Jan Swasthya Abhiyan Rajasthan held its meeting on 27th February 2018 at Vinobha Gyan Mandir in Jaipur after a gap of three months. It was attended by about 70 health activists, public health experts, academicians, lawyers and some PRI members from across the state. At the meeting, the state health budget for the financial year 2018-19 and the government’s increasing inclination towards privatization of public health facilities was discussed in detail. The members reiterated the concern that public health facilities in the state, and especially preventive and primary health care services, have for long been in a state of neglect and that there is an urgent need for adequate budgets to revamp and expand existing health and nutrition related services. The Abhiyan also expressed concern over increasing dependence of the state on health insurance scheme and PPP of public health facilities and cautioned the state that while this approach to health care may attract patients to seek treatment, but it would do little to reduce out of pocket expenditure on health or improve indicators such as maternal mortality, infant mortality, anemia, malnutrition etc.
In the meeting it was highlighted that while the overall state health budget has shown an increase in monetary terms from 10800 crores (RE) in 2017-18 to about 12813 crores in the current budget, yet in terms of state GDP it’s not any different from the previous budget. Abhiyan has for long been demanding that the state health budget should be increased to at least 2.5% of the state’s GDP, while it has been hovering at close to 1% since quite some years, which is grossly inadequate to deliver quality health care services to a population of 7 crores. What is astonishing is that this fiscal year the budget for NRHM has seen a steep decline from 2158.62 crores in revised budget estimates of previous year to 1788.61 crores in the current announcements. This would certainly mean that preventive and promotive health care services in rural and deprived areas would evident huge setback.
At the meeting the issue around Bhamashah Swasthya Beema Yojana was also talked about. Many members shared cases where the patients faced innumerable problems while seeking treatment due to inability to produce the card or ill-treatment by the hospital staff. Some members also shared their experiences of visiting the PHCs that have been handed over to private bodies. The people of the village of the PHCs that are now running on PPP mode are protesting against this step. More PILs have been filed at the high court as well. And a stay order has been given by the court. The reason behind this protest is that these PHCs are not functioning well after they have been handed over to private bodies.
Participants voiced concern and shared instances about the slackness in the implementation of free medicines and diagnostics schemes of the state. It was mentioned that in the absence of effective monitoring, many doctors prescribe and push patients to buy medicines which are not included in the list of free medicines. Need was expressed that the campaign in support of free medicines and diagnostics should be intensified.
At the meeting another issue discussed was about the poor health, nutrition and pre-primary education of children in the age range of 3-6 years currently forced to either get admitted in private schools or attend highly ill equipped aganwaris. After intense discussions, JSA Rajasthan decided to develop a position paper around the issue that admission of children in government schools should begin at age three instead of age six. Nursery trained teachers are recruited for these schools and Anganwadis should intensively work for pregnant & lactating women and children up to three years.
In conclusion, there was a consensus that there should be public engagement through discussions/dialogues/hearings around the issues discussed during the day. It was also decided that the pamphlet on free medicines and free diagnostics must be distributed as widely as possible to clear the myth among service provider and common citizens around medicines supplied free. It was also reported that GO was issued for reconstitution of drugs and therapeutic committees at district and block levels in Pratapgarh and Karauli districts with representatives of Prayas as members. It was also decided that in the future meetings, wherever possible, members would carry documentary evidences in support of the instances they shar