PHA-Exch> PHM in action!: PHM India Manifesto 2009

[Claudio Schuftan]

* *

*PHM India*

*Manifesto 2009*

*A Call to all Political Parties*

(edited)



While India, by many accounts, is poised to take its rightful

place as a leader in the community of nations, the stark reality

that faces a majority of the Indian people cannot be ignored. A

recurring and distressing face of this reality is the unacceptable state of
ill-health

of our people. PHM India believes that healthy living conditions and

access to good quality health care for all citizens are not only basic human

rights, but also essential accompaniments of social and economic
development.

Such an understanding would, in turn, require that *people’s*

*health is given priority as a national political issue. *The current

health policies and their implementation need to be seriously examined

so that new policies can be implemented in the framework of quality

health care for all and access to basic determinants of health as a basic

right. The following core recommendations are made to strengthen and

reorient the health system so as to ensure quality health care for all. We

hope these *recommendations will be incorporated by political parties*

*in their election platforms *for the upcoming general election as

a demonstration of their commitment to public health. PHM India looks
forward to such a commitment from all political forces in the country.

* *

*Peoples Health Manifesto - 2009*

We challenge political parties to:

Take effective measures to achieve the right to health, which includes

the right not only to timely / appropriate quality health care but also to

the underlying socio economic and environmental determinants of

health.

􀂙 Food insecurity and malnutrition are particularly critical factors

currently determining ill health. Serious attention needs to be

paid to the current agricultural crisis. Food security programs should be

universalised with urgency.

􀂙 Ensure 100% availability of safe water without discrimination, in

each village and habitation and 100% access to safe hygienic

toilets in homes, institutions and public places (markets, streets,

bus-stands, railway stations), along with adequate water supply

and proper waste disposal system for sanitary waste.

􀂙 Ensure adequate and safe housing with legal entitlements; assure

equal inheritance and ownership of land and property for

women.

􀂙 There should be a moratorium on genetically modified cropping and import
of GM foods till health concerns are satisfied and the regulatory frameworks

are in place.

*Enactment of a National Health Act*

Enact a National Health Act to guarantee the right to comprehensive,

quality health care at public expense in relevant health institutions

to all, where every one is entitled to the full range of guaranteed, free

health services.

􀂙 The Act must ensure that all persons approaching all clinical

establishments, including private establishments,* *would

enjoy legally enshrined rights including the rights to information

and records, display of rates as relevant, informed consent,

confidentiality, non-discrimination, rational care according

to minimum standards and management guidelines, and

emergency medical care.

􀂙 The Act must ensure the entitlements of the people to key

health determinants including nutrition, clean drinking water and

healthy environmental conditions.

􀂙 The Act must ensure systems and processes for community based

monitoring and mechanisms for redressal at various levels towards

the fulfillment of rights in both public and private settings.



To operationalise the right to comprehensive, quality health care for all as

envisaged in the Act, the following policy measures will also have to be

implemented:

􀂙 Substantial strengthening and expansion of primary as well as

secondary, tertiary, rural and urban health facilities in public sector

as models whose standards should be followed by the private

sector.

􀂙 Regulation and standardization of structures and processes in

the entire private medical sector. A progressively expanding proportion

of private facilities providing standardised, rational care

could be reimbursed through public funds at defined rates, within

the framework of a Universal Healthcare Coverage Scheme.

􀂙 A Universal Healthcare Coverage Scheme to include all sections of

the people given the fact that any scheme targeted to the

poor is implemented poorly. State’s share of contribution should

be 100% for resource-poor families. Rest of the population would

contribute to begin with; this contribution will be progressively

more as we go up the socio-economic ladder. But within 10

years, all Health Care expenses for all people to be financed by

the State.

􀂙 As a key first step towards this Universal coverage, implement a

Universal Social Health Insurance scheme as part of Social security

for all unorganized and organised sector workers, which is

mandatory and offers comprehensive health care coverage, covering

all members, their families with a schedule covering all health

conditions.

􀂙 Increase health care budget from current 1% of GDP to 3%

within 5 years and to 5% in 10 years. This would increase the

share of public funds in health-care expenditure from the current

20% to 60% in 5 years and to 100% in 10 years. Ensure

increase at both the Center and State levels.

*Rural Health Infrastructure and services*

􀂙 Ensure increased allocation and effective expenditure of funds

for PHC.

􀂙 PHC needs to be true to its mandate of strengthening

the public health system through improving infrastructure at all

levels, ensuring adequate staffing, better supply systems and

flexible financing.

􀂙 Take strict action to eradicate corruption in the entire public

health system. Close systemic gaps that allow corruption to proliferate.

􀂙 Expansion of facilities must go hand in hand with substantial improvement

in quality of care. Especially since increased demand

generated for institutional deliveries has not always resulted in
commensurate

increase in quality of services. In fact, in a large number of

instances there may be a deterioration as compared to home

deliveries.

