PHM-Exch> PHM-Maharashtra state convention on 5-6 March 2011

[Claudio Schuftan]

*PHM-Maharashtra (Jan Arogya Abhiyan) state convention on 5-6 March 2011 *

*Critique of state health policies; decision to launch campaigns and
strengthen network.***



Marking ten years of activities by the health movement coalition,
PHM-Maharashtra state, India organised a *State Health rights convention* on
5-6 March 2011 in Pune. Over 160 representatives from health sector and
social organisations drawn from 27 districts across Maharashtra attended the
convention.



The convention was inaugurated on 5th March morning with a collective song
‘Let the right to health for all, be attained and sustained’.



This was followed by a brief introduction given by Abhay Shukla, tracing the
evolution of the People’s Health movement in the state over the last ten
years (2000 to 2010), various phases of activities and campaigns, the
modified situation created by launching of National Rural Health Mission
(NRHM), and the current challenges in the health sector as well as within
the movement. It was shared that the idea of a state level convention had
emerged from the participatory review last year, where the need for
organizational strengthening and revitalization of Jan Arogya Abhiyan (JAA)
had been stressed.



Subsequently, four major thematic sessions were conducted on the themes
identified for the convention: Right to Rural health services, Right to
Urban health services, Patients rights and regulation in private and trust
hospitals, and Right to Social determinants of health.



The session on *Rural health services* outlined key policy level issues and
deficiencies concerning the rural public health system in Maharashtra,
especially since launching of NRHM in 2005. These included continued low
state government health budget, lack of guaranteed health services and
medicines, poor support to staff, lack of inter-departmental coordination,
and urgent need to form the state level monitoring committee as a part of
community based monitoring activity under NRHM. Organisation of Community
based monitoring of health services was noted as a positive development
which had contributed to improvements in services in concerned areas, but
was tending to draw away energies of health activists from movement
activities, a situation that needed to be changed.



It was then suggested some key campaign strategies to be adopted by JAA such
as large scale community assessment and dialogue in campaign mode to demand
guaranteed health services; demanding availability of essential medicines in
public facilities along with suggesting implementation of a Tamil Nadu type
procurement and distribution system; need to reverse recent hike in user
fees and to abolish such fees at all levels; stressing need to appoint staff
on a regular basis rather than contractual appointments leading to better
retention of staff and less corruption; regular honorarium and medicines to
comm. health workers (ASHAs) along with their providing basic care at
village level; social audit of utilisation of Village untied fund at all
levels, and demand for generalization of community based monitoring. About
twenty ASHA-activists from the Maharashtra state ASHA workers union had
attended the convention, and their representatives emphasised the need to
ensure improved support and working conditions for ASHAs.





The next session on *Urban health services* outlined the challenges given
the context that Maharashtra has numerically the largest urban population in
the country, with about 45% people living in cities and towns. These include
lack of primary health systems, major deficiency in number of urban health
posts, lack of clearly shared responsibility and coordination between urban
local bodies and state governments, and recent hike in user fees in Medical
college hospitals. The poor plight of health services in smaller towns,
which often lack even basic health care institutions was emphasised. Then
the wide range of vulnerable and excluded groups in urban areas was
mentioned – including street children, migrant and unorganised sector
workers, homeless people, people living in slums including ‘unauthorised’
settlements, and people living in institutions. The need for strengthening
the Municipal corporation health system was stressed and some campaign areas
were suggested such as initiating community monitoring of health services in
urban context, campaign for withdrawal of fee hike in public hospitals and
suggesting special provisions for vulnerable groups to be included in the
Urban health mission.











The further session on *Patients rights and regulation of Private and trust
hospitals,* began by outlining the current situation of total lack of
regulation, extremely weak political will for regulation, and official
tendency towards ‘inspector raj’ rather than participatory regulation, vocal
private doctor’s lobby and growing corporatisation of the private medical
sector. At the same time the new opportunities created by growing popular
interest in patients’ rights, High court order to ensure free beds for poor
patients in Trust hospitals, and central ‘Clinical establishments regulation
act’ were mentioned. Experiences were shared of the ‘Patients rights forum’
formed in a smaller town, where doctors have been effectively brought into
dialogue around issues of patients rights. A union worker from Pune shared
experiences of how union activists have been fighting for the right of woman
waste-pickers with insurance cards to receive free care in large Trust
hospitals, and despite resistance from such hospitals have managed to obtain
free care in several cases, which could become an example for others.

The need to press for implementation of the High court order on free beds in
trust hospitals, to build a large scale campaign including possible legal
intervention on legally enshrining Patients rights under existing rules, and
the suggestion to form Patients rights forums or ‘Patient-doctor dialogue
committees’ across the state were shared as possible further steps.



