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PHM Maharashtra demonstration to demand Health policy changes in the state

Date: 
3 Jan 2013

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 Nagpurduring 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:

  • Deployment of designated additional regulatory structure and staff to effectively implement this act
  • Work on details of the process of regulation in a way that allows involvement of relevant claim holders including patients rights activists
  • 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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