Letter to Dr. Manmohan Singh on Universal Access to Health Care


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To,

The Honourable Prime Minister,

Government of India

 

Copy to-

Mr. Ghulam Nabi Azad, Minister of Health and Family Welfare, GoI

Mr. Montek Singh Ahluwalia, Deputy Chairman- Planning Commission, GoI

Dr. Syeda Hameed, Member- Planning Commission, GoI

Mr. P.K. Pradhan, Union Health Secretary, GoI

 

Subject: Regarding Universal Access to Health Care.

 

Dear Dr. Manmohan Singh,

 

Janaarogya Andolana Karnataka (JAAK) is the Karnataka state unit of the global People’s Health Movement (PHM) and the national level Jan Swasthya Abhiyaan (JSA) and comprised of public health professionals, activists, progressive people’s movements and representatives of community-based organizations.

 

JAAK had a one day state level convention on 30.05.2012 in Bangalore to debate and discuss the various processes underway to roll out Universal Access to Health Care (UAHC) in the country.

 

While we appreciate your efforts to place health as an important agenda on the 12th five year plan, we would also like to express certain apprehensions following the publication of the PC-SCH report which we feel is not in the right spirit of a truly Universal Health care system.

 

We support the recommendations of the High Level Expert group with regard to strengthening the public health; primary funding through tax-based funding, abolition of user fees of all forms for accessing health care facilities and provision of free essential medicines for all. One more specific recommendation which we support is the advice against any forms of commercial insurance for organizing the healthcare in this country.

 

The subsequent PC-SCH report of February 2012 shows significant deviation from the vision of Universal Access to Health Care. Some of our concerns are as follows:

 

Essential Health Package (EHP) – The PC-SCH restricts the EHP to only Reproductive Child Health and the vertical programs. This would lead to exclusion of several medical conditions which contribute to significant mortality and morbidity in the country. Since one of the principles of UAHC is that healthcare services are arranged according to the needs of the community, curtailing these needs would defeat the spirit of universality. In addition to this, the PC-SCH proposes that the services additional to EHP should be purchased by the families from open market with “top-ups”. This is tantamount to encouraging user fees and we strongly denounce such a move to introduce user fees through other means. Given that one of the objectives of Universal access to Health Care is to reduce out of pocket expenditure (OOPE), ‘top-ups’ as proposed by PC-SCH will only aggravate OOPE leading to further impoverishment of vulnerable families. The UAHC model should involve comprehensive primary, secondary and tertiary care with the government as the provider of choice.

 

Financing of UAHC – The HLEG, while giving prominence to the public health systems

strengthening, had suggested that the public expenditure should be increased from the

present 1.2% of GDP to 2.5% of GDP by the end of 12th plan and to 3% of GDP by 2022 for the UHC system. We are now given to understand, even though not explicitly mentioned in the PC-SCH report, that there is a move to reduce this to 2.1% by the end of the plan and the Union contributing only 30% and the rest 70% expected from the states. Going by the financial situation that the states are in and also due to the fact that some of the revenue generating avenues for the states have got transferred to the Union, it would be unreasonable to expect the states to contribute to the UAHC system. This would also run counter to your own Independence Day 2011 pronouncement that funds would not be a constraint to the important areas of health and education.

 

Health insurance – We also strongly condemn the present Rashtriya Swasthya Bima Yojana (RSBY) model of financing the private and public providers on a fee-for-service basis. This would result in not only huge cost spiral and waste of precious public resources but only focus on some tertiary care further consolidating the dominance of private providers and weakening of the public provision. JAAK believes that private providers should never substitute public provision of health care services.

 

Additional Central Assistance (ACA) – We have noted with apprehension the proposed model by the Planning Commission to provide ACA directly to the District societies which has the potential of bypassing the Ministries of health and family welfare at both the union and the state levels (p24). We strongly oppose any such move as we strongly feel the leadership for UHC should come from the respective Health ministries.

 

Contracting in private services – The PC-SCH report points to making public health facilities compete with private providers while allowing for financial and operational autonomy. JAAK opposes the corporatization and privatization in health and other social services, whether at the planning, policy making, financing and provisioning of health care services and in all its forms including user fees, contracting-in, and public private partnerships.

 

Autonomy of district units – JAAK is deeply concerned with the drive towards making primary, secondary and tertiary health units autonomous and functioning as Societies. While operational autonomy (planning and day to day functioning) is desirable, these hospitals/ health centers should not have to raise their own funds or provided only conditional performance-based grants. Further, they should be accountable to district or local health authorities.

