support to JSA in future.

Dr. Amit Sengupta told health is our right. It should be the country agenda. Health should get the prominent place. Fact is that malnutrition children are getting diabetes and hypertension at a very tender age. Jan Swastha Aviyan is not only isolating from basic facilities like livelihood, food, nutrition, drinking water, cleanliness etc. Man is not a beast and no man like to live in the filthy place if the situation is not forced on them. But our tendency is victim blaming. Illiterate and uneducated people are not idiots. People need to live with dignity. Giving medical services may help to give health 10% but 90% of health depend on health determinants? Government is emphasizing on maternal health and that also begins when a female conceived. What about women health? What about last 20 years before she gets married? What is primary health institution? Where are 24×7 services? The ASHA and Anganwadi workers are the primary caregivers in the rural pocket. Private health service is becoming the part and partial our life. There is a time when doctors were opening the clinic but today anybody can open a hospital. Tractor Company started Escort Hospital. There is no law to restrict. Doctors are nothing but one part of the entire private health system. Mow Health service is purely commercial. In corporate system, Doctors are nothing but servants to fulfill the quota or target given to them in a month by the owner. In India, people are spending money from their pocket from private health care. We are calling it 70:70 paradoxes. 70% of out of pocket money spending in private healthcare and out of that 70% spend on medicines. Treatment is becoming a market policy. The first session came to an end with vote of thanks given by Bijayalaxmi Rautaray.

Second session started with an open house discussion. The representative of different district raised their health issues and sharing the experiences with different field level intervention and solution.

Ashutosh Mishra, from Dhenakanal told the members of Rogi Kalyan Samiti haven’t the knowledge about RKS and most of the members are unaware about the membership in the committee. Huge corruptions are going on of RKS fund at field level. So for better utilization of the fund committee members should be sensitize and capacitate. Chinamayee Pattnaik of Koraput shared, they have a study on adolescent girls. Out of 400 adolescent girls of the age of 11-14, not a single had normal hemoglobin level. Strangely girls living in residential schools are 56% anemic. Where in the red level 39% of girls from residential school are identified them out of school living in villages have 19% in red grade. Why girls are the residential school not only for education but their health should be lookout. Residential schools need to intervention on proper health care to increase the hemoglobin level. They have introduced drumstick plantation among 400 households in association with Horticulture department. The result is very good. People are no more interested to give leaves to others because they are telling our female members needs more so they will no more anemic. Her suggestion was to improve adolescent health intervention is very essential.

The representative from the RARE Mr. Nagi, told whatever government introduced should give regularly. They are giving three months then another three months a gap. It may be sanitary napkin in Khushi programme or Chhatua programme(take home ration). Meghana Sahoo representing the transgender community told nobody is telling about the third gender. They are more discriminated against than a female. Counselor needed to normalize the mental pressure on a transgender. Proper health and sanitation related counseling are needed. In the hospital form, there is no place for transgender. Even the doctor also doesn’t know about the health problem of transgender. One doctor inserted a cathode tube in urine intact of the implanted vagina of a transgender. Within I month two transgender commit suicide and two murdered. What about other. Transgender health should be in the medical education as most of the doctors are unaware about it.

Swapna from Project SWARAJ, Cuttack told in d-addiction center they are unable to keep women and adolescents. Urgently government needs to give separate facilities for women and adolescents. Upendra from TATA trout, Balesore told time is now to give attention and care for the preventive health. GKS is not functional in village level where a gig amount of flaxy fund is unutilized. Bibhu Prasad Sahoo from Ganjam told in IREL plant area 70 people died in kidney disease when 200 patients diagnosed there. Before giving clearance to any plant health impact also analyzed along with social and environmental impact. Health and family welfare department should rename as Health, Hygiene and Family Welfare department.

Alaka Sahho from SEVA organization Berhampur told task force needed for every district to monitor the public facilities. D. Sworupa from SAKAR told emphasized should be for hospital cleanliness and infection control. Bulbul Swain from Surakshya told about acute mental health, gastric and urine problem and govt. should emphasize on it.