In the next session on *Social determinants of Health*, an overview was
given about the current status of food security and PDS, anganwadi services,
drinking water, environmental conditions, education, and social exclusion as
key determinants which were affecting people’s health. She stressed the
political nature of the demands and need for health activists to actively
support and engage with campaigns and struggles on this spectrum of issues.
Some concrete campaign actions were suggested such as organising
multi-sector meetings at block or district level through collaboration of
various concerned networks, and the need for multi-sectoral community
monitoring of all social services. The issue of health impact of GM foods
was raised and some participants expressed the need to include it in JAA’s
agenda.



Following these thematic plenary sessions, the delegates divided into four
sub-groups according to the already discussed themes, to work out specific
campaign strategies and plans. In these groups, based on already suggested
actions, district wise or city wise activists stated the activities they
would take up in their particular areas. In addition, a few specific areas
were identified to be taken up by the entire coalition as state level
campaigns.



On 6th March morning, representatives from each sub-group presented the key
campaign actions that had been decided upon in their group.

Key campaign decisions included:



·         Launching a State level signature campaign addressed to Chief
Minister demanding:

o      Urgent *reversal of sharp hike in user fees* at Medical college
hospitals, moving towards abolition of user fees in all public health
facilities

o      Basic overhaul in medicine procurement and distribution policy to
ensure *guaranteed availability of all essential medicines* in all public
health facilities



The Marathi text of the signature campaign letter was read out and all
present delegates signed this letter, which was subsequently sent to the CM.
It was further decided that large numbers of signatures of Village health
committee members, Panchayat representatives, CBM committee members and
representatives of NGOs and Community based organisations would be obtained
in the coming month and would be collected in each district and *would be
sent to the Chief Minister and** released to media across the state on
7thApril – Health rights day
.*



·         In parallel, a campaign was planned to demand *immediate adoption
of rules for the Bombay Nursing Homes Registration Act to ensure protection
of Patient’s rights* in private hospitals. Since successive Chief Ministers,
including the current Minister, have not been able to sign on the pending
rules to finalise these (five years would be completed in April this year),
each JAA organisation would symbolically send the campaign letter along with
a pen to the Minister, urging him to sign on the rules with provisions for
protection of Patients’ rights. Thus scores of pens would be sent to the
Health Minister from across the state, and this campaign would be publicized
in the media. Along with this, appropriate legal action to ensure passing of
the rules would also be seriously explored.



·         Based on the response from the State government on various issues,
a meeting of JAA representatives with the Chief Minister would be sought in
May to communicate the entire range of demands and to press for action on
the issues which have been raised in campaign mode.



·         Various organisations working in rural areas (in at least a dozen
districts) would carry out monitoring of public health facilities in
campaign mode and wherever possible, would organise local dialogue or mass
actions on health rights. Similarly, JAA groups working in 12 cities / towns
across the state would carry out assessments of urban health services and
would publicise the need for a comprehensive urban health system.









Following the adoption of these campaign decisions by the convention, a
presentation was made on need for a *‘System for universal access to health
care’*, that outlined the current situation of predominant private sector
where vast majority of doctors are located, and the need to regulate and
bring under public management a section of private services to ensure access
to health care for all. Key issues raised in the recent Medico Friend Circle
annual meet, the need to ensure that strengthened and expanded public health
services would be at the core of any such system, and the threat of current
outsourcing type ‘PPPs’ which are siphoning off public funds to private
providers without any larger framework of regulation, rationalisation of
care, social planning or accountability were stressed. The overall direction
of a publicly managed and funded universal access system based on
strengthening the public health system, and public regulation and
socialization of a section of the private medical sector, was emphasised.
Given the need for detailed discussion on this large and complex topic, it
was suggested that JAA would organise a separate workshop for activists on
this issue where all aspects could be deliberated upon in detail.



In the final session on organizational issues, the need for strengthening of
JAA as a campaign network was emphasized. Many suggestions were discussed
and the need for organized district level JAA units was strongly raised.
Some key decisions were as follows-

·       Processes would be carried out to form District level JAA units in
most districts of Maharashtra in the next two months. Discussing district by
district, activists from each of the concerned 27 districts who were present
took up responsibilities to form such units. In some districts, where
presently only one organisation is involved in JAA, they would act as
‘contact persons’ and would contact further organisations to help from a
district unit.

·       Regional level co-conveners would be finalised during regional level
JAA meetings in next three months.

·       The State coordination committee was expanded. Besides the current
members (existing regional convenors), representatives from various state
level networks were incorporated in the state level committee. New regional
co-convenors would be included in the coordination committee.

·       The State level committee would meet on a six monthly basis. The
next meeting would be held in July 2011 at Nagpur or Pune.

·       State level JAA conventions would be organized periodically.

·       Updated booklets on the People’s Health Charter would be prepared in
Marathi, Hindi and English.

·       Specific campaign material especially on urban health services and
provision of free beds in charitable trust hospitals would be developed for
wide circulation among JAA activists.



The accounts of expenditure and donations related to the JAA convention were
shared with all participants; the entire expenditure for this large
convention could be met through small organizational contributions and
individual donations without any institutional funding.



The convention was concluded with the collective song ‘Health is our Right -
all of us together will obtain it’!’.
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