Comments=As I was ruminating over the 50-page draft of the Health Bill, I could recall a very large number of factors, which were left unattended in the Draft. I will limit myself only to some major ones. It can turn out to be a substantial article, if we attempt even to confine ourselves only to a few. It is so extensive because, as I have written elsewhere, after Independence the freedom struggle had changed to a class struggle. Gunnar Myrdal had stressed this aspect in his Asian Drama. An account of health actions has been a series of betrayal of the masses by the ruling classes. Whatever the masses have been able to acquire has been through active struggle. NRHM is the latest of this betrayal. Our response to the Draft Bill will be an effort to raise the voice of the voiceless and expose the series of the betrayals. Here are some more of the flaws in the Bill, apart from what I had written earlier and what Mira Shiva and others are going to present, particularly the drugs issues:
1. Why this bill?
a. The NRHM had been a disaster, both in terms of its design as given in the Mission Document as well as in implementing the limited range set out in their Mission.
b. We had miserably failed in Polio eradication, in AIDS programme, in Revised National Tuberculosis Control Programme, in the Universal Immunization Programme -- to name the prominent few.
2. We designed the National Health Policy of 2002, saying that the NHP of 1982 as too ambitious. Even in the 2002 Policy we had confessed that the vertical programmes were "not cost effective"; "non-sustainable"; and "distort othere health programmes". Yet we have been going on with these. Why?
3. We had designed the 1982 Policy, saying that the path we had been following in the previous 35 years were "curative", "Urban oriented" and "privileged class oriented"
4. We had the ambitious Mudaliar Committee of 1963.
5. Then we had the Bhore Committee of 1946 and Sokhey Committee of 1938
6. Besides we has each of the Five Year Plans, political menifestoes, several other solemn promises to the people. What happened to them? Then why this bill?
7. The basic reason is political. Politicians have to go on cheating the people since 1947. The bill is the latest in the series.
8. IAS bureaucrats serve the interests of the politicians very well because they know so little and their accountability is virtually non-existent. This also suits the foreign agencies of various kinds in imposing their agenda on the people of the country.
9. Specialists in public health and health administration must be "eliminated" to make way for the racketeers.
10. The clinician dominated Central Health Services is also convenient to the rulers because they know so little about people's health.
11. India is among the lowest five countries of the world in terms of the investment in public health.
12. It is among the lowest five in in the world in terms of maternal mortality and morbidity, child malnutrition and maternal anaemia
13. The Directive Principles for the State Policies enjoins that `the state shall protect and promote health and nutrition of the people'.
14. The Draft Bill ignores the fact that health is a state subject. Most of health actions take place at the state level. Following the character of the ruling class, over the past 62 years it has abjectly surrendered to the international mafia and allowed them to impose their will over the states in the form of `centrally sponsored' schemes. The Family Planning Programme is an outstanding example of such imposition.
15. Both the Centre and the states have grievously suffered due to virtual decimation of the once towering key public health institutions like the All India Insititue of Hygiene and Public Health, the National Institute of Health and Family Welfare, the National Institute of Communicable Diseases, the Planning Commission and ICMR.
16. One consequence of such gross neglect and lack of public health competence has been an almost unbridled growth of communicable diseases like Japanese Encephalitis, Kala-Azar, Dengue Heamorrhagic Fever and Malaria.
17. The states too are dominated by bureaucrats fom the IAS cadre. They are mortally afraid of retributions from their controllers from the Centre should they ever dare to call into question the dictates in centrally sponsored schemes.
18. The states have lost the cadre structure for physicians and they have given up our institutions for education and training for public health physicians and the support staff.
19. National Health Information and Evaluation System, vital element in health administration, is virtually nonexistent in the country. We are still to get of reliable birth and death record for the country.
20. The Medical Council of India has to acquire the stature (and then surpass that too!) that it had under the Presidentship of B C Roy during the freedom struggle.
I hope this will suffice. I will be glad to elaborate on the 20 points, if required.
With regards,
Sincerely yours,
D Banerji
Debabar Banerji
Professor Emeritus, JNU
B 43 Panchsheel Enclave
New Delhi 110017
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Name=D Banerji
E-mail=banerjinhpp@gmail.com
1) There should be law which protects the Providers from assaults, and damages from public fury in cases of unfavorable outcome, and heavily punishes offenders with arrests and fine to compensate the losses.Assaults on Medical professionals should be a cognisable offense and needs to be dealt with sevely, only then will the Providers risk caring and treating serious patients - Medical establishments Protection act.
ReplyDelete2) Individual standards for hospitals should be different for different class of hospitals , its location - even there: the physical structural attributes ( like xyz sq feet area /bed ) of an already existing hospital needs to be relaxed. It becomes impossible to shift a place and modify an existing building structure for an already existing hospital for years.
3) Supervising and monitoring - Should not promote corruption. Only competent Medical Authorities should be there in licencing and monitoring activities. The system should be transparent and preferably online with enough safety to protect from corruption and blackmailing by officials. There should not be any incompetent , uneducated political goon in any such supervising committee , as such persons are more of a nuisance and promote corruption.
4) The act should look at the medical fraternity with due respect and not just make them vilians in the eye of common public.
5) Private providers ( not taking any Government grants) should be duly compensated by the government for their compulsory services during an emergency, in unaffording patients.Law says no provider can refuse emergency treatment, but no body mentions who's going to pay for the treatment costs( which can run into huge amounts), if the patient refuses to pay??
6) There should be some promotional scheme for providers to improve quality by the way of accreditations - like NABH/ISO in the form of reimbursement of accreditation costs, tax and duty concessions, specially in small cities and rural areas to promote quality healthcare in such areas.