#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 The RFP and tenders which had come in are no longer valid.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.

Chhattisgarh diagnostic project on hold


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 – The Land Bill is tainted by a colonial hangover

Instead of focussing on the industry, the Centre should uphold the citizens’ rights
Madhuresh Kumar

Madhuresh Kumar

4-05-2013, Issue 18

Left in the lurch The revised Bill is still vague on rehabilitation and resettlementLeft in the lurch The revised Bill is still vague on rehabilitation and resettlement, Photo: AP

Hectic parleys with political parties have been ongoing in the past few months to reach a consensus on the Land Acquisition, Rehabilitation and Resettlement Bill, 2011, so that it gets passed in the current Parliament session. In principle, it is the Manmohan Singh government’s effort at addressing the problems in the Land Acquisition Act, 1894, which is not only outdated, but has promoted forcible land acquisition.

Land acquisition continues to take place without any resettlement and rehabilitation, drastically affecting people who lose their land and/or livelihood. However, given the direction of negotiations and changes in the Bill, it is clear that although it is framed by the ministry responsible for rural development, it is more concerned about the industry sentiment and urbanisation needs.

The National Alliance of People’s Movements feels that while the new Bill is an improvement over the 1894 Act, several key issues remain. Many of these were addressed by the Parliamentary Standing Committee, but remain neglected by the Centre. One important recommendation made by the Standing Committee was that the government should not be acquiring land for private players. But the Centre has refused this recommendation, saying that it is ideologically committed to private firms playing a larger role in the nation’s development. Under the 1894 Act, the government was not legally mandated to acquire land for private firms and public- private partnership (PPP) projects. This new Bill will legitimise that. This is our fundamental problem: why should the government act like a middleman for private companies?

Second, the 1894 Act works on the principle of eminent domain, which is the power of the State to seize private property without the owners’ consent. That framework has still not been changed in the new Bill. And when you look at the current framework of development, the government is handing over sectors like power, roadways, railways, etc, to private players. As the State tries to acquire more land for private companies, there will be more and more conflict. Farmers have nothing else to depend on, and even if they are resettled and rehabilitated in some way, that may not suffice for their future generations.

It is being said that to make any acquisition for private and PPP projects, consent of 80 percent and 70 percent of the land losers, respectively, will be sought. But why is there no provision of consent for the public purpose projects? Until 1984, the Land Acquisition Act was used primarily to forcibly acquire land for government projects, leaving people to fend for themselves in the absence of any resettlement and rehabilitation provisions. That legacy of forcible acquisition will continue even after this law comes into force. This will also mean an unequal frame of land acquisition for power plants to be set up by the public sector National Thermal Power Corporation and Reliance in the same area.

Third, there remains serious concern about food security. Land is a critically limited resource. If we don’t put a cap on the diversion of agricultural land for non-agricultural purposes, this will create severe food and water shortages. The Standing Committee has said that the government should not acquire any agricultural land, whether irrigated or not. The government is saying that only multi-crop land will not be acquired, but we are saying that it is single-crop land that is most often held by marginalised farmers, who are most in need of protection for economic and food security reasons. There must be strict norms for preventing diversion of agricultural land to non-agricultural purposes, like the regulation of any diversion of forests for development projects. On the same lines, there must also be a provision for compensatory development of agricultural land whenever there is a diversion of agricultural land.

Fourth, the Standing Committee report said that more than 90 percent of land is acquired through Central and state laws other than the Land Acquisition Act, which have been listed in a separate schedule in the Bill. However, the provisions of the new Bill don’t apply to those. Why they have been left out is not clear and only three non-significant Acts have been brought under its ambit (By a notification, the Union government will bring all such relevant Central Acts under its ambit within a year). But, more importantly, there is an urgent need to uniformly streamline the process of land acquisition, and so, the process of acquisition, resettlement and rehabilitation must be the same in all cases.

