State Health Assembly – Bhopal 30th August 2018
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 …