Save public health care
The Maharashtra government is making moves to sell a newly-constructed wing of the state-run G.T. hospital in Mumbai to a private party to set up yet another private super-speciality hospital. At the same time, user charges have been introduced at all levels in municipal corporation hospitals.
These moves are part of a larger trend. Under the instructions of the International Monetary Fund and World Bank, the government has been steadily withdrawing even its minimal commitments to the poor. Even as liberalisation increases our already high unemployment levels, forcing more people into subsistence labour, ration subsidies have been reduced sharply, cooking fuel costs have shot up, and so on. Such policies have contributed to malnutrition, dangerous working conditions and the absence of clean water and sanitation — all of which make the poor even more vulnerable to disease, even as the withdrawal of public health services puts treatment further out of their reach.
Mumbai has 80 municipal and state government hospitals and nursing homes, with 20,700 beds. 235 dispensaries and clinics, and 176 health posts. The municipality and state government spend Rs 540 crore on these facilities, which provide essential care to the city’s poor. These include five teaching hospitals which have trained thousands of doctors while providing essential tertiary care to the poor.
Municipal hospitals have not been “free” for many years. Poor people have had to pay for disposables, tests, and even out-of-stock drugs. Those who cannot pay are deprived of life-saving treatment.
The new user charges are levied at every stage, from case papers to diagnostic tests. People must pay Rs 10 for a new OPD case paper, and another Rs 10 for repeat visits after more than 14 days. Tests such as the stress test, and life-saving super-speciality operations, earlier done free, are now charged an astronomical Rs 500 and Rs 5,000 respectively. Existing user charges for most tests, ICU bed charges and various treatments have been hiked by between 67 and 233 per cent, and are expected to rise further.
The government’s moves are direct attacks on the right to health as a fundamental human right.
Over the years, the government’s already-low commitment to public health services — only five per cent of total government expenditure in 1960 (compared to the WHO-recommended five per cent of GDP) — has declined to just 2.5 per cent today. An increasing proportion of this goes for family planning.
From the 1980s onwards, investment in health facilities has stagnated. At the same time, both OPD and in-patient use of public facilities dropped sharply, as a ratio of overall services and in absolute numbers. Dispensaries are not supplied medicines, diagnostic materials and maintenance costs, increasing pressure on tertiary care hospitals to provide primary health care. The focus of public health services has also changed from integrated, comprehensive health care to selective, target-oriented programmes.
At the same time, the private sector has grown rapidly, and without regulation. Its services are more accessible but of variable quality, and come at a price. It has come to provide the bulk of out-patient care in the cities, with over four-fifth of health care costs being borne by individual households.
Public health facilities have declined sharply in their efficiency, efficacy and availability. Yet the public sector still provides about two-thirds of in-patient care in the city. This includes the state government’s GT hospital. Public health services are used by the poorest of the poor. It is these poor who are worst hit by user charges and current moves to privatise existing public health institutions.
Despite the crucial role the public sector plays in health care provision, the government has increased its efforts to weaken it:
- Inadequate budgetary allocation means medicines are not available in public dispensaries and hospitals — shifting the burden to patients.
- Patients in public institutions are forced to get tests done outside the hospital, further adding to their financial burden.
- Existing user charges for various services in public hospitals are now being hiked to virtually market levels.
- Many non-medical services in hospitals have been privatised or out-sourced.
- Public institutions are being handed over to the private sector.
What does it mean to the people?
People use government services because they have no other option. User charges are known to keep people from seeking life-saving care. People already overburdened with other expenses are forced to ignore critical health problems. When they eventually seek care, they must borrow money to pay for treatment, whether in public or private facilities. Health is the second largest cause of indebtedness in India.
We demand that the state government and the Brihan-Mumbai Municipal Corporation:
- Remove all user charges for services in dispensaries and hospitals.
- Raise medicine and maintenance budgets for existing dispensaries, and honour its commitment for one dispensary per 50,000 population. Rationalise hospital services through referral systems and strengthen dispensary-hospital linkages.
- Increase budgetary allocations for non-salary components like medicines, equipment, maintenance and medical records to improve efficiency, efficacy and patient satisfaction. Regulate the private sector and organise it under a public-private mix so that it becomes part of the public domain.
Foundation for Research into Community Health, Association for Consumer Action in Safety and Health, Indian Centre for Human Right and Law, Centre for Enquiry into Health and Allied Themes, Medico Friend Circle, IWID, Committee for Protection of Democratic Rights, Janwadi Mahila Sanghatan, Bluestar Union and Trade Union Solidarity Committee, Municipal Mazdoor Union, Indian School of Social Sciences, Bombay Municipal Nursing and Paramedical Union, Forum for Medical Ethics Society, Lokshahi Hak Sanghatana, Centre of Indian Trade Unions, Forum for Women’s Health, Vacha, Prayas