Fifth, as per the Planning Commission numbers, India’s urban population is expected to go up from 377 million in 2011 to about 600 million by 2031. This implies an increase of more than 200 million in just 20 years. It also says that the duration of water supply in the cities is only between one to six hours; about 13 percent of the urban population defecate in the open; about 37 percent of households are connected by open drains and 18 percent are not connected at all. The number of urban poor has increased by about 34.4 percent between 1993-2004, residing mostly in slums and bastis. In Mumbai, 60 percent of the population lives in slums or slum-like conditions, but together they occupy only 10-12 percent of the total land area — often described as ‘encroached land’.

Even where the land deeds are disputed, or in some cases where the land is officially recognised by the government, their land rights are not accepted, their homes are demolished and they are evicted from their place of residence without any resettlement and rehabilitation. The new Bill is not going to provide any relief to them as it is enacted in a rural framework and so a separate legislation to address the urban displacement is necessary.

Lastly, while the government says that the new Bill has better rehabilitation and resettlement clauses, it does not provide those who lose land with sustainable livelihood options or land for land. The whole framework revolves around increased monetary compensation, though most of the marginalised communities need secure means of livelihood more than money. Adivasis and Dalits, who are the most vulnerable and are often cheated because of their ignorance and illiteracy, will be further impoverished and end up in penury within years of losing their livelihood and migrating to cities, putting the whole economy and urban infrastructure under severe strain.

The number of people who face loss of livelihood because of land acquisition is so huge that they cannot be accommodated within the industrial and services sectors. So, while we are forcibly pushing people out of agriculture, we are not creating adequate educational or technical alternatives for them. The State is acquiring land in the name of public purpose and industrial growth, but we need to rethink how we define ‘development’.

We have to acknowledge that India is a country of 1.2 billion people. The kind of development the government is promoting caters only to the top 20 percent of the population. The government is revising the 1894 Act after 120 years to further growth and development, which gives it a historic opportunity to change how acquisition takes place. We should not lose this chance to create a policy that helps make India’s citizens participants in the development planning of the nation.

The key issue of citizens taking part in planning development remains unaddressed. The 73rd and 74th Constitutional amendments, which empowered local self-governance institutions in rural and urban areas, have not yet been fully implemented. Their power is being taken away by the creation of other authorities and governance structures that interfere in the exercise of local institutions’ authority, thereby violating the Constitutional rights of the people.

Union Rural Development Minister Jairam Ramesh takes pride in the fact that the new Bill is an attempt at balancing the needs of the country. Since the likes of Medha Patkar and the industry associations are both unhappy, it means he is doing something right.

However, lest he forget, the laws framed by governments are neither for Patkar nor for the industry bodies, but for the citizens and the values enshrined in the Constitution, which recognises the supremacy of the citizens, and professes ideals of growth with justice and equity and a respect for the fundamental rights of the citizens that the new Bill violates.




Out of shadow, PPPs at last come under RTI ambit

DoPT issues guidelines providing for suo motu disclosure of all information relating to PPPs under RTI Act

