Glimpses of the action at the Third National 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.
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.
Railway Station– The railway station for Raipur is ” Raipur Junction Station”. On getting down at the Raipur railway station you all have to come to Sarvadharma Hanuman Mandir which is on left side of exit of Platform no.1. NHA voulunteers holding flexi/placard/printout of JSA/NHA will be waiting there to guide you to pre-paid auto/taxi/cab/ola cab that can be taken to reach the place of accommodation. In case of any querry, the contact persons for contacting are Amulya Nidhi- 9425311547/9826774739 , Gargeya- 9948971353.
Airport- At Raipur airport, NHA volunteers will be waiting near the exit of arrival gate with a placard holding flexi/placard/printout of JSA/NHA. And, the volunteers will guide you to pre-paid cab/ola cab that can be taken to reach the place of accommodation. In any case of any queries, contact Alok- 9930911043
Venue of conference:
The main venue of NHA for participants to arrive is Ravindra Manch, Kalibadi Chowk, Raipur. Some of the parallel sessions ( after 11:30 AM everyday) would be happening at Ashirvaad Bhawan and Pastoral house as well.
Distance from Raipur airport- 15 km aprx.
Distance from Raipur railway station- 3 km aprx.
The accommodation for JSA participants is spread across 5 different places. Please find here, the state-wise allocation of accommodation. In addition, the organisers would arrange pickup and drop on the 22nd and 23rd for participants staying in Patidar Bhawan ( as the place is away from Venue of NHA).
Breakfast/ Morning Tea/ Lunch/ Evening Tea/Dinner will be provided at the NHA venue. Food would be provided to participants from the night of 21st September to 24th afternoon.
Tips for travel-
As it might rain, please do carry your rain coat/umbrella etc.
Kindly carry your Blanket, Bedsheet, Soap, toiletries, Odomos, own basic hygiene kit and medical kit with yourself.
Avoid bringing any valuables/expensive if possible.
During travel do not let your state/team go anywhere without your knowledge.
Keep own photo ID (preferred) or piece of paper with basic information like name address and emergency contacts on it, in your pocket.
Looking forward to meeting you at Raipur.
– NHA Organising Team
“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
“Raahe Haque Par Jo Chalogey to Rahogey Zinda,
Zulm ko Gar Zulm Kahogey to Rahogey Zinda”
The 5th State Level People’s Health Assembly by Jan Swasthya Abhiyan Haryana has begun with this revolutionary song by Jatan Natya Kendra Haryana on September 09, 2018 at Rohtak, Haryana as part of preparations and mobilisation towards for NHA-3 Raipur and PHA-4 Savar, Bangladesh. “Time to Make Health and Healthcare a Fundamental Right is Now” was the central slogan of the assembly.
The Assembly have been attended by around 200 elected delegates from more than 25 organisations working on health and social issues in the state of Haryana. This assembly was presided jointly by Dr. R. S. Dahiya, President, Haryana Gyan Vigyan Samiti and Ms. Savita, General Secretary, AIDWA.
State Convener Mr. Satnam Singh have welcomed the delegates and presented the background and perspective of health assembly and the journey of PHM at Global, National and Haryana state level 2000.
Dr. Amit Sengupta, from the National Team of JSA have inaugurated the Assembly. In his inaugural speech Amit have covered the National, International as well the state level issues concerned with health of people. He had discussed how the Government of India is handing over the healthcare facilities to the private sector. How the health services are turning in to a high profitable business. He criticized the target based private health services. How the pro-business and pro-private healthcare schemes & policies have damaged the public healthcare structure. The issues concerning health education, gender and health, strengthening of public health sector, access to medicines, safe drinking water, nutritious food, clean air and a proper space to live have also been covered. He pointed out the need of strengthening of PHM movement across the globe and said that a strong health rights movement is the only option to achieve the goal of Health for All.
Dr. Madhu Nagla, Professor Sociology, MD University Rohtak has spoken on Gender & Health. How the women of this so-called No.1 and developed state are suffering from anaemia and other illnesses. Their working conditions, lack of appropriate education and intervention by government is claiming women and children life. How maximum schemes for women have only limited to the reproductive health. The government policies never account their real health issues and needs.
Dr. Ajay Chhikara (Surgeon) and Dr. Sonia Dahiya (Gynae) have discussed the issues related to implementation of health schemes, availability of health services in government health facilities. Both the doctors have also raised and discussed the challenges faced by the honest doctors and other health workers.
Dr. Dinesh Khosla (Paediatrician), a private practitioner discussed the lack of proper health education. He also pointed out the need of dissemination of scientific information related to health to the masses.
Then all constituent organizations have intervened in the discussion reiterating the need of collective efforts for health rights movement. Subhash-a RTI activist, Surekha & Sunita from ASHA, Sheelawati & Savita from AIDWA, Rishikesh from Viklang Adhikar Manch Haryana, Sandeep Singh from DYFI, Rahul from SAKSHAM Haryana, Kapoor Singh from BNKU, Saroj from MDM Haryana, Sohandass from HGVS/AIPSN, Shesshpal from BGVS, Suresh from MPHE, Shakuntala from Aanganwadi, Veena Malik from Himmat, Ramneek from Saptrang, Vikram from LT association have participated in the discussion. All these people have presented the report of interventions done by their respective organizations in health rights movement as part of JSA Haryana.