Geetanjali Panda from CCWD told for health card City Health officer is not renewing. Where is the book nobody knows? In Insurance card beneficiary name also missed out. There has  a huge corruption in insurance card.  In Chandrasekharpur UPHC most of the free medicines are not available, when patients demand they advice to purchase from outside.

Tapasi Praharaj from AIDWA and panelist of the assembly told whatever facilities available in public facility Jan Swasthya Aviyan should be informed to the community. She also told women health should be more focuse. Usharani Behera, BGVS and panelist told health depends on education, income, culture, food, and nutrition many more that need to address.  Santosh Patro from Oxfam told Right should speak in a right spirit. Accountability standard is there but is it reached? Citizen voices need to strengthen. Grievance redress mechanism is nowhere. Sashikanta Nayak from The Union, Jharkahand told Government is setting the highly ambitious target. All are electorally dividend. Community monitoring is diluted. When there is no such vaccine not yet came how can you eliminate TB. In govt. monitoring, only the quantity target asked in video conferencing. No one bothered about the quality.

In post-lunch session, Bibhuti Bhusan Das Community leader from Khordha shared people are not aware about the facilities available for them and how to access those. They are forced to pay or cheated by the broker. They are innocent and poor. They don’t know the corruption but need immediate health care. When they failed to get anything then no more believe in the government health system. Renubala from CCWD told Saliasahi the largest slum in Bhubaneswar in every household you can witness a dengue patient. They are using private health care. Urban PHC staffs should make people sensitized. Shradhanjali Sahoo from Sahayog told in Municipality Hospital doctor prescribed her for private labs for diagnosis and her grandfather denied for diabetes medicines in free when just now Joint Director Public Health told 4 types’ diabetes medicines are freely available. Anil from Jagatsinghpur told doctor also needs to know what the schemes available are for people.

Banamali from ISRD told child marriage has severe consequences by premature and lbw baby. People coming from remote areas are wandering for support in MKCG Medical College. So help desk need to set up in front of the hospital gate so people can easily get required support. Another woman from Bhubaneswar slum shared now in the capital hospital they are paying user fees. But they have to stand in a queue for the test. Even the security other people ignored which patient needs emergency care. Utkal Keshari Mohapatra from Sahayog told he is a student and witnessed the problem of accessing medicines by the poor people. The government declared schemes but in implementation out of 10 medicines patients are getting 2-3 medicines of low cost. Out of three counters for NIRAMAYA at Bhubaneswar, only one line is for ladies. More ladies counter needed. So, they will not wait for a long time.

The hospital is ours. We have to keep clean our place. Patient, family members are making hospital campus filthy which his very unhealthy and may spread to infection. Along with right people should make aware of their duties to the cleanliness of hospital. Sandip from Bhubaneswar shared when we are telling about river connectivity, road connectivity then why not we are thinking about departmental connectivity. That is very much necessary and then only we ensure health for all. Kalipad Ray from Bhadrak told in his district there are 193 sub-centers. Out of which 90% centers are not functioning. IFA tablet and Vitamin B syrup before expired date destroyed in many places when people are not getting medicines. Sanjit from Laxmipur, Korpaut told health Schemes handbook needed for wide publicity of demand.

Amiya Biswal from USS told about the health budget and with a minimum budget how the quality health will provide to the people. In simple word Basant Nayak from CYSD narrated about health budget. He told that in one year a G.P is getting 50 lakhs untied fund. So, the nearest Block health officials need to support a sarpanch in planning for preventing care in health. Sudarsan Chhotray told in last election peoples manifesto presented to different political parties. Ruling BJD and Congress almost accepted the demands. So, we have to prepare manifest and meet them to make health as their priority area.

Sujata from HRLN told we need to take the campaign in a mission mode. In conditional cash transfer schemes when because of two child norm the poor, the tribal and women vulnerable groups are suffered. It should be universal It’s the right. The third and fourth child has the same right. In last Dr. Amit Sengupta told about the national health assembly and global health assembly. Before end Gouranga Mohapatra discussed about the participation in National Health Assembly and how their raise the state health issues.

At last Sadasib Swain, Secretary CCWD shared about the vulnerable peoples’ food security issues and with his vote of thanks, the Assembly closed.

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