MSC Memorandum

 
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Memorandum

MSC/CC.Policy /E-2015/1 5 May 2015
Sri J. P. Nadda
Honb’le Minister-in-Charge
Ministry of Health & Family Welfare
Government of India
New Delhi 110011.
Sub: Memorandum on the National Health Policy 2015 Draft, NHM – UHC – Health Insurance and other health policy matters; and your intervention thereof
Sir,
We submit to you on behalf of the concerned section of the citizens of the country at large, and the medical profession in particular upon the sorry plight of the people’s health in most sections of our wide country, and the unfortunate trick being played upon them in this issue.
Medical Service Centre is a national level socio-medical voluntary organisation working since 1977, comprising of doctors to grassroots level health workers of all systems of medical practice in India. It has been the mission of our organization since the past three decades and a half, to stand by the people in times of disaster, distress and deprivation rendering voluntary services during disasters. We are also taking part in raising health consciousness of the people, setting up regular free medical & health check up camps for the needy, inculcating medical ethics as well as fighting for right to health of the people and opposing any anti people health policies & measures.
The 1st NHP which was instated by the Congress (I) Government in 1982-83 had heralded in the concept of privatisation of health services
The 2nd NHP formulated by the BJP led-NDA government in 2002 opened the floodgate of privatisation-commercialisation of health and furthered the same trend.
NRHM – PPP – UHC projects and reports initiated by the subsequent Congress (I)-led UPA Government actively encouraged the entry of domestic and foreign corporate houses in the health sector.
NHP 2015 Draft, 3rd NHP: Although the Ministry has displayed the Draft in its website, but nowhere it mentioned who authored or composed it. Before finalising the Draft the Ministry should hold state/zonal level discussions/debates on the subject and formulate an Expert Committee/Health Commission to give the Draft a final shape taking representatives of sound standing on the matter -covering all streams of medical practices and all categories of health personnel.
In this Draft Policy by the present BJP Government, not only is there no time commitment to increase the health budget, actually the budget allocation for Health & Family Welfare has been slashed down by 20%.
Universal Health Coverage (UHC) links health entirely to insurance by introducing ‘Health Entitlement Card’ (HETC). We cannot but differ that insurance coverage of health is not at
all right to health of the people! Giving extraordinary emphasis on private health facilities for ensuring secondary & tertiary health care of the people, the plan seems to be to directly assist private health & insurance industry for their sustenance & growth by ensuring the patient flow and superprofit of private hospitals against payment of public money. With NHP 2015 Draft, the full circle of privatization-commercialization and commodification of health will be complete.
As per the present infrastructure and manpower availability India has reached only 50% of its requirement and falls far behind even of Indian Public Health Standard (IPHS) in catering to health care delivery services through govt. facilities.
Preventive & promotive aspects of health care, different national disease control programme, immunizations are built on the fundamentals of preventive health care on the anvil of modern scientific medicine; it cannot be just replaced by AYUSH. To manage scientifically it should get the leadership at least of a MBBS doctor (as the ‘Basic Doctor’ defined by Bhore Committee) having scientific concept of disease-host-environment, where AYUSH doctors and other workers will be other important member of the integrated team. Primary health care practice based on AYUSH is a different entity, which need to be developed. We do not agree with this proposal also on regards to cross prescription. We need and recommend proper evaluation, research, utilization and scientific integration of AYUSH.
Health Manpower Norms: While putting responsibility of large variety of health activity upon ASHA, the Government but has not arranged adequate training nor appointed them as permanent health worker. Neither did the draft plan proper utilization of unqualified village practitioners. They could efficiently fulfill the need of innovative health cadres to ensure rural health care services if imparted rational training and employed as permanent health workers.
Medical Education: The Draft virtually declared medical education as mere commodity. Already medical ethics as a part of social ethics has been eroded deeply with the fall of standard of medical education. GNM should not be abolished, but run by govt. institutions as per population requirement. BSc Nursing & further studies have to be conducted merit-basis in govt. institutions, not self financing & private institutions. Capitation fee in education has to be done away with, and merit can be the only criteria. Further commodification of Medical education will practically destroy the noble ethos of medical ethics.
On drugs and medical equipments: Govt. needs to institute laws and statutory bodies to control and compel manufacturers to produce adequate quality and quantity of generic medicines including National List of Essential Medicines (NLEM). Public Sectors Undertakings (PSU) in pharmaceutical industry rendered sick and withering by the lethal effect of globalisation-liberalisation-privatisation, and gradual encroachment on DPCOs have to be reversed. Health can never be achieved with such a dismal drug production-supply-price control and quality control scenario of the country. Draft Health Policy is silent on this very essential sector. Not only medicine, Govt. should deal public sector manufacturing units of medical equipments, diagnostic instruments, appliances, so that they can be given at affordable and cheaper cost.