􀂙 Formulate a road map for the creation of 2.5 service providers

per 1000 population as per the recommendation of the WHO by

ensuring sufficiency of training institutions as well as increased

sanctions of facilities and posts.

􀂙 The shortage of trained health personnel needs to be addressed

by augmenting the capacity in the public sector to train all levels

of health personnel – from health workers to doctors. At the

same time, taking note of the effect on deterioration in ethics

and standards of medical practice, all private medical colleges

charging fees in excess of Government colleges should be closed

down and the students should be absorbed in augmented capacities

in the public sector.

􀂙 All health personnel including doctors and health workers

need to be provided promotional avenues, adequate remuneration

and secure employment terms that are not based on short

term contracts.

􀂙 Initiate massive transformation in the governance of health systems

by introducing much greater decentralization of administrative,

financial and technical decision making powers, and establishment

of resource institutions at district and sub district

levels for continuing knowledge and skills upgrading.

􀂙 Increase allocation for drugs per capita. Set up systems and ensure

their effective functioning for transparent procurement of drugs,

equipment, etc.

􀂙 Declare national ban on any kind of private practice by all full

time medical care providers in public health system whether employed

by state or central government.

􀂙 All public – private partnerships (PPP) must be governed by a

regulatory policy framework that protects in particular principles

of equity.

􀂙 Abolish user fees with immediate effect.

􀂙 Ensure services for persons with special health needs - persons

with disabilities, and those requiring mental health care.

􀂙 Ensure a strong political commitment to the process of Community

monitoring and planningso as to increase democracy

in the health care system as well as the social determinants

of health.

􀂙 Expedite setting up and implementation of a National Urban

Health Care System with civil society consultation and participation.

*Drugs / Medicines and Patents*

􀂙 Immediately declare an essential drugs and

consumables list and enforce the use of WHO prescribed list of

medicines in generic forms.

􀂙 Withdraw all irrational and harmful medicines ensuring that medical

care providers adhere to standard treatment procedures and

do not prescribe unreasonable drugs, surgical and diagnostic procedures.

Develop and implement an Ethical Code of marketing

of medicines.

􀂙 Reduce prices of all essential medicines and keep them under

strict price control. Withdraw excise duty from all essential medicines.

􀂙 Revive all public sector medicine and vaccine producing companies

with no transfer of vaccine production to the private sector.

􀂙 Set up of an inter-ministerial mechanism with representation also

from the Ministry of Health that examines all health related patent

applications before they are granted, with a view to weighing

the public health implications of a patent grant.

􀂙 Promote liberal use of the public health safeguards in the Indian

Patent Act to promote access to medicines, including through

issuance of compulsory licenses

*Gender and Health*

􀂙 Abolish all coercive laws, policies and practices that violate the

reproductive and democratic rights of women.

􀂙 Stop coercion in the use of contraception. Make user-controlled

contraceptives available.

􀂙 Guarantee comprehensive, quality health services (preventive,

promotive and curative) for women, that are accessible, accountable,

irrespective of capacity to pay. Special provisions – resources

and implementation- to be made to address health issues specific to women.
For example, access to safe abortion services

􀂙 Assure women of gender-specific health entitlements (maternity

leave, abortion leave, sterilization leave, creches, toilets) in

public and private employment. A national scheme for maternity

entitlements in the informal sector should be introduced.

􀂙 Register all deaths and initiate audits of all maternal deaths.

􀂙 Ensure safety, transparency and accountability in all clinical trials,

and guarantee that the post-trial benefits of research are made

available to women even from marginalized groups. Ensure disclosure

of funding and of potential conflict-of-interest in all clinical

trials, medical research and publications.

􀂙 Make mandatory the inclusion of women’s organizations and

women’s health advocates on ethics committees, from national

to local and institutional level.

􀂙 Recognise violence against women as a public health issue and

ensure provision of necessary services. Ensure prosecution and

conviction of violators.

􀂙 Include the topics of ‘Violence against women’ and ‘sexuality

and gender’ as part medical and paramedical curricula to equip

medical professionals deal in a sensitive manner with survivors of

violence, including domestic violence. Train forensic experts on

the social aspects of sexual assault and rape, collection and retention

of proof in cases of individual or mass sexual violence.

􀂙 Repeal any laws, policies and practices that discriminate on the basis of
sexuality.

*Child Health and Nutrition*

􀂙 A national policy on Child health and nutrition should be formulated

with urgency. This must ensure policies and technical interventions

follow the overall approach of decentralization, self-reliance

and promotion of food security and local economies. A

clear ‘no conflict of interest’ needs to be demonstrated by any

agency that is allowed to work on child health and nutrition

issues.

􀂙 A high-level overseeing mechanism (e.g. empowered steering

committee) should be created to

ensure convergence and accountability in the entire range of

interventions concerned with child nutrition.

A system of crèches must be established progressively.

􀂙 Infant and young child feeding counseling and support should

be recognized as one of the core “services” with a clear budget head.
Special sub-scheme to give appropriate supplementary nutrition to children
in the age group 6 months to 3 years.
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