#India – Chhattisgarh Diagnostics Privatisation Cancelled #goodnews #healthcare


The plan for privatisation of diagnostics services in Chhattisgarh has been cancelled. The RFP and tenders which had come in are no longer valid. This is a victory for  Jan Swasthya Abhiyan in Chattisgarh , The most heartening part of the struggle was the overwhelming support that this issue got from varied quarters.
indiahealth

Chhattisgarh diagnostic project on hold

SUVOJIT BAGCHI, The HINDU

State government says the policy requires a “fresh look”

The Chhattisgarh and Union governments have decided to halt the prestigious public-private partnership (PPP) project in diagnostic services in the State.

While Chhattisgarh’s Principal Health Secretary M.K. Raut said privatisation of diagnostic services was rolled back “for the time being,” the National Rural Health Mission (NRHM) refused to partially fund the outsourcing of diagnostic services. Last February, the State government invited private players to “set up shops” in the health facilities sector. Defending the programme on the government’s behalf, the Health Department’s technical assistance body, the State Health Resource Centre (SHRC), said that “outsourcing of health services” to private laboratories would enhance efficiency and facilitate delivery of services.

Mr. Raut, however, denounced the flagship privatisation project, which required a “fresh look.”

“In [the] near future we will take a fresh look at the project and decide a course of action,” he told The Hindu . A “revised PPP model” would be in place “in the coming months.”

Chhattisgarh has 154 community health centres (CHC) and 756 primary health centres (PHC). The government, Mr. Raut said, may consider implementing the PPP model in “a few” remote CHC and PHCs. “It would depend on whether it is possible for us to reach those areas or not. The PPP in diagnostic services will not be implemented in the district hospitals or 5,211 sub health centres.”

The government had issued request for proposals (RFP) from private health service providers to set up diagnostic services at public hospitals and health facilities, paid for by the taxpayer. The proposal was severely criticised by health activists and Mr. Raut said the “RFP and the floated tenders are closed chapters now.”

Explaining what compelled the government to retract a project floated only few months back, he said the “gaps need more scrutiny.” “We have to figure out a mechanism to monitor private players in remote areas.”

The Health Department is also not sure how the private players can be regulated. “A diagnostic chain may use government premises to market its services to the outpatients. We need to ask, why the government should provide incentive to a private player to do business using public facility,” said Mr Raut. He clarified that the government would not dismantle its “existing infrastructure and retrench staffs” to create space for the private players.

Owing to inadequate and chaotic public health care services in India, patients turn to private facilities, which are mostly unregulated and where quality is a concern. With the Union Health Ministry’s growing focus on more privatisation in health care, it was clear decades back that the health budget would not get the necessary boost. Rather, in view of the growing flow of private finance in health sector a National Health Policy was formulated in 2002 and the PPP model was suggested.

Chhattisgarh, known for abysmal health care in remote regions, has followed that model as it could not fill the post of 965 radiographers and laboratory technicians over the last several years. To fill those vacancies and provide necessary equipment to the health centres, the State health budget needed an additional funding of at least Rs. 30 crores, which was not available. Besides, trained technicians are generally reluctant to work in remote areas. In this context, the government opted for the PPP model.

However, in a span of four months the policy changed and Mr. Raut said the government had a “new PPP policy” in place and the “diagnostic sector policy has to fall in line with the new one.”

The NRHM has also refused to partially fund the present model and asked the State to “revise the proposal based on the Government of India recommendation” and submit a supplementary programme implementation plan.


  • Private players were invited to “set up shops” in the health facilities sector last February.
  • The Chhattisgarh Government has put the scheme on hold pending a “fresh look”.

 

#India -Do you know incentive and target based health services can be coercive ? #Vaw


Permanent sterilization-incentive based and target based health services: a glimpse from Rajasthan

– Leena Uppal

My elder sister in law was the one who suggested that I should go for female sterilization, if I get lucky I may win a motor cycle in the lottery….. 

The Ration Unit and Fair Price Shops in Bundi District of Rajasthan have been given instructions by the State Health Department to meet the target of at least two sterilizations before 30th March. There is also an incentive attached. The dealer s with the maximum cases will be certified and rewarded.  Targets are distributed further to the fair price dealers because the health department workers could not meet their family planning targets, which focus heavily on sterilization….. (Source: local newspaper, Rajasthan Patrika, 22.03.2013).

