Anna Adhikar Abhiyan (AAA) is a network of about 100 organizations across Maharashtra, campaigning on the right to food security and sovereignty while Jan Arogya Abhiyan(JAA) is the state level campaign platform working for Health rights of people in Maharashtra since over a decade.
AAA and JAA are jointly organizing a protest demonstration on 22nd March, 2013 at Azad Maidan, Mumbai, in collaboration with Anna Adhikar Abhiyan to press for urgent action on important policy demands regarding Health services and Food security in Maharashtra. Around 2000 people from various parts of the state including Right to Food activists, Health rights activists, health professionals and social activists will be participating in this mass protest and ‘Dharana Andolan’ to demand prompt action on various outstanding policy issues.
Jan Arogya Abhiyan
Press release –
Regulate Private Hospitals, Protect Patient’s Rights By
Enacting Maharashtra Specific Regulatory Act!
Stop privatization of public health services, ensure essential medicines in all public facilities,
End private practice by government doctors!
Jan Arogya Abhiyan, the State level campaign platform working for Health rights of people in Maharashtra since over a decade, is organizing a protest demonstration on 22nd March, 2013 at Azad Maidan, Mumbai, in collaboration with Anna Adhikar Abhiyan to press for urgent action on important policy demands regarding Health services and Food security in Maharashtra. Around 2000 people from various parts of the state including Right to Food activists, Health rights activists, health professionals and social activists will be participating in this mass protest and ‘Dharana andolan’ to demand prompt action on various outstanding policy issues. In this press release we are describing the context and demands concerning the Health sector, that are being raised in this joint protest on Food security and Health issues.
Jan Arogya Abhiyan’s main demands
- Adopt a state specific ‘Maharashtra Clinical Establishments Act’ to regulate private hospitals, based on the national act but with inclusion of provisions for protecting Patient’s rights, along with participatory review and grievance redressal mechanisms.
- Stop privatisation of radiological services in Medical college and District hospitals.
- Overcome gross shortage of essential medicines in all public health facilities by implementing the ‘Tamil Nadu model’ in comprehensive manner at earliest.
- Strictly and effectively implement the ban on private practice by Govt. doctors, without diluting this order in any manner.
- Adopt a state specific ‘Maharashtra Clinical Establishments Act’ to regulate private hospitals, with inclusion of provisions for participatory regulation and Patient’s rights.
More than 80% of patients in Maharashtra seek care in private hospitals and clinics, however this sector is today characterized by large scale commercialization and overcharging, lack of effective self regulation by Medical councils, frequent irrational procedures, and violation of patient’s rights. In this context the national ‘Clinical Establishments Act 2010’ is an important step towards standardization of quality and costs of care. However, if Maharashtra government adopts this act in existing form, then due to certain major lacunae in the national act and rules, its implementation would hardly lead to significant benefits for patients or accountability of private hospitals. Rather in absence of accountability mechanisms and participatory forums, it is likely to promote ‘Babu raj’. Hence JAA demands that certain key improvements must be made in the regulatory framework; this is possible only if Maharashtra government adopts its own state specific Clinical Establishment Act, incorporating various positive features of the national act, and adding key provisions to ensure that Patients’ rights are protected and accountability mechanisms are made functional.
Some positive features of the national act, which must be included in the Maharashtra Clinical Establishments Act are:
- 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.
- Charges by hospitals will have to be within the range decided by the government, after following consultative process with stakeholders including representatives from doctors. This will check exorbitant charging currently resorted by many doctors.
- 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.
Jan Arogya Abhiyan welcomes these provisions, and stresses that these must be ensured in the regulatory framework. However we also note that the national act and rules have certain major lacunae such as there is no separate, autonomous structure (and dedicated budget) to ensure implementation of the act; there is no mention of Patient’s rights or any kind of grievance redressal mechanism for patients; there are no district level multi-stakeholder review forums with representation of consumers, patients rights groups or civil society organisations. In this situation, the act is not likely to be effectively implemented, patients’ rights in private hospitals would continue to be sidelined, and since there are hardly any accountability mechanisms regarding the regulatory authority, there is likely to be misuse of powers and corruption, instead of promotion of patients welfare.
Jan Arogya Abhiyan holds that the regulatory framework for Clinical establishments should be accountable and participatory, with involvement of relevant stakeholders; and there should be adequate mechanisms to uphold patient’s rights. If Maharashtra wants to adopt this Central Act, it can do so only in totality, without any significant amendments, due to existing constitutional provisions. However the State government has full constitutional mandate to enact its own health-legislation since health is a state subject. Hence JAA demands the formulation and adoption of a state specific Maharashtra Clinical Establishments Act, based on the current national act but also including provisions for:
- Deployment of designated additional regulatory structure, staff and budget to ensure proper implementation of this act
- Recognition and protection of patients rights, with clear redressal mechanisms for patients in case their rights are violated or defined rates, standards, protocols are not observed in practice
- Multi-stakeholder review bodies at district level, including Patients rights activists and civil society organisations, to ensure accountability and functionality of regulatory authorities
- Stop privatisation of Radiological services in Medical college and District hospitals!
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 BPL cards are supposed to get free services from these privatised facilities, since the genuine poor people are excluded under one pretext or other. Jan Arogya Abhiyan demands that this decision of privatization of radiological services be reversed immediately and corrective steps be taken as mentioned above, so that Public hospitals can provide quality health care services to the people.
- Ensure adequate provision of essential medicines in all public health facilities by implementing the ‘Tamil Nadu model’ in comprehensive manner at earliest
Maharashtra’s medicine procurement and distribution system requires complete overhaul to overcome continued gross shortages of medicines in Public health facilities. The current system of procurement is non-transparent and inefficient hence Jan Arogya Abhiyan demands that the tried and tested, renowned system of medicine procurement and distribution in Tamil Nadu should be 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 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 medicine procurement and distribution system in Maharashtra requires complete overhaul and not half baked, ill conceived experiments.
- Government should strictly and effectively implement the ban on private practice by Public doctors, and should not dilute this order in any manner.
Today one reason for decline in people’s confidence in public health facilities is the frequent absence of doctors. Particularly specialist doctors may be 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 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 Govt. doctors have reportedly demanded 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.
We would like to note that Jan Arogya Abhiyan had presented all these demands to the Health Minister of Maharashtra, during our protest at Nagpur at time of the Assembly session on 19 December 2012, however no concrete action has been taken by the Government so far. Hence we have planned the protest at Mumbai on 22nd March 2013, by means of which we would like to draw attention of the public to these issues, and assert the need for the Government to address these issues promptly.
Dr. Anant Phadke Dr. Suhas Kolhekar Brian Lobo Leni Chaudhuri
(9423531478) (9422986771) (9421549824) (9820639762)
Dr. Satish Gogulwar Bandu Sane Kajal Jain Pramod Nigudkar
(9422123016) (9890359154) (9970231967) (9860287966)
All activists belonging to constituent organisations and networks: Kashtakari Sanghatana, Jan Swasthya Abhiyan – Mumbai, National Alliance for People’s Movements, Mahila Rajsatta Andolan, Bharatiya Mahila Federation, Rationing Kruti Samiti, Movement for Peace and Justice, ASHA Workers’ Union
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