 

Regulation of the private sector – The PC-SCH report repeatedly mentions regulating the health sector including the private sector. We welcome this, but the report lacks the details for bringing about concrete and effective regulatory mechanisms. If this important piece of reform is left vague without giving sufficient attention and detail, we feel that it would be subjected to regulatory capture by vested interests. A strong regulatory structure must be set up for the private sector. This would cover hospitals, medical colleges, private practitioners, diagnostics labs and all other health providers. The private sector must be made more transparent and accountable.

 

Piloting in a single district – The PC-SCH proposes that to be eligible for the ACA, the states have to prepare a UHC plan along with a District Health plan; Frame standard treatment guidelines and to ensure its compliance; strengthen the program units both at the state and district levels; empanelment of private providers by means of a transparent selection system put in place; enhancement of community involvement in planning and management and development of a strong monitoring and evaluation mechanism. While these are all laudable objectives, it must be noted that most of these processes that have to happen at the state level at both systemic and legal levels. The states would have very little incentive to bring in all these reforms just for piloting in a single district. In the absence of these state level enabling reforms just piloting at the district level is bound to fail. Hence we urge that the piloting of these reforms must happen at the state level rather than a piecemeal approach of doing it at district level.

 

We also note with some concern that the states, which are largely responsible for healthcare services, are kept largely out of discussion. JAAK advocates for a central role for the government in stewardship, governance, financing, regulating and provisioning of health care services, with community participation in planning, implementing and monitoring of health care at all levels.

 

Keeping the above concerns in mind, we urge you to use your high offices to organize further consultations with all the stakeholders giving the Union Ministry of Health and Family Welfare the lead role in the larger interest of the health of the people of this country and to make your Independence Day pronouncement reach its logical conclusion.

In solidarity,
K B Obalesha, State convenor, JAAK, 9742586468, thamate2005@yahoo.co.in

Dr Gopal Dabade, MBBS, DLO, Chairperson JAAK 9448862270, drdabade@gmail.com

 

 

Hunger strike by Palestinian prisoners succeeds


In the middle of April 2012, over 2000 political prisoners lodged in Israeli jails joined a hunger strike launched by a group of their compatriots nearly two and half months ago. The fasting prisoners were protesting against the brutal measures adopted by the Israeli state to persecute the Palestinian patriots in its jails.

Nearly a month after the 2,000 prisoners joined the initial group in the hunger strike, the Israeli government was compelled to allow family visits for prisoners from Gaza, end the policy of solitary confinement, and significantly reduce and limit the use of detention without trial, also known as “administrative detention”.

This struggle of the Palestinian prisoners was supported by justice and freedom-loving people all over the world, including organisations of Jewish people opposed to the racist, fascist and colonisation policies of the Israeli state. Just hours before the strike ended, Jewish peace organisations and the US Campaign to End the Occupation delivered over 8,000 signatures to the United States State Department asking them to force the Israeli state to relent.  Several thousands of people around the globe had pledged to undertake a 24-hour hunger strike in solidarity with the prisoners on 17th of May 2012, which was called off in view of the Israeli governments acceding to the demands of the Palestinian prisoners.  The victory of the Palestinian prisoners coincides with the Palestinian commemoration of the 64th anniversary of the Nakba; the systematic campaign of ethnic cleansing that uprooted most Palestinians from their homeland around 1948.

The prisoners’ victory has heightened hope about the prospects for Palestinian freedom, justice, self-determination and the return of refugees. Mazdoor Ekta Lehar hails this victory of the Palestinian people incarcerated in the jails of Israel and reiterates the support of the Indian working class and people for the just struggle of the Palestinian people for their national rights.

Haryana shocker: Women, children raped in government shelter


Rohtak: It is a sordid tale of exploitation and official involvement from Rohtak in Haryana where women and children at a government-aided shelter in the Chief Minister‘s own constituency are being abused and raped.

CNN-IBN has accessed the High Court Committee’s report that shows the involvement of certain Haryana government and police officials as well.

The women and the children in the government shelter in the Chief Minister’s constituency are being gang-raped, and forced into prostitution. Also, pregnant women are tortured to induce abortions.

The woman who runs the shelter has been arrested along with 3 relatives… the report reveals she is being given special treatment so she doesn’t name the officers involved

A probe ordered by the court into Apna Ghar, the shelter, revealed the shocking facts.