BACKGROUND PAPER
1. Introduction
We submit to you on behalf of the concerned section of the citizens of the country at large, and the medical profession in particular upon the sorry plight of the people’s health in most sections of our wide country, and the unfortunate trick being played upon them in this issue.
Medical Service Centre is a national level socio-medical voluntary organisation working in the field of health since 1977, comprising of doctors to grassroot level health workers of all systems of medical practice in India. It has been the mission of our organization since the past three decades and a half, particularly following the Supercyclone Orissa 1999, Destructive Earthquake Gujarat 2001, Devastating Tsunami-ravaged Tamilnadu-Andaman & Nicobar-Kerala in the 2004-5, Devastating Cyclone AILA in 2009 and Floods in Assam-Bihar-Bengal-Gujarat-Maharashtra 1978, 2000 & again in 2004, 06, 07, 08, Kosi River Flood 2008, through a year in the Uttarakhand Disaster 2013 (www.facebook.com/uttarakhandreliefactivity), Jammu & Kashmir Flood 2014 (www.facebook.com/kashmirreliefactivity), presently in North Bihar & Nepal following the killer Himalayan Earthquake, to stand by the people in times of disaster, distress and deprivation rendering voluntary services during disasters. We are also taking part in raising health consciousness of the people, setting up regular free medical & health check up camps for the needy, inculcating medical ethics as well as fighting for right to health of the people and opposing any anti people health policies & measures.
2. The direction of the National Health Policies
2.1 The 1st NHP which was instated by the Congress (I) Government in 1982-83 had heralded the concept of privatisation of health services, “… with a view to reducing governmental expenditure and fully utilizing untapped resources, planned programmes may be devised … to encourage the establishment of practice by private medical professionals, increased investment by non-governmental agencies establishing curative centres” [Art. 8.7]. Acts like CPA ’86 pushed out the service-motive and relationship in health care, and instated commercial relationship and commodification. This was also a first time an official policy indicated in a direction of withdrawal of government from responsibility of caring for people’s health in a welfare state that India was, at least in declaration.
Superstitions were allowed to be institutionalized, in the name of preserving traditions, possibly keeping an eye on the vote bank, instead of practicing science and rationality.
2.2 The 2nd NHP formulated by the BJP led-NDA government in 2002 highlighted problems in orientation of the previous policy and spoke on the contrary. Yet it opened the floodgate of privatisation-commercialisation of health and furthered the same trend. Its plea was “… considering the economic restructuring underway in the country and over the globe in the last decade, the changing role of the private sector in providing health care will also have to be addressed in this policy. … Also the private sector contributes significantly to secondary level care and some tertiary care.”[Clause 2.16.1]
2.3 NRHM – PPP – UHC projects and reports initiated by the subsequent Congress (I)-led UPA Government actively encouraged the entry of domestic and foreign corporate houses in the health sector. The NRHM document in the chapter on Health financing Mechanism championed the cause of privatisation-commercialisation of health: “…progressively the District Health Missions to move towards paying hospitals for services by way of reimbursement, on the principle of – money follows the patient.” The budgetary allocation was squeezed to hover around a paltry 1% of GDP.
2.4.1 NHP 2015 Draft, 3rd NHP: Although the Ministry has displayed the draft in its website, but nowhere it mentioned who authored or composed it. before finalizing the draft the Ministry should hold State/Zonal level discussions/debates on the subject and formulate an Expert committee/Health commission to give the Draft a final shape taking representatives of sound standing on the matter -covering all streams of Medical practices and all categories of health personnel. In this draft policy by the present BJP Government, though it has been acknowledged that public health expenditure of the country is the key to improve its health parameters as well as comprehensive health care services, it has finally accepted a maximum of 2.5% of GDP for health sector as public health expenditure from the 1.2% at present. This is just 50% of the commitment of India at ‘Health For All by 2000 AD Declaration’ and also of WHO and UNO guidelines which was at least 5% of GDP for the developing countries. Let alone release of 5 % GDP, even Govt. has denied to set any target for achieving this goal of 2.5% GDP in the present Draft. More over the budget allocation for Health & Family Welfare has been slashed down 20% from Rs. 35,163 Crores last year to Rs. 29,653 Crores. There is no tendency of increasing of health budget. If the government talks of paucity of funds, facts will go against it. In the last one decade, the government has liberally granted relief of an estimated amount of Rs. 40 lakh crores rupees to the industrial houses and monopolists in the form of various waivers, exemptions and concessions.
2.4.2 Universal Health Coverage (UHC) talks of linking the health entirely to insurance by way of introducing ‘Health Entitlement Card’ (HETC). In other words, the citizens would have to obtain this card by paying a stipulated premium by the name of Health tax from all citizens and Health cess from direct tax payers. We cannot but differ that ‘insurance coverage of health’ is not same as ‘right of health’ of the people! Government seems to be out to ensure the patient flow and superprofit of private hospitals against payment by public money. Giving extraordinary weightage on private health facilities for ensuring secondary & tertiary health care of the people, is the draft planning to directly assist private health & insurance industry for their sustenance & growth? With this draft national health policy-2015 the full circle of privatization-commercialization and commodification of health will be complete.