The report of last for years activities has been placed before the house by State Convener Satnam Singh. The major activities and campaigns carried out during last four years are:
1. Free Health Clinics (Twice a week) at three locations
2. Health Camps
3. Publication of a Quarterly Magazine named “Health Dialogue”
4. Publication of Booklets, Pamphlets, Brochures on various issues like Anaemia, Fever, Sanitation, Gender and Health, Working Conditions of Health Activists like ASHA.
5. Seminars on various issues like Women & Health (Rohtak 1 Seminar), Food Safety (Jind 2 seminar), Strengthening of Public Health Sector (Hisar 3 seminar).
6. Meeting of various District Core Committees
7. Agitation & Demonstrations for availability of proper facilities like medicines and other services at CHC, PHC level etc.
Dr. R. S. Dahiya, Member State Secretariat of JSA & President Haryana Gyan Vigyan Samiti has concluded the discussion. And proposed the future activities:
1. Formation Village Level Committees (2 Village per District) as a pilot.
2. Publication of Two Posters (Fever, Anaemia), Two Booklets (Women Health, Health Status of Haryana) and One Book comprising of selected articles which have been published in our Magazine in last 9 years.
3. Inclusion of new organisations in the state JSA team.The strike and ongoing movement of different government employees’ associations of Haryana, specially, the MPHE, Nurses, Lab Technicians associations affected the attendance of Assembly.
4. Launch of Agitations for availability of health services (manpower, machines, buildings etc) at all levels.
The Assembly have selected the 45 delegates to participate in NHA-3 to be held at Raipur on 22-23 September 2018.
The Assembly ended with a play named “Ponga Panditon ki Jageh Jel Mein Hai” by Jatan Natya Kendra Haryana.
In the end Ms. Savita, General Secretary of AIDWA, presented the vote thanks on behalf of presidium.
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.
Jan Swasthya Abhiyan (JSA), Bihar organized Health Assembly Bihar-2018 on 13th September 2018 at Bihar Chamber of Commerce, Patna. More than 100 participants from about 60 different organizations have participated in the programme. Ms Priyadarshini Trivedi, Population foundation of India (PFI) welcomes the guest and participants.
Mr Rafay Eajaz Hussain, Save the Children shared the purpose and importance of the health assembly. He said in 1978, at the Alma‐Ata Conference declared “Health for All by the Year 2000” selecting Primary Health Care as the best tool to achieve it. The Alma-Ata declarations were given a silent and reticent burial. It was ensued by developing another international protocol -Millennium Development Goals in 2000 and set a target to achieve these Goals by 2015. Regrettably, these dreams never came true – not the least in India.
Key speaker Dr Abhay Shukla, JSA said that the health, public health and democracy have the deep relationship if we want to create a welfare state. He also emphasized on the slash in the health budget by current government. He shared the nutrition status of country and Bihar. He said recently launched National Health Protection Scheme (NHPS) aims to cover almost half the population with publicly funded health insurance. The scheme is built and formulated around an interpretation of universal health coverage that reduces universal health care to health insurance coverage and that too for a proportion of the population. The private health insurance companies and health care providers are already expecting huge windfalls from NHPS. In parallel to this the government has also launched a programme for the provision of Comprehensive Primary Health Care (CPHC). This programme envisages the strengthening of 1.5 lakh existing sub centres and all primary health centres into Health and Wellness Centres (HWC) that would deliver a broader package of preventive, primitive, curative and rehabilitative services delivered close to communities by health care providers. However, for its successful implementation, the system has to commit to more finances, a regular well trained considerably expanded work force and a very robust continuity of care arrangements with a strengthened secondary and tertiary healthcare. Both these components under the Ayushman Bharat have a significant involvement of the private sector, indicating a shift from public provisioning of health towards privatisation. These developments are altering the policy and governance landscape in India, which would have far reaching implications especially in the area of health and healthcare. He said “we don’t need health card we need health right”.
Dr Shakeel, JSA shared the health charter prepared by JSA Bihar core committee and unanimously it was adopted. He said Government Health Expenditure per person per year in Bihar at paltry Rs 338 is the lowest of the 20 states in the country for which estimate was released by National Health Accounts. Total Health Expenditure per capita in Bihar is RS 2047, out of which Out of Pocket Expenditure is Rs 1685 – constituting whooping 82.3% of Total Health Expenditure. A noteworthy percentage of India’s population is being pushed to BPL category because of health expenditure. According to a study by P. Berman, R. Ahuja, L. Bhandari (2010), 6.2 per cent of India’s population has fallen below the poverty line due to expenses incurred on health. More than 40 per cent of the population has to borrow or sell assets for treatment, according to the 2004 National Sample Survey Organisation. He said “The time to make health and healthcare a fundamental right is Now!”
Dr Nilangini, SAHAJ shared experience of data driven advocacy for gender equality.
Dr Madhumita Chatterjee, PMCH, Mr Pratiush Prakash, OXFAM, Mr Sandip Ojha, C3, Ms Priyadarshini Trivedi, PFI, Mr Saurabh Kumar, Action Aid, Mr Rupesh Kumar, Right to Food, Ms Sushila & Nivedita Jha, Bihar Mahila Samaj and others has also shared their views.