Discussing the National Health Bill

1. Discussing the National Health Bill Need to address both text and context – towards a comprehensive campaign strategy

2. Key questions • What kind of political will exists for this bill? What is today’s political economy context? • What are the core objectives we want to achieve through the bill itself and how do we reshape the bill for this? • Which changes and modifications must be made in the bill? • Which other legislations need to be influenced to complement provisions in the bill? • Which core elements of the bill are positive and need to be protected from dilution or distortion? • What kind of Health system and Social system changes are required to make the act operational, without which it would remain on paper? • What kind of socio-political process and campaign is required to ensure all the above are addressed in a pro-people manner?

3. Where is the ‘will for the bill’? • Contradictions of ‘Globalisation with a human face’ – continuing onslaught of corporate globalisation accompanied by some social legislation and programmes (NREGA, Forest rights act; problems with Rt. to education and emerging food security act) • Strong official tendencies to strengthen PPPs, or to continue limited ‘safety net’ approach to public health system with targeting and user fees • In this context Govt. political will for right to universal, comprehensive free health care with major regulation of private sector appears weak – this will must be built from below through social and political mobilisation if it is to be achieved

4. Core objectives we want to achieve through the act • Legal and operational entitlement to comprehensive, universal access to free health care • Comprehensive set of Health rights and patients rights to be enjoyed by all • Additional entitlements and rights for various sections with special health needs or conditions • Health system obligation to activate and ensure provision of social determinants of health, to ensure basic rights to food and nutrition, water, sanitation, environmental conditions etc.

5. Major modifications required in Bill • Section 3c. – Universal access to free health care is a comprehensive entitlement, within which there should be no prioritisation. Based on this foundation of universal access, add additional services and entitlements for sections with special needs. • No scope for ambiguity which may allow any form of ‘targeting’ esp. based on BPL

6. Major modifications required in Bill • Universal Free health care implies no user fees in the public health system which must be made explicit • Dominant form of ‘PPPs’ need to be explicitly rejected – instead social obligations of private providers and utilising private resources for public health strengthening based on overarching principles e.g. no reduction in responsibility of public system; all publicly funded services would be regarded as public services meeting same norms for accountability, standards, employees and patients rights etc.

7. Major modifications required in Bill • Section specifying population based norms for public health facilities ensuring no dilution in their role • Section specifying no privatisation of public health facilities or dilution of public health obligation • Section on ‘Certificate of need’ for all new private providers be added to restrict their proliferation • Mechanisms for ensuring rationality of care in both public and private health sectors • Major section on obligations of Health departments in activating and ensuring various key health determinants

8. Major modifications required in Bill • Provision of minimum proportion of budget to be allocated for Public health at National, State and Local body levels • Separate section on Urban health taking into account specificities (outreach coverage, homeless and migrant people) and different population based norms • Separate section on Work and health as a key determinant as well as area of services and social protection

9. Core positive elements in the Bill to be protected or strengthened • Overarching Rights based framework • Entire set of Health rights which apply across Public and private health systems • Comprehensive scope encompassing health care as well as determinants of health • Monitoring (incl. community monitoring) and redressal mechanisms

10. Other legislations which need to need to be brought in line with NH act • Clinical establishments registration act • Factories act, Workmens compensation act, ESI act, Mines act etc. • Pharmaceuticals act and regulations • Emerging food security act • Environment protection act etc.

11. Which complementary health system changes are required? In the Public health system • Abolition of user fees in all public health facilities (presently have been more or less universalized through Rogi Kalyan Samitis) and removal of all types of targeting (esp. based on ‘BPL’ criterion) which presently exclude any users • Expansion of Public health facilities in both rural and urban areas, bringing these to meet adequate population based coverage norms • Expansion and assured delivery of ‘Guaranteed health services’ at all levels, making these comprehensive, and converting these into assured entitlements, which can be effectively claimed with the help of specified mechanisms

12. Which complementary health system changes are required? Concerning private medical sector • Comprehensive legal and operational regulation of the entire private medical sector, including health care process standards and patients rights, rational treatment guidelines; effective community based monitoring and redressal mechanisms to ensure that these are observed • Organising a system for social / public management of the mandated free beds for ‘less affording’ patients in Trust hospitals, ensuring that these large number of beds are actually regularly provided free of charge; this would be a step towards socialization of large scale health care resources in Trust hospitals • Certificate of need provision to prevent proliferation of private hospitals in overserved areas • Developing a well defined and realistic plan for progressive socialization and rationalization of health care resources in the private medical sector

13. Where would political will come from? • Given weak and problematic nature of Govt. will, we need to build broadest possible social and political mobilisation in favour of a comprehensive Health act and health system changes Three pronged strategy required: • Large scale discussion and mobilisation related to modifications and pushing for a modified, strengthened act • Proposing ‘People’s Health Policy’ containing related policy measures • National ‘Right to health – Universal access to health care campaign’

14. Towards a ‘Right to Health’campaign • Need to significantly broaden JSA and involve large number of organisations working in the health sector in existing and new states • Need to interact with other health sector specific networks such as those working on mental health, HIV/AIDS, child health etc. • Develop ‘social sector alliance’ with linkages to Right to Food campaign, Water rights networks, Environmental networks, Trade unions and organisations working with unorganised sector workers • Interaction with progressive political forces to ensure their proactive political action A massive social-political mobilisation is required to make a genuine ‘Right to health’ Act a reality!