discussing the national health bill
DESCRIPTION
Discussing the National Health Bill. Need to address both text and context – towards a comprehensive campaign strategy. Key questions. What kind of political will exists for this bill? What is today’s political economy context? - PowerPoint PPT PresentationTRANSCRIPT
Discussing the National Health Bill
Need to address both text and context – towards a comprehensive campaign strategy
Key questions What kind of political will exists for this bill? What is today’s
political economy context? What are the core objectives we want to achieve through the
bill itself and how do we reshape the bill for this? Which changes and modifications must be made in the bill? Which other legislations need to be influenced to complement
provisions in the bill? Which core elements of the bill are positive and need to be protected
from dilution or distortion? What kind of Health system and Social system changes are
required to make the act operational, without which it would remain on paper?
What kind of socio-political process and campaign is required to ensure all the above are addressed in a pro-people manner?
Where is the ‘will for the bill’? Contradictions of ‘Globalisation with a human face’ –
continuing onslaught of corporate globalisation accompanied by some social legislation and programmes (NREGA, Forest rights act; problems with Rt. to education and emerging food security act)
Strong official tendencies to strengthen PPPs, or to continue limited ‘safety net’ approach to public health system with targeting and user fees
In this context Govt. political will for right to universal, comprehensive free health care with major regulation of private sector appears weak – this will must be built from below through social and political mobilisation if it is to be achieved
Core objectives we want to achieve through the act Legal and operational entitlement to comprehensive,
universal access to free health care Comprehensive set of Health rights and patients
rights to be enjoyed by all Additional entitlements and rights for various
sections with special health needs or conditions Health system obligation to activate and ensure
provision of social determinants of health, to ensure basic rights to food and nutrition, water, sanitation, environmental conditions etc.
Major modifications required in Bill Section 3c. – Universal access to free health
care is a comprehensive entitlement, within which there should be no prioritisation. Based on this foundation of universal access, add additional services and entitlements for sections with special needs.
No scope for ambiguity which may allow any form of ‘targeting’ esp. based on BPL
Major modifications required in Bill Universal Free health care implies no user fees in the
public health system which must be made explicit Dominant form of ‘PPPs’ need to be explicitly
rejected – instead social obligations of private providers and utilising private resources for public health strengthening based on overarching principles e.g. no reduction in responsibility of public system; all publicly funded services would be regarded as public services meeting same norms for accountability, standards, employees and patients rights etc.
Major modifications required in Bill Section specifying population based norms for
public health facilities ensuring no dilution in their role
Section specifying no privatisation of public health facilities or dilution of public health obligation
Section on ‘Certificate of need’ for all new private providers be added to restrict their proliferation
Mechanisms for ensuring rationality of care in both public and private health sectors
Major section on obligations of Health departments in activating and ensuring various key health determinants
Major modifications required in Bill Provision of minimum proportion of budget to be
allocated for Public health at National, State and Local body levels
Separate section on Urban health taking into account specificities (outreach coverage, homeless and migrant people) and different population based norms
Separate section on Work and health as a key determinant as well as area of services and social protection
Core positive elements in the Bill to be protected or strengthened Overarching Rights based framework Entire set of Health rights which apply across
Public and private health systems Comprehensive scope encompassing health
care as well as determinants of health Monitoring (incl. community monitoring) and
redressal mechanisms
Other legislations which need to need to be brought in line with NH act Clinical establishments registration act Factories act, Workmens compensation act,
ESI act, Mines act etc. Pharmaceuticals act and regulations Emerging food security act Environment protection act etc.
Which complementary health system changes are required?In the Public health system Abolition of user fees in all public health facilities (presently
have been more or less universalized through Rogi Kalyan Samitis) and removal of all types of targeting (esp. based on ‘BPL’ criterion) which presently exclude any users
Expansion of Public health facilities in both rural and urban areas, bringing these to meet adequate population based coverage norms
Expansion and assured delivery of ‘Guaranteed health services’ at all levels, making these comprehensive, and converting these into assured entitlements, which can be effectively claimed with the help of specified mechanisms
Which complementary health system changes are required?Concerning private medical sector Comprehensive legal and operational regulation of the entire
private medical sector, including health care process standards and patients rights, rational treatment guidelines; effective community based monitoring and redressal mechanisms to ensure that these are observed
Organising a system for social / public management of the mandated free beds for ‘less affording’ patients in Trust hospitals, ensuring that these large number of beds are actually regularly provided free of charge; this would be a step towards socialization of large scale health care resources in Trust hospitals
Certificate of need provision to prevent proliferation of private hospitals in overserved areas
Developing a well defined and realistic plan for progressive socialization and rationalization of health care resources in the private medical sector
Where would political will come from? Given weak and problematic nature of Govt. will, we
need to build broadest possible social and political mobilisation in favour of a comprehensive Health act and health system changes
Three pronged strategy required: Large scale discussion and mobilisation related to
modifications and pushing for a modified, strengthened act
Proposing ‘People’s Health Policy’ containing related policy measures
National ‘Right to health – Universal access to health care campaign’
Towards a ‘Right to Health’campaign Need to significantly broaden JSA and involve large number of
organisations working in the health sector in existing and new states
Need to interact with other health sector specific networks such as those working on mental health, HIV/AIDS, child health etc.
Develop ‘social sector alliance’ with linkages to Right to Food campaign, Water rights networks, Environmental networks, Trade unions and organisations working with unorganised sector workers
Interaction with progressive political forces to ensure their proactive political action
A massive social-political mobilisation is required to make a genuine ‘Right to health’ Act a reality!