Struggle against outsourcing of diagnostics in Chhattisgarh

JSA Chhattisgarh

The proposal and JSAs critique

Context of the proposal

State PPP Policy written Huge no. of PPPs floated at once- Mobile Medical Unit, functioning of CGMSC, Primary health centers, Referral transport, school health programme All in the name of reaching the unreached, improving access in underserved, rural, tribal, remote areas

 Outsourcing of radiology and lab services in 379 public health facilities Agreement for 10 years with annual renewal
Type of Facility
District Hospitals Civil Hospitals CHCs PHC (24*7) Number of facilities Total facilities to Category-A Category-B Category-C be outsourced 10 12 8 46 (FRU) 103 (Non FRU) 200 22 Total facilities in the state 27 8 149 200

District Hospitals

10

12

22

Geographical Area
First divided into 4 divisions- Sarguja, Bilaspur, Raipur and Bastar Later forced to club Tribal/remote region with mainstream districts as no bids for those

JSAs critique
Bulk Coverage ALL Community Health Centers (CHCs) in the state; 80 % of the District Hospitals (22 out of 27 District Hospitals); 8 out of 17 Civil Hospitals; and 200 of the best functioning Primary Health Centers (PHCs) in the state

Services to be provided
Radiology and laboratory services Three category of services Upto25% of category-C centres may be allowed to function as collection centres Critique Not an interim arrangement Replacing existing diagnostics services: Existing services not improved or expanded Lack of Match between Lab Services proposed and availability of Specialists/Doctors

Eligibility and operating procedures

Private profit or not-for profit Avg turnover of Rs. 4 to 6 crorein last 3 yrs NABL accreditation not necessary Can further contract it out to a concessionaire Each to be maintained as a business centre

Concessions and Rates

Space and electric meter provided by Hospital management committee Freedom to serve external customers Will get right to first refusal in expanding this network Rates will be those approved for non-NABL accredited centre in Delhi under CGHS.

Payments
The payments will be made by Hospital Management committee for the following patients: Patients being treated under National and State Health Insurance Scheme BPL patients under OPD treatment Rest will pay for the services themselves Critique: Insurance covers only in-patients Irrational practice and malpractice in insurance reflected in diagnostics too Free to serve external patients- possibilities for mixing

Cost to patients
Only costs of Below Poverty Line (BPL) outpatients covered As per GoI- 18.75 lakh families BPL Chhattisgarh Food Security Act 2012- 42 lakh families (75% of families in the state) as poor 23 lakh families identified as deserving support for food but not free healthcare! What about Govtprogrammes like malaria, sickle cell, TB and those under Mother and Child Health Programme will people have to pay for those?

Monitoring
Monitoring by third party monitoring system Critique 3rd party monitoring mechanism will remain ineffective if Govt is not able to monitor

Experiences in other states ignored

The 6th Common Review Mission clearly states that similar privatisation in Bihar has been a complete failure and led to: Increase in costs Reduction in availability collection centers Reduction in quality- Accuracy and reliability of test results is doubtful High turnaround time Govt. lab technicians without work In-house labs under utilization and dysfunctional

Our demands
STOP privatisation of diagnostic services in public hospitals Fill posts of lab techs and radiographers Recruit/train local youths from marginalised communities Modify 24 year old recruitment rules Multiskilling training for existing lab techs Every health facility should be equipped with adequate HR, equipment and supplies Make public health services more responsive and accountable to people STOP privatisation of health services and strengthen public health services

The Struggle

Getting the message out

 Critiquing the proposal Memorandums to Governor Evidence building-RTI on Lab services and feasibility study, Rapid survey of facilities Connecting with trade unions and other stakeholders

State level Rally and Press conference

District level events and signature campaign

State level Silent March

Other actions
Representations made to Chief Secretary, Finance Secretary and other senior govt officials Representations made to GoI Team from GoI comes to study this proposal and critiques it NRHM refuses to fund this proposal

Government stalls project

The struggle-1
Building awareness Critiquing the proposal point by point Evidence building Partnership with all stakeholders Rapid survey of health facilities Use of RTI

The struggle-2
District/block level action State level Rallies Signature campaign Media advocacy Advocacy with critical persons in the state government Advocacy with Central Government Relentless pressure

keep awakes
Despite evidence : Private hospitals holding govt to ransom for higher rates, eg. In insurance Negative outsourcing/PPP experiences Evidence of denial of patients rights Obvious push from the pvt healthcare sector to demand more public funds

Govts response : Reducing public health expenditure in the name of fiscal consolidation Promotion of PPPs Leading to : Weakening of public health system Active & Passive privatisation Denial of access to free and quality healthcare for the poor

Monitor-Critique-Organise-AgitateBe visible