In a family planning camp held in a Community Health Centre (CHC) in Raipur Block of Pali district of Rajasthan on 22.03.2013, though the district collector announced various prizes including motorcycles, Colour TVs and home appliances to be distributed to ‘lottery winners’ among couples who opted for permanent sterilization as well as targets of village health providers to motivate women for sterilization; this camp did not see much of a turnover. The service providers shared that this could be because of Holi (a festival of colours in India) and during Holi people in the villages were busy.

Women present in the camp at Raipur were going under the knife without fully understanding the risks, precautions, consequences and their rights as claimants in case of failures, as nothing was explained o them or read out to them from the consent forms on which they gave their thumb impressions.

There are national guidelines of the Ministry of Health and Family Welfare that have a detailed description of the contents of medical history, Personal characteristics and reproductive history, menstrual history, obstetrics history, contraceptive history that is to be recorded in detail before female sterilization is done, however, this has not yet been built into the MIS system of the facilities. The only records that were maintained were the social-demographic profile and the consent form of the acceptors.

Follow up instructions, discharge cards, monitory incentive to sterilization acceptors were not given to the women before they left the facility. The families of women arranged their own transport to get back homes after the camp concluded at 3:00 pm on 22.03.2013.

Family planning should be regarded as a matter of choice and rights by both the service providers and the community. But this is not at all the case of what is being recorded and reported. While the National Population Policy has seen no place for targets, rural women continue to be seen as family planning targets and family planning camps as best models to meet these targets. This approach is problematic as there is no equal precedence given to post operative care and follow-up.

The government must audit and ensure strict compliance to the quality assurance mechanisms that have been established. There is an urgent need to understand both population issues and health service delivery within in the perspective of ‘women’s rights’ and justice, by the service provide

Gujarat HC pulls up state govt on swine flu: why not declare it an epidemic


Ahmedabad, Wed Mar 27 2013, ,IE

The Gujarat High Court on Tuesday came down heavily on the state government over the prevalence of swine flu in the state and asked why it did not declare the disease “an epidemic”.The court also termed the state government’s report on steps being taken to handle the disease as “an eyewash”.After lashing out at the state government, the court directed the Commissioner of Health to file a detailed affidavit on a variety of issues related to the disease and medical emergency situation in the state by April 9, when further hearing is scheduled.

The court presided over by Justice Anant Dave had, in the last hearing, asked the state government to submit a detailed report related to the disease while acting on certain bail petitions by some undertrial prisoners who had sought bail to attend to their relatives suffering from diseases like swine flu, malaria and dengue.On Tuesday, the state government counsel presented the report before the court and apprised it about the instructions being given to the government hospitals and health centres.

The court, however, was unimpressed. “Instructions do not work. There are no qualified doctors in your CHCs (Community Health Centres). Even for X-ray, patients have to go outside,” the court said.The court said there were norms of cleanliness and hygiene in government hospitals but expressed doubts about how many hospitals were following the same.

Apprising the court about various provisions at government hospitals, the state government’s counsel said they were having rain-basera facilities in major centres for accommodation of relatives of the patients.To this, the court said, “Even for patients there are no beds in hospitals, what rain basera for their relatives? This is an eye-wash. They (relatives of the patients) are sleeping outside the Civil Hospital. And health and hygiene are worst in government hospitals.”

Referring to private hospitals, the court asked the state government if there was any specific requirement for opening multi-specialty and super-specialty hospitals or it was “part of industrial policy (of the state government)”.The court asked the state government counsel why it did not declare swine flu as an epidemic. When the government counsel said it would require a notification to be issues, the court wanted to know about the criteria set to declare a particular disease an epidemic.

On the role of private hospitals in medical emergency situation, the court asked the state government to provide details of provisions under which services of private hospitals could be summoned.It also sought details on what special treatment was being given to pregnant females as they faced increased threat from H1N1 infection.

The HC also referred to an earlier court order under which a committee of lawyers had visited the Civil Hospital after some junior doctors had died of dengue at the hostel and a public interest litigation was filed seeking cleanliness and hygienic conditions at the Ahmedabad Civil Hospital.Govt gives figures on swine flu

In its report submitted before the High Court, the state government has given figures of swine flu cases in Gujarat since 2009 while comparing the same with states like Maharashtra, Delhi, Rajasthan, Karnataka, Tamil Nadu and Kerala. According to these figures, in 2013, Gujarat has so far recorded 689 swine flu cases. The report also gives history of the H1N1 virus in detail. It also contains details of the awareness campaign the state government has launched and various steps taken by the Health Department to mitigate the situation. The report also records that additional ventilators are required to attend critically-ill patients having H1N1 infection.

