Struggle against outsourcing of diagnostics in Chhattisgarh

JSA Chhattisgarh

The proposal and JSA’s 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

Number of facilities

Category-A Category-B Category-C

Total facilities to

be outsourced

Total facilities in

the state

District Hospitals 10 12 22 27

Civil Hospitals 8 8

CHCs 46 (FRU) 103 (Non FRU) 149

PHC (24*7) 200 200

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

JSA’s 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 centresCritique• 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.

PaymentsThe 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 themselvesCritique:• 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 systemCritique• 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

Govt’s 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-Agitate- Be visible