PHM-Exch> PHM mobilizes claim holders in Maharashtra, India: Lessons can be learned

[Claudio Schuftan]

*PHM-Maharashtra *

*Organises Mass Protest at State Assembly, Nagpur *

*Draws attention to neglected health care policy demands *

* *

The People’s Health Movement coalition in Maharashtra organised a protest
demonstration and ‘sit-in’ on 15th December, 2011 in front of the State
Assembly at Nagpur to press for various key policy demands about health
services in Maharashtra. These demands have been neglected despite PHM’s
repeatedly drawing attention to these demands. About 300 activists from
across Maharashtra participated in the demonstration; the police prevented
them from going all the way. After this, the protestors sat for nearly four
hours while PHM representatives went as a delegation to meet the Health
Minister and State level officials.

The PHM activists had converged in Nagpur from various districts and cities
for the protest. Among the large number of organisations which
participated, many grassroots activists were mobilized by the mass
organizations. Since one major theme of the protest was ‘Patient’s rights’,
many of the activists had tied bandages on their heads and arms,
symbolically representing patients. The protestors carried placards and
raised slogans like “Enact regulation for Patients rights”, “Health care is
our right!”, “Free and adequate medicines must be available in public
hospitals!”, “Stop privatisation of public health services!”, “Guaranteed
health services must be displayed!”, “Ensure health services in urban
areas!”. This was accompanied by singing of songs which called upon the
Health Minister to take action on people’s key health issues.

A small delegation was allowed to proceed to meet the Health Minister.
After considerable wait, the Minister and Health Secretary very briefly met
the delegation, which raised some of the key, long standing PHM demands
related to health policy issues. Unfortunately the Minister gave little
time for discussion and proceeded for another meeting, while the State
level officials responded by largely sidetracking the main issues raised.
The main outcome was an assurance of a detailed meeting with the Minister
on 3rd January 2012 at Mumbai, where the issues could be discussed in
detail. The nature of this ‘encounter’ with those in power signifies that
there is a long struggle ahead before the ‘people’s representatives’
recognise the major issues related to the health of ordinary people in
Maharashtra.

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*Demands of the **PHM-Maharashtra **protest*



*1.     **To protect Patients rights in private hospitals, immediately
enact long pending rules under a pending Act with full provisions for
Patient’s rights**:* Approval to the demand for enacting the Act’s rules
with provisions for patient’s rights is pending since more than last five
years.  After a series of discussions, the Health department had posted
draft rules including *charter of patient’s rights *on their website in
July 2006. Indian Medical Association (IMA) has also supported this
charter. However, three consecutive health ministers could not get time to
sanction its final draft as yet. Hence PHM demands that, to protect the
patient’s rights in private health facilities, the Act’s rules must be
passed including charter of patient’s rights at earliest.

*2.     *List of *guaranteed health services* should be displayed in the
Public Health Facilties (PHF) and these guaranteed health services should
be made available round the clock. Natl Rural Health Mission ‘Framework for
Implementation’ published by Central Ministry of Health in 2005 states that
designated guaranteed health services will be made available in all PHFs by
2011. This has not yet been achieved in Maharashtra.

*3.     **Maharashtra’s medicine procurement and distribution system
requires complete overhaul to overcome the gross shortages of medicines in
Public health facilities:** * Findings of a survey by PHM, published in
November 2010, of certain Primary Health Centres (PHCs) in five districts
showed that out of 69 selected essential medicines that should certainly be
available in all PHCs, on an average 52 % of medicines had zero stock!
Gross shortages would continue till Maharashtra’s system of procurement and
distribution is overhauled. Hence PHM *demands that* the tried and tested,
renowned system of medicine procurement and distribution in a neighboring
state be fully adopted in Maharashtra (with minor modifications if needed)
instead of indulging in half-hearted experiments. When Kerala has adopted
it and other states like Rajasthan, Bihar are in the process, why is
Maharashtra govt. reluctant to go in for an autonomous, transparent
body?The inefficient, wasteful and corrupt medicine procurement and
distribution
system in Maharashtra requires complete overhaul and not half baked, ill
conceived experiments.

*4.     **State monitoring and planning committee should be formed at
without further delay**- *Since 2007, an innovative process of community
based monitoring and planning is being implemented in five districts and
since the current year in 13 districts of Maharashtra. Participatory
monitoring of public health facilities in rural areas is carried out by
members of Monitoring and planning committees at different levels, which
have been formed from village to district levels. Formation of the State
monitoring and planning committee is the further necessary step to ensure
resolution of state level systemic and policy issues, which is however
pending since last two and half years.

Hence PHM demands that, to take forward and broaden the process of
Community monitoring and planning, the *State monitoring and planning
committee must be formed without further delay**. *

*5.     **Adopt and implement a state wide policy to provide health care in
all urban areas* (including smaller towns) by putting in place an
infrastructure for urban health care on a similar basis as rural health
care with reorganization and redistribution of dispensaries, Primary Urban
Health Posts and Urban Family Welfare Centers in accordance with the
population growth, and with enhanced access to people living on the fringes
of the city.

*6.     *Due to a very large number *of vacant posts of doctors and other
staff in Public Health Facilities*, these cannot provide satisfactory
health care to the people. These vacant posts must be filled urgently
through regular recruitments. Overdue improvements should be carried out
urgently in residential quarters, in place of work and in working
conditions, so that the staff can deliver health care to the people
satisfactorily.

*7.     **Halt all direct and indirect* *privatization of Public Health
Facilities**. *Indirect privatisation which consists of increasing the user
fees in PHFs, gross under supply of medicines and other supplies (which
forces people to buy these from private stores) should be halted
immediately. Direct privatisation like handing over radiological services
or laboratory services to the private interests should also be halted
immediately.

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