“I’ve been doing work related to child welfare for seven to eight years now. But I haven’t seen this kind of torture or sexual exploitation anywhere in my life,” said Utsav Bains, a member of the High Court investigation team.

Jaswanti Devi, who runs the shelter, has been arrested along with her daughter, son-in-law and a relative.

However, the investigation also reveals that Devi is being given special treatment for fear that she will name government and police officials involved in the sexual exploitation racket.

Meanwhile, more shocking statements have emerged from the probe, that pregnant inmates were forced to undergo painful abortions that verged on torture, and were gangraped by police officers.

“One of the demands was either a special investigation team with members outside Haryana or the CBI should investigate it. The local administration is hand-in-glove in this,” said Bains.

Reacting to the report, the Haryana Police has assured action, and that the culprits will be punished strictly.

“We will investigate and find out who are the officers involved. Anyone who is found guilty will definitely be strictly punished,” said Ranjeev Dalal, DGP, Haryana Police.

The whole case only came to light because two girls ran away from the home in May and told their horrific story to the National Commission for Child Rights. The Punjab and Haryana High Court formed an investigative team after a PIL was filed.

Helpless children and women were sexually exploited under the garb of running a shelter home. And helping keep it under wraps were some Haryana police officials, the very men meant to prevent it from happening in the first place. At least that is what the High Court team’s initial investigations reveal.

CRPF brutalises a tribal family in Jharkhand


Who will answer for Lucas’ death?

The CRPF’s high-handedness has brutalised a tribal family in Jharkhand, where the force wants AFSPA cover to fight the Maoists. Kunal Majumder reports from Palamau

Lucas’ body was found floating in a river
Family affair Lucas’ body was found floating in a river

Photos: Saikat Chattopadhya


EVERY MORNING, as the villagers of Nawarnagu in Palamau jungle, Jharkhand, travel to work — farming or picking tendu leaves — jawans of the Central Reserve Police Force (CRPF) and Commando Battalion for Resolute Action (COBRA) stand at their pickets, “protecting” them from the Maoists. The jawans stop every vehicle, ask for the driver’s licence, enquire about their destination, family and jobs. At other times, they conduct combing operations inside the villages, entering homes, shops and schools in search of Maoists. On finding anything or anyone suspicious, the jawans immediately take them into custody.

According to official data, 577 people have been killed in anti-Maoist operations since the creation of Jharkhand in 2000. Human rights activists allege that the casualties include many innocents. The latest in the list, they claim, is Lucas Minj, 33, a deaf-mute tribal who was shot dead on the banks of the Koel river inside the Palamau jungle on 31 January 2012.

For the Minj family, the death of Lucas was only the beginning of the miseries to follow. The family claims that they are facing backlash from the security forces because they dared to file a police complaint seeking an investigation into the death.

Lucas’ cousin Sylvester is one such victim. The 40-year-old lies in the orthopaedic ward of the Rajendra Institute of Medical Sciences (RIMS), Ranchi, with his neck and head strapped to iron rods; his left hand paralysed.

“It’s difficult to speak,” he mutters, as his eldest son, Roshan, enters the room. With a pregnant mother and five young siblings at home, it’s Roshan’s responsibility to look after his father.

On 5 April, Roshan was at home when some villagers informed his mother, Susanna, that Sylvester had been beaten up by CRPF jawans. Sylvester was returning home from Chhipadohar in a shared private jeep. CRPF and COBRA jawans from the Labra police picket were patrolling the entrance to his village. They stopped the jeep and asked the driver for his licence, which he didn’t have. All the passengers were asked to step out and questioned. “They asked about my village, family and soon realised that I was Lucas’ cousin,” recalls Sylvester. He was forced to stand on his head, legs in the air, for 30 minutes. A COBRA jawan kicked him in his neck, rendering him unconscious.

Later, Sylvester was put back in the jeep and let go. Sensing trouble, the driver dropped him midway, where he lay alone, howling with pain, unable to lift his head. After much effort, Susanna’s relatives carried him home to Karamdih village on a cycle. Once home, Sylvester lay in bed, unable to move. Susanna managed to collect some money from her relatives and took him to a local government hospital, where the doctors referred him to RIMS. They had no money for the journey until Lucas’ brother, William, pitched in.

