PHM-Exch> India: PHM Maharashtra demonstration to demand Health policy changes in the state

[Claudio Schuftan]

* *

*PHM Maharashtra demonstration *

*to demand Health policy changes in Maharashtra*

* *

Jan Arogya Abhiyan (PHM-Maharashtra), the State level campaign platform
working for health rights of people in Maharashtra since over a decade,
organised a *protest demonstration on 19th December, 2012 in Nagpur *during
anAssembly session to press for action on policy demands about health
services in Maharashtra which have been neglected despite repeatedly
drawing attention to these demands. Over 150 health activists, health
professionals and social activists from across various districts of
Maharashtra participated in this demonstration to demand prompt action on
outstanding health policy issues.

Many of the demonstrators were wearing colourful masks and were shouting
slogans like “stop cheating by private hospitals”,  “private health
services must be regulated”, “Adopt the act for regulation of private
hospitals in Maharashtra”, “stop private practice by government doctors”,
“stop privatisation of public radiological services”, “everyone should get
all medicines free of cost, “everyone should get free treatment” and
“implement a Tamil Nadu type model for medicine procurement in Maharashtra”.



*JAA’s main demands are*

   1. *Adopt a ‘Clinical Establishments Act’ immediately* *to regulate
   private hospitals,* with inclusion of provisions for protecting
   patient’s rights.
   2. Strictly and effectively *implement the ban on private practice by
   Govt. doctors*, without diluting this order in any manner.
   3. *Stop privatisation of radiological services* in the Medical college
   and District hospitals.
   4. *Ensure adequate provision of essential medicines in all public
   health facilities* by implementing the ‘Tamil Nadu model’ earliest.





*1. *More than 90% of doctors in Maharashtra practice in the private
sector, however this sector is today characterized by large scale
commercialization, lack of effective self regulation by medical councils,
rising costs of health care and frequent violation of patients rights. In
this context, there is a long overdue need for standardization of quality
and costs of care through social regulation. *Adoption of the
national* ‘*Clinical
Establishments Act’ in Maharashtra with certain improvements *can be a key
step in direction of this much-needed regulation. *Some* *positive features
of this act are*:

A) All private hospitals and clinical establishments (including labs,
imaging centres) will have to adopt Standard Treatment Guidelines, and will
need to maintain some minimum standards. This would help protect patients
from irrational, exploitative treatment and from substandard facilities.

B)  Charges by hospitals will have to be kept within the range decided by
the government, after following a consultative process with various  claim
holders. This will prevent exorbitant charging resorted by some doctors.

C)  Clinical establishments will have to display charges for some of the
typical main items like consulting charges, room charges, etc. This will
help patients to know the affordability of each hospital, enabling them to
choose hospitals they can afford and have idea in advance of the expected
charges.



JAA welcomes these provisions with the caveat that the *regulatory process
should be more participatory involving relevant  claim holders; and there
should be adequate mechanism to uphold patient's rights*. Hence, along with
adoption of this act, JAA demands:

ü   Deployment of designated additional regulatory structure and staff to
effectively implement this act

ü   Work on details of the process of regulation in a way that allows
involvement of relevant claim holders including patients rights activists

ü   Protect the human rights of the patients and the legitimate interests
of small hospitals and general practitioners.





*2. *Today, one reason for the decline in people’s confidence in public
health facilities is the frequent absence of doctors. Particularly
specialist doctors may often be absent since they are busy in their private
practice, even as they draw a full salary from the Government! In this
context, the *State health department has recently taken a positive
decision to ban all private practice by Govt. doctors, along with providing
a 35% additional Non-practicing allowance (NPA).  *However due to weak
implementation of this order, several Govt. doctors continue their private
practice. Hence JAA demands strict implementation of this order across the
state.



Certain doctors are demanding an ‘option’ of not accepting NPA and
continuing their private practice, and pressure is being brought on the
Health Department to allow such relaxation. *JAA demands that the Health
Department should not give in to any such pressures, and should not dilute
the ban on private practice or reconsider this key decision.*

* *



*3. *The *decision of the Maharashtra Government to privatise radiological
services in Medical college and District hospitals is retrogressive and
unnecessary*. Any existing deficiencies in these services should be
remedied through appropriate steps and policy decisions; privatisation is
not the answer. Continued provision of X-ray and CT scan facilities in
district hospitals and above should not be a problem, since radiologists
and other technical human power is available in such cities. If no
radiologist is available to work full time in these district hospitals and
medical college hospitals, some radiologists can be hired on a part time
basis. To effect such arrangement of in-sourcing of medical experts,
the *professional
and administrative environment in these Public hospitals would have to be
improved considerably by removing bureaucratic obstacles and political
interference*. The general experience has been that *privatisation of
healthcare services increases denial of healthcare services to the poor*,
even if those with waiver cards are supposed to get free services from
these privatised facilities, since the genuine poor people are mostly
excluded under one pretext or another. JAA demands that this *decision of
privatization of radiological services be reversed and corrective steps be
taken as mentioned above* so that Public hospitals can provide quality
health care services to the people.



*4. Maharashtra’s medicine procurement and distribution system requires a
complete overhaul to overcome continued gross shortages of medicines in
public health facilities**.* The current system of procurement is
non-transparent and inefficient. Hence, *JAA demands that the tried and
tested, renowned system of medicine procurement and distribution in Tamil
Nadu fully adopted in Maharashtra *(with minor modifications if needed),
instead of indulging in half-hearted and inadequate initiatives. When
states like Kerala and Rajasthan have effectively adopted this model, and
other states are in the process, why is the Maharashtra Govt. reluctant to
go in for an autonomous, transparent procurement body, and pass-book based
demand driven distribution system? The *inefficient, wasteful and corrupt
medicines procurement and distribution system in Maharashtra requires a
complete overhaul* and not half baked, ill conceived experiments.




After the demonstration, about half a dozen JAA activists was called to
meet the Health Minister of Maharashtra with whom a meeting took place for
about 45 minutes. The Health Minister assured that the Clinical
Establishments Act would be adopted in the state, and based on a suggestion
by JAA activists, assured that a multi-stakeholder state level consultation
on this could be organised soon. He stated that private practice by
government doctors would be strictly checked and asked JAA activists to
communicate names of any such doctors found to be still practicing
privately despite the ban. He agreed that local JAA activists would be
involved while conducting  enquiries of such doctors.

On the issue of implementing the Tamil Nadu type system for procurement and
distribution of medicines, he stated that ‘Maharashtra is implementing a
system even better than Tamil Nadu’ which was, of course, challenged by JAA
activists who pointed out the continued gross shortages of essential
medicines in PHC centres across the state. While on other issues he at
least accepted some validity of the points made by JAA activists, the
Minister defended the decision to privatize radiological services in
District hospitals across the state and expressed inability to understand
JAA’s opposition to this move. However, since JAA representatives
persistently pointed out the likelihood of denial of free services to poor
patients, he agreed to conducting a participatory review of this decision
after six months. The meeting concluded with an assurance from the Minister
of organizing follow up meetings towards resolving such issues,
particularly implementation of regulation of private medical services in
the state.
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