 

Doctors signed into rural work, Maharashtra can’t place them


Medical students

Medical students (Photo credit: Wikipedia)

Anuradha Mascarenhas : Pune, Thu May 03 2012,

The general reluctance shown by doctors to serve in rural areas has all but disappeared. In Maharashtra, so many medical students have agreed that there are now more willing doctors than the state can accommodate. Maharashtra has 1,500 posts of medical officer vacant; for these there are 3,000 applications, says Dr G S Chinde, director of health services.

It is not that the new crop of students has suddenly become more sensitive to the requirement of rural service. It’s just that should they want to skip a year’s stint in villages, the bond money has become unaffordable.

Maharashtra’s 14 medical colleges yield 2,000 MBBS graduates every year, of whom around 700 enrol in a postgraduate course. After MBBS, a medical graduate is required to sign a bond with the government to serve in rural areas for a year. If they opt to skip this, they need to pay Rs 10 lakh. The payment was Rs 1 lakh initially, raised to Rs 5 lakh in 2004 and doubled in 2010.

From students who signed a bond of Rs 5 lakh, the Directorate of Medical Education and Research has collected barely Rs 50 lakh, compared to Rs 3 crore collected in three years from students who had signed for Rs 1 lakh.

Dr Pravin Shingare, state director of medical education and research, said since the hike to Rs 10 lakh, over 4,000 doctors have enrolled for rural service.

The bond is higher for postgraduate and super-specialty doctors, Rs 50 lakh and Rs 2 crore. Now, the authorities are wondering where to place these highly qualified doctors.

“We are scrutinising the applications so that the doctor’s specialisation can be suitably utilised,” an official said. The delay in doing this has led to several students writing to the DMER that they have not got any response to their applications. Shingare said he has got more than 30 such letters and will write to the health department to start filling the vacancies. “The DMER has in fact listed 400 vacancies at Employees State Insurance Corporation hospitals.”

The health department is also trying to fill vacancies under NRHM, which needs 400 school-level health medical officers.

‘Plea of mental instability being misused as grounds for divorce’


English: Karnataka High Court, in Bangalore, I...

Image via Wikipedia

 ‘Show compassion’:Karnataka High Court judge N. Kumar speaking at a workshop on mental health awareness in Gulbarga on Sunday.

GULBARGA : Karnataka High Court judge N. Kumar on Sunday expressed anguish over the incidence of married couples seeking divorce on the grounds that either the wife or the husband was mentally unstable, and said that courts should be very careful while allowing such divorce petitions.

Inaugurating a workshop on Mental Health Awareness organised jointly by the Karnataka State Mental Health Authority, the district administration, Department of Health and Family Welfare and district judiciary here on Sunday, Mr. Kumar said the provision of mental instability as grounds for allowing divorce was being misused. He urged courts to thoroughly verify the doctor’s certificate while hearing such cases, and check whether the person accused of mental instability was really suffering from mental illness before allowing the petition for separation.

Mr. Kumar said that only cases where either the husband or the wife was “incurably of unsound mind” and or suffering from “continuous mental disorder” should be allowed, adding that divorce should only be allowed as a last resort.

Mr. Kumar said the replacing of joint families by nuclear families had resulted in the neglect of people with intellectual disabilities. It was the responsibility of society to show compassion towards them and help them to get the best possible treatment.

Rise in numbers

He expressed concern over the growing number of people afflicted with mental illness, and said that suicide among those with intellectual disabilities was on the rise. According to estimates, around 8 lakh of them ended their lives every year in the country, with the highest number in Bangalore, he said.

New rules for mental health rehab centres


4-FEB-2012, K.P.M. Basheer

Draft rules to be submitted soon; centres will come under disabilities Act

Centres to be taken out of the ambit of Mental Health Act, Many private-run centres function ‘illegally’ 

KOCHI : The State government is planning new procedures to bring on board hundreds of mental health rehabilitation centres run by NGOs and philanthropic individuals, a situation unique to Kerala, and place them under the Social Welfare Department.