‘No one can explain why my brother was killed,’ says William. Instead, the Minj family was hounded for approaching the police

William works as an NGO worker at Daltonganj. All six brothers, except Lucas (born deaf-mute), attended missionary schools. Their grandfather, John, was a schoolteacher and first-generation Christian convert. Their father, Kliment, was a farmer. After college, all the brothers found respectable jobs in Ranchi — teacher, guard, firefighter, driver, NGO worker and police constable. Only the youngest, Prakash, stayed back in the village to look after Lucas and the family property.

ON 31 JANUARY, security forces were combing Lucas’ village Nawarnagu, located 50 km from Chhipadohar. The day before, it was the turn of Karamdih, Sylvester’s village. Clashes between the Maoists and CRPF were reported. Villagers of Nawarnagu admit that the rebels were holed up there when the security forces were in the neighbouring village. “But do you expect them to wait for the security forces to attack them? They escaped easily,” says a villager.

At around 8 am on 31 January, just like any other day, Lucas took the family cattle — 17 cows and 19 goats — into the forest for grazing. Jawans from the CRPF, COBRA and state police surrounded the village between 9-10 am, says Ranjita, Prakash’s wife. The villagers heard two gunshots between 9.30-10 am near the Koel river, located less than a kilometre from Lucas’ house.

Prakash and William Sylvester
Prakash and William sit near Lucas’ dug-up grave Sylvester in a hospital in Ranchi

Usually, Lucas returned home by noon. That day, he didn’t. “We thought he got scared of the police and was hiding in the jungle,” says Ranjita.

On 4 February, fishermen from a neighbouring village found a body floating in the river. Prakash and Ranjita feared that it could be Lucas’. But they were afraid to venture out of their house. Two days later, the couple went to check the body and their worst fears came true. A bullet had gone right through Lucas’ head. He was lying on his stomach with his sickle beside him. The next day, the family buried his body in the village graveyard.

“We never thought of approaching the police because we suspected the security forces had murdered him,” says William.

However, a rumour made the rounds that the Maoists had killed Lucas, an allegation the rebels vehemently denied. “Lucas was deaf and dumb. He has been living here since birth, looking after our cattle for 15 years. Why would the Maoists suddenly want to kill him?” asks Prakash.

William finally filed a complaint with the police on 12 February. Two days later, Lucas’ body was exhumed and sent to RIMS in Ranchi for a post-mortem examination. The post-mortem report confirmed the Minj family’s suspicions — Lucas had been shot around the same time the security personnel were conducting the combing operation in his village.

On 17 February, when his body was being brought home, the Maoists declared a strike to protest his death. Fearing the Maoists, the ambulance driver transporting Lucas’ body refused to venture deeper into the forest to get to the village. Lucas was buried at a new grave in Chhipadohar.

William pursued the matter, meeting senior police officers, who assured help. But nothing happened. “Nobody answered why my brother was killed,” he says. Instead, the family was hounded by the security forces for approaching the police.

On 5 April, the day Sylvester was attacked, William was also roughed up. William was stopped at the same Labar police picket. His camera was confiscated. It had contained the photograph of a CRPF jawan who had abused him a day ago. He was branded a Maoist spy and the photo was converted into “telling evidence”. He was slapped, humiliated and threatened with death. “I thought they were going to kill me,” he recalls.

However, locals informed William’s family in time, who immediately alerted human rights activists in Ranchi. They, in turn, requested a senior police officer to intervene. That’s how William survived that day. But the family still lives in fear.

While the police has instituted a highlevel team to investigate the death of Lucas and the violence against Sylvester and William, the CRPF refused to respond when asked about the incident.

Lucas’ brother, the police constable, has been posted at the same hospital to keep an eye on Sylvester under the pretence of looking after him, despite the former’s reluctance. “What kind of people would assign one brother to spy on another?” asks human rights activist Gladson Dungdung.

Pushed into a corner by both the Maoists and the State, the tribals are in a quandary. Meanwhile, CRPF Inspector General (Operations) DK Pandey, who is in-charge of the anti-Maoist operations in Jharkhand, has demanded the enforcement of the Armed Forces Special Powers Act in the state.

But before it can get a free hand to fight the Maoists, the CRPF has to answer for the pending charges against it.

Kunal Majumder is a Senior Correspondent with Tehelka.
kunal@tehelka.com

Sunday Reading–Artivism In The Age Of Capitalism- #SJ #Aamir Khan


by-Samvartha Sahil–

In a recent article on Satyameva Jayate (SJ hereafter) one of our important film, TV and theater artist B. Suresha brought in the argument of the visible and invisible connection between commerce and art and on how the control of commerce over art can limit art and also corrupt and dilute it.