Prasanna Mohanty | New Delhi | April 17 2013, Governance Now
In a dramatic turnaround, the union government has now opened up public-private partnership (PPP) projects to public scrutiny.
The move comes in the wake of a fresh set of guidelines issued by the department of personnel and training (DoPT) on April 15. Till now any information sought through the RTI Act was stonewalled not only by the union government but also the state governments.
DoPT guidelines make it clear that “all information relating to PPPs must be disclosed in the public domain” henceforth suo motu, as per provisions of section 4 of the RTI Act.
This will gladden the hearts of all those fighting for accountability and transparency in the way PPP projects are being implemented in the country. Most big-ticket projects in the infrastructure sector, like roads, ports, airports, power, water supply, irrigation and telecommunication are being carried out under the PPP model. And for a while PPP projects are being seen as “public money for private profit”.
Social activists have been fighting for years to get information about PPP projects in vain. The fight that started in January 2011, with RTI activist Venkatesh Nayak approaching the CIC to get information about PPP projects, has succeeded in breaking down the wall.
DoPT’s guideline of April 15 says: “If public services are proposed to be provided through a public private partnership (PPP), all information relating to the PPPs must be disclosed in the public domain by the public authority entering into the PPP contract/concession agreement. This may include details of the special purpose vehicle (SPV), if any set up, detailed project reports, concession agreements, operation and maintenance manuals and other documents generated as part of the implementation of the PPP project.”
It adds: “Further, information about fees, tolls, or other kinds of revenue that may be collected under authorization from the government, information in respect of outputs and outcomes, process of selection of the private sector party may also be proactively disclosed. All payments made under the PPP project may also be disclosed in a periodic manner along with the purpose of making such payments”.
The stumbling block
In issuing guidelines for suo motu disclosures, the guideline admits that “the quality and quantity of proactive disclosure is not up to the desired level” and a part of the problem is that certain provisions of the RTI Act “have not been fully detailed”, and that in case of some “there is need for laying down detailed guidelines”.
Seen as the biggest stumbling block, Montek Singh Ahluwalia, deputy chairman of the planning commission, has publicly opposed every attempt to throw PPPs open to RTI by stating that it would inhibit private investment. He also contended that since PPPs are contracts with private entities they don’t come under the purview of the RTI Act.
The planning commission is the nodal body for PPPs.
Things took a turn for better when CIC wrote to the planning commission in January 2011 and sought modifications within PPP agreements to ensure public disclosure of details related to infrastructure projects being funded by the public exchequer. The DoPT supported CIC, but instead of legal changes suggested that the planning commission should draft the PPP agreement in a way that allows the government agency to disclose information on behalf of the private entity.
The planning commission opposed this and referred the matter to the law ministry.
In March 2011, Ahluwalia issued a statement clarifying his position. The statement said: “It is further clarified that concession agreements are executed by the respective ministries and not by the planning commission. So far as the planning commission is concerned, it has published several model concession agreements (MCAs) for PPP projects. These MCAs provide for full disclosure of the concession agreement, the maintenance manual, the maintenance programme and maintenance requirements in respect of each project.
“Where an MCA is followed, any person can obtain certified copies of these documents from the respective concessionaires.” (emphasis added)
But even after this statement, Ahluwalia publicly opposed throwing open PPPs to provisions of the RTI Act.
But DoPT set up a task force to look into the issue. In August 2011, the task force, which included civil society activists, favoured suo motu disclosure. The report was then referred to the PMO.
Apparently, after the PMO’s clearance, DoPT issued the guidelines on April 15.


Privatisation of radiological services opposed

Ananya Banerjee : Mumbai, Mon Mar 19 2012,

The decision of the state government to privatise radiology services in 14 government medical colleges and all district hospitals in the state has not gone down well with the healthcare professionals, trade unions and NGOs.

At a state-level convention held on Saturday, members of these organisations have unanimously opposed the move expressing their fear of further privatisation of the public health sector.

“Following the Seven-Hills debacle, the state government should have known better than to involve the private sector into the public domain. What the government is calling a Public Private Partnership (PPP) is actually a back door entry for private organisations. There is no need for PPP if the existing public health system can be strengthened,” said activist Kamyani Bali Mahabal.

While announcing the move to privatise the radiology services a few months ago, additional chief secretary Jayant Kumar Banthia had said that government hospitals had been unable to run efficiently due to the lack of competent staff. Paucity of funds was also stated as one of the reasons for the privatisation.

“There are hospitals in the public sector like Bhabha Hospital in Mumbai and the All India Institute of Medical Sciences (AIIMS) in Delhi which are functioning smoothly. Once the staff is sufficiently trained, better treatment can be provided. As far as funds go, if the state government puts forth a planned proposal to the Centre seeking funds for the health care, then there will be no need to resort to privatisation,” said Dr Anant Phadke, member of the Jan Aarogya Abhiyan.

A petition having the signatures of 171 people from across Maharashtra has been sent to Vijay Kumar Gavit, Maharashtra health and education minister, seeking a withdrawal of the proposal.

However, there are those working within the public sector who feel that privatisation will help in boosting the quality of treatment in public hospitals.

“ Most of the public hospitals are understaffed. Technicians have to be trained separately to operate MRI and CT scan machines. If trained personnel are deployed to operate the machines, it will lead to better utilisation of manpower,” said a senior doctor from JJ Hospital.

“Machines worth crores have been sold off as scrap as no one knows how to use them. If trained people provide services, the quality of treatment will improve,” another doctor from JJ Hospital said.


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