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. 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. 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. 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. 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. 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. 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. 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’. 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,
Draft People’s Health Manifesto, 2018 Read More »