2.4.3 As per the present infrastructure and manpower availability India has reached only 50% of its requirement and falls far behind even of Indian Public Health Standard (IPHS) in catering health care delivery services through Govt. facilities.
2.4.4 We need and recommend proper evaluation, research, utilization and scientific integration of AYUSH. Unscientific, irrational overemphasis on traditions and indigenous practices will not help achievement of scientific health; rather encourage superstitions & outdated thoughts & obscurantist ideas and beliefs. You are well aware that preventive & promotive aspects of health care, different national disease control programme, immunizations are built on the fundamentals of preventive health care on the anvil of modern scientific medicine; it cannot be just replaced by AYUSH. Therefore we oppose this proposal. To manage scientifically it should get the leadership at least of a MBBS doctor (as the ‘Basic Doctor’ defined by Bhore Committee) having scientific concept of disease-host-environment, where AYUSH doctors and other workers will be other important member of the integrated team. Primary health care practice based on AYUSH is a different entity, which need to be developed. We do not agree with this proposal also on regards to cross prescription.
2.4.5 Health Manpower Norms: The draft makers do not seem to realize that health human development is a highly complex research exercise to understand the requirements of various categories of health personnel for running public health services starting from ASHA to doctor to highest level of health personnel at State and Central level. We are deeply concerned about govt. attitude regarding ASHA. Govt. seems to believe that they should perform every health activity i.e. immunization, normal delivery, family planning, treatment of common ailments of diseases, they are to vigil and control any type of epidemics outbreaks etc. But the Draft does not arrange neither their adequate training nor recommended to recognize them as a permanent health worker with proper wage and amenities which we strongly demand.
2.4.6 The draft did not spend a word regarding proper utilization of unqualified village practitioners though The Draft admitted ,as per NSSO , 40% of private OPD services are provided by this category of health workers. They can efficiently complement the works assigned to ASHAs and can eradicate the need of creating innovative health cadres very often planned by the Ministry and its loyal experts to ensure rural health care services as permanent health workers.
Medical Education: The Draft virtually declared medical education as mere commodity. At present more than 50% medical colleges are run by private & corporate sectors, where money is the prime criteria for admission, for passing examination and achieving degrees. GNM should not be abolished, but run by govt. institutions as per population requirement. BSc Nursing & further studies have to be conducted merit-basis in govt. institutions, not self financing & private institutions. Capitation fee in education has to be done away with, and merit can be the only criteria. We like to emphasize that already medical and nursing ethics as a part of social ethics has been eroded deeply with the fall of standard of medical education. Further commodification of medical education will practically destroy the noble ethos of medical ethics.
On drugs and medical equipments: Govt. needs to institute laws and statutory bodies to control and compel manufacturers to produce adequate quality and quantity of generic medicines including National List of Essential Medicines (NLEM). Public Sectors Undertakings (PSU) in pharmaceutical industry rendered sick and withering by the lethal effect of globalisation-liberalisation-privatisation, and gradual encroachment on DPCOs have to be reversed. Health can never be achieved with such a dismal drug production-supply-price control and quality control scenario of the country. Draft Health Policy is silent on this very essential sector. Not only medicine, Govt. should deal public sector manufacturing units of medical equipments, diagnostic instruments, appliances, so that they can be given at affordable and cheaper cost.
2.4.7 Some of the vital issues not addressed
Constitution Art. 47, Directive Principle note responsibility of Govt. regarding nutrition, standard of living, improvement of public health; yet nothing is mentioned
Piecemeal approach to Primary Health Care, pursuing Selective Primary Health Care approach
Frequent country-wide outbreak of communicable diseases despite NVBDCP; Malaria death in Tripura due to non-availability of medicine; JE deaths in N-E : question of non-availability of diagnostic kits & vaccines though these were manufactured in Kasauli following research of National Institute of Virology, Pune & Calcutta School of Tropical Medicine
Disastrous failure of RNTCP
Malnutrition – anaemia – LBW, stunted maturity of foetus & babies
Withdraw User’s Charge; handing over public hospitals to private in PPP; not contractual but permanent.
Paramedical council declared but not uniformly implemented.
Implement rational pro-people disaster policy with adequate budgeting.
Stop bureaucratic intimidation upon doctors, nurses & other health workers in govt. service.
Prof. Sanatan Rath Dr. Asok Samanta Dr. Tarun Mandal Dr. Bijnan Bera
President Vice President Vice President General Secretary
M e d i c a l S e r v i c e C e n t r e C e n t r a l C o m m i t t e e