struggle against outsourcing of diagnostics in chhattisgarh-sulakshana nandi
TRANSCRIPT
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Struggle against outsourcing of diagnostics in Chhattisgarh
JSA Chhattisgarh
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The proposal and JSA’s critique
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Context of the proposal
• State PPP Policy written• Huge no. of PPPs floated at once- Mobile
Medical Unit, functioning of CGMSC, Primary health centers, Referral transport, school health programme
• All in the name of “reaching the unreached”, improving access in underserved, rural, tribal, remote areas
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Outsourcing of radiology and lab services in 379 public health facilities
Agreement for 10 years with annual renewal
Type of Facility
Number of facilities
Category-A Category-B Category-C
Total facilities to
be outsourced
Total facilities in
the state
District Hospitals 10 12 22 27
Civil Hospitals 8 8
CHCs 46 (FRU) 103 (Non FRU) 149
PHC (24*7) 200 200
District Hospitals 10 12 22
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Geographical Area
• First divided into 4 divisions- Sarguja, Bilaspur, Raipur and Bastar
• Later forced to club Tribal/remote region with mainstream districts as no bids for those
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JSA’s critique
Bulk Coverage• ALL Community Health Centers (CHCs) in the
state; • 80 % of the District Hospitals (22 out of 27
District Hospitals); • 8 out of 17 Civil Hospitals; and • 200 of the best functioning Primary Health
Centers (PHCs) in the state
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Services to be provided
• Radiology and laboratory services• Three category of services• Upto25% of category-C centres may be allowed to
function as collection centresCritique• Not an interim arrangement• Replacing existing diagnostics services: • Existing services not improved or expanded• Lack of Match between Lab Services proposed and
availability of Specialists/Doctors
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Eligibility and operating procedures
• Private profit or not-for profit• Avg turnover of Rs. 4 to 6 crorein last 3 yrs• NABL accreditation not necessary• Can further contract it out to a
‘concessionaire’• Each to be maintained as a ‘business centre’
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Concessions and Rates
• Space and electric meter provided by Hospital management committee
• Freedom to serve ‘external’ customers• Will get ‘right to first refusal’ in expanding this
network• Rates will be those approved for non-NABL
accredited centre in Delhi under CGHS.
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PaymentsThe payments will be made by Hospital Management
committee for the following patients:• Patients being treated under National and State Health
Insurance Scheme• BPL patients under OPD treatment• Rest will pay for the services themselvesCritique:• Insurance covers only in-patients• Irrational practice and malpractice in insurance
reflected in diagnostics too• Free to serve external patients- possibilities for mixing
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Cost to patients• Only costs of Below Poverty Line (BPL)
outpatients covered• As per GoI- 18.75 lakh families BPL• Chhattisgarh Food Security Act 2012- 42 lakh
families (75% of families in the state) as poor• 23 lakh families identified as deserving support
for food but not free healthcare! • What about Govtprogrammes like malaria, sickle
cell, TB and those under Mother and Child Health Programme – will people have to pay for those?
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Monitoring
• Monitoring by third party monitoring systemCritique• 3rd party monitoring mechanism will remain
ineffective if Govt is not able to monitor
Experiences in other states ignored
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The 6th Common Review Mission clearly states that similar privatisation in Bihar has been a complete
failure and led to:
• Increase in costs• Reduction in availability – collection
centers• Reduction in quality- “Accuracy and
reliability of test results is doubtful”• High turnaround time• Govt. lab technicians without work• In-house labs under utilization and
dysfunctional
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Our demands• STOP privatisation of diagnostic services in public hospitals• Fill posts of lab techs and radiographers• Recruit/train local youths from marginalised communities• Modify 24 year old recruitment rules• Multiskilling training for existing lab techs• Every health facility should be equipped with adequate HR,
equipment and supplies• Make public health services more responsive and
accountable to people• STOP privatisation of health services and strengthen public
health services
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The Struggle
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Getting the message out
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• Critiquing the proposal• Memorandums to Governor• Evidence building-RTI on Lab services and
feasibility study, Rapid survey of facilities• Connecting with trade unions and other
stakeholders
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State level Rally and Press conference
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District level events and signature campaign
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State level Silent March
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Other actions• Representations made to Chief
Secretary, Finance Secretary and other senior govt officials
• Representations made to GoI
• Team from GoI comes to study this proposal and critiques it
• NRHM refuses to fund this proposal
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Government stalls project
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The struggle-1
• Building awareness• Critiquing the proposal point by point• Evidence building• Partnership with all stakeholders• Rapid survey of health facilities• Use of RTI
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The struggle-2
• District/block level action• State level Rallies• Signature campaign• Media advocacy• Advocacy with critical persons in the state
government• Advocacy with Central Government• Relentless pressure
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“keep awakes”Despite evidence :• Private hospitals holding
govt to ransom for higher rates, eg. In insurance
• Negative outsourcing/PPP experiences
• Evidence of denial of patients rights
• Obvious push from the pvt healthcare sector to demand more public funds
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Govt’s response :• Reducing public health
expenditure in the name of fiscal consolidation
• Promotion of PPPs
Leading to :• Weakening of public health
system• Active & Passive privatisation• Denial of access to free and
quality healthcare for the poor
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Monitor-Critique-Organise-Agitate- Be visible