A draft set of rules, tentatively titled The Kerala Registration of Psycho-Social Rehabilitation Centres, has been formulated by the Social Welfare Department by invoking Section 73 of the Persons With Disabilities (Equal Opportunities of Protection of Rights and Full Participation) Act 1995 (the PWD Act).

The rules intend to take the mental health care homes and rehabilitation centres out of the purview of the Mental Health Act 1987 and bring them under the PWD Act.

“The rules, after consultations with the stakeholders, will be submitted to the government in a couple of weeks,” K.K. Mony, additional secretary in the Social Welfare Department, told The Hindu .

The Mental Health Act (which also created the State Mental Health Authority) mainly deals with mental health care hospitals and psychiatric nursing homes.

There is no separate law to govern rehabilitation centres. The result: hundreds of such centres function ‘illegally.’ The Mental Health Authority cannot issue licence to majority of rehabilitation centres because of legal lacuna.

In other States

The Mental Health Act does not recognise the fundamental differences between a mental health hospital and a mental health rehabilitation centre. States such as Tamil Nadu and Gujarat found a way out by bringing the mental health rehabilitation centres under the PWD Act whose definition of disabilities includes mental illness. The Kerala rules have borrowed some provisions from Tamil Nadu’s.

The rules, in the first place, recognise the social reality of the existence, and need for, mental health care homes and rehabilitation centres.

The rise in the number of persons with mental illness and families’ tendency to go ‘nuclear’ have added to the relevance of such centres.

The public sector treatment facilities are clearly unequipped to handle the load.

The Kerala rules would include registration norms of the centres, criteria for inmates’ admission, accommodation, sanitation, and medical help among others.

Local community

The rules would also look into the functioning, funding, licensing, supervising, and monitoring of the centres. They would encourage the participation of the local community in the well-being of the inmates, Mr. Mony said.

Facilitated by the People’s Council for Social Justice, the first round of consultation with functionaries of care homes, social workers, and psychiatrists was held at Kochi on Tuesday.

Consultations

Two more consultations, one at Kannur and another at Thiruvananthapuram, would be held before finalising the draft, Mr. Mony said.

One major outcome of the rules would be that the Social Welfare Department, not the Health Department, would have the responsibility of licensing, supervising, and channelling government aid to the care homes and rehabilitation centres.


Harassment of mentally ill patients: Court orders high-level probe


Jan 17, 2012 (Thrissur )-Chief Judicial Magistrate P.S. Anthony on Monday directed the City Police Commissioner to investigate into the alleged harassment of inmates at the illegal mental health centre at Avanur, near here. The court directive was on the basis of a detailed report submitted by District Medical Officer V.V. Venus at the court on the issue.

The Health Department had recently rescued 41 mentally-ill patients from the Santhi Bhavan Sarvodhaya Pankuvakal Charitable Trust, functioning for the last 28 months at Avanur, during a raid. According to the health officials, the patients were kept in chains in dilapidated, roof-less sheds without proper care or treatment. An inspection conducted by Mental Health Authority Secretary D. Raju at the Centre revealed that the Centre had sold body of an inmate, who died at the centre, to a private medial college in Kollam. The Centre, registered as a charitable institution, did not hold licence to keep mentally-ill patients. Though the register kept at the institution showed 78 patients, only 41 were found at the time of raid. Many patients, including women, were missing. When asked about the missing patients, Thalikkulam Veetil Joshi, 50, secretary of the centre, told Dr. Raju that 11 patients had escaped from the centre at various occasions and five had succumbed to illnesses. One patient was killed during a fight between the inmates.

No documents available

According to the health officials, except for the murder case and another death, no documents were available at the centre about the missing persons. The deaths were not registered at the panchayat. The illegal sale of corpse was revealed when the driver of the ambulance in which the body was transported from the centre to a Kollam-based private medical college was interrogated by the authorities. “The procedural complications to get bodies for academic purposes often encourage private medical colleges to acquire bodies from such illegal institutions,” said a health department official. And for such centres, it was a lucrative business to make easy money.

The DMO’s report has recommended a high-level investigation into the functioning of a large number of orphanages, old-age homes and de-addiction centres in the State.

 

Directive on the basis of a detailed report submitted by District Medical Officer V.V. Venus

The Health Department had recently rescued 41 mentally-ill patients from a Charitable Trust 

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