When the strings of art is in the hands of commerce, whichever art may it be, how much ever concerned the art is and has its heart in the right (rather left) place finally its concern and artivism will be playing within the framework of commerce (read capitalism) and all its concern will be, in one or the other way, benefiting the larger capitalist structure. Else why would the capitalist structure even bother to hold the strings of art in the name of artivism.

What actually makes such associations quite limiting and also dangerous is that the art, in the name of artivism, will not be able to survive of its own and the commercial interest becomes more important than the very artivism of such art.

With all respects to the concern of Aamir Khan and all those who are watching the show, we should not let the question on how Aamir Khan, with so much of advertising, Ambani and corporate interest intertwined with SJ will be able to raise some of the most inhumane issues of this country- say caste discrimination/oppression, demand for reservation, khap panchayat, communalism etc- in his show? One show on caste discrimination and a call for mass support for reservation will make Aamir Khan a villain in the eyes of most of the viewers. One show on how monopoly of Reliance can ruin this nation and the capital flow for the show will vanish- or make the show itself vanish. Or let Amir give us one show on NBA- a movement with which he has identified earlier- and speak of the problems associated with the popular model of development. Will he and his show have the same number of audience the following week? The point here is not whether Aamir Khan is concerned or not but how these associations and negotiations chain one! He may not be able to speak of NBA, even while having his heart with the movement, because of the fear of losing TRPs.

This association between commerce and art, thus, lets art be concerned and speak about all those issues which, if spoken, doesn’t harm its commercial interest. So what happens as a result is that the structure of world, which in itself is very oppressive and needs to be fought, remains untouched. Moreover it keeps benefitting from such programmes too.

Have not people like Sainath, Kalpana Sharma, Harsh Mander, Arundati Roy, Anand Teltumbde spoken about burning issues to us? The fact that we require an Aamir Khan- with an aura of being a star- to wake us up speaks about the thick skin we have developed. This is a sort of moral illness. May be the world which we have constructed for ourselves is not a thick skinned one and – to use a marketing word- “good packaging” is required to take the message. But it becomes important to see what is happening to the message itself when it is sealed in a plastic cover?

This moral illness of our times is something which artivism has to cure. We the people, with this moral illness, who are a part of this larger structure and also benefiting from this structure, amidst our busy life strengthening the status quo and this larger structure for our own benefits, feel satisfied about our ‘sensitivity’ about ‘burning issues’ of the world by watching and speaking of some socially relevant issues. This is like personal/ individual CSR. It is, forgive the language, a kind of moral masturbation.

One should remember the recent Idea and Samsung advertisements which showed that ‘like’ buttons on facebook can change the world, bring a revolution, and awaken a generation. It may be speaking about how facebook can help in raising questions and bring about awareness. But the bottom line is “buy idea 3G” and “buy samsung”. Worse it takes activism and artvism from the real to the virtual space. SJ is not very different from this because it again is playing within the framework of an oppressive system, with its close association with commerce, which surely is benefitting capitalism.

One problem with SJ (and also the column by Aamir Khan in The Hindu) is that they sound very much like a moral science class. Bringing up issues and discussing them and thus opening the eyes of the people to the issues and also awakening them are fine. But what makes one turn skeptical about it is the moral high position that Aamir Khan seem to assume for himself. One wouldn’t become so skeptical about it the research team of SJ was to come and narrate these stories.  When SJ becomes more of an Aamir Khan show and not a programme which speaks of reality as it really is, there are all reasons for one to be skeptical about it as one has all reasons to be skeptical about all such works where an individual’s aura eclipses the work. In the narratives narrated by Sainath, Kalpana Sharma or Harsh Mander (for example) we do not see their individual personality casting its shadow on the issues they are raising.

It can be argued that Sainath, Kalpana Sharma or Harsh Mander has not been able to penetrate to the larger mass and mass consciousness the way Amir Khan has done. But how can we ignore the difference in the issues being raised by Sainath, Mander, Roy etc and Amir Khan? May be there is a need for the former to invent newer methods of speaking. Possible. But SJ does’nt become an alternative for the former.

That does’nt mean that SJ does’nt have any right for existence. To think that though within the framework of a capitalist system it is raising questions and trying to bring in a difference from within is to just have imaginations and not an imaginary. Like there is poverty of morality and poverty of sensitivity there exists also poverty of imagination. We have been tied by imagination and have not been able to imagine the imaginary to bring in a new form of activism and artivism.

Read more on his BLOG HERE

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