Alliance for Defence of Health Services and Rights is a newly emerging joint initiative of various social organisations working in the field of health, along with trade unions and federations of health sector employees in Key demands of the Alliance.
This alliance has been established for strengthening public health services and defending rights of both health sector employees and people using the health system.
Key issues being raised by the alliance include inadequate budget for health care, lack of guaranteed health services, massive shortage of essential medicines, large sale vacant posts, corruption and lack of transparency in health systems, adverse policies of contractualisation and privatisation, poor working conditions for frontline health staff, and most importantly, the need to restore political will which is urgently required to improve the public health system.
Given this background, the alliance is being formally launched on November 26, 2018, by organising a ‘Convention for commitment to build joint movement on Health Rights’ (Nirdhaar Parishad) in Mumbai. This convention will finalise the key demands to be taken up in coming period and will initiate a sustained combined movement by all involved organizations, to resolve various long pending issues related to health rights of the public as well as rights of health sector employees.
This will be done through developing a state-wide campaign targeted at Maharashtra State Government, as well as various political parties and representatives during the run up to national and state elections next year.
Convenors of the Alliance include Dr Abhijit More, Dr Narayan Joshi, Shankar Pujari, M.A. Patil, Salim Patel, Bhagawan Deshmukh, Shrimant Ghodake, Dr Manoj Khomane, Suman Tilekar, Avinash Deshmukh.
Key demands of the alliance, towards defending public health services and promoting various rights are as follows:
- Provide essential medicines: Keeping in view the massive and continued shortages of medicines in government hospitals and health centres across the state, radical changes need to be made in the drug procurement and distribution system in Maharashtra, which must be on war-footing. These changes should be on the lines of effective medicine systems in Tamil Nadu, Rajasthan and Kerala. Based on such policy changes, all essential medicines must be provided to the people of the state in government health system as soon as possible.
- Ensure guaranteed health services: Quality health services must be ensured to people approaching all public health facilities in the state. The current Service Guarantee Act is limited to only provision of certificates and does not cover actual health services. Citizens must be assured of all necessary treatment, medicines in government health centres and hospitals. All required equipment, medicines, laboratory and imaging services needed for the patients must be provided in adequate manner ensuring such guaranteed access to quality public health care. There should be strict implementation of ban on private practice by government doctors.
- Implement Health Human power policy: Current policies of relying on contractual appointments and privatization must be abolished. Instead, a new comprehensive Health Human power Policy for the state, based on strengthening public health services with regular staff appointments, must be formulated and implemented. This would ensure provision of adequate compensation to all health workers and doctors at various levels, good working conditions and periodic promotions.
- Fill all vacant posts: Since Health is an extremely essential service, vacant posts of employees at all levels in the government health system at various levels should be filled promptly. Regarding the contractual and honorarium workers in the government health system, until they are regularised they should receive equal pay for equal work.
- Eliminate corruption and ensure transparency in staff management: Recruitment of all Health employees and doctors, as well as promotion and transfer process must be made corruption free and transparent. Open counselling system should be used to ensure responsiveness and fairness in postings and transfers. Overall corruption in the public health system especially in construction, procurement and staff management should be eliminated through transparent and accountable systems.
- Stop all forms of privatisation of health services: All proposals for privatisation and weakening of government health services in different forms (e.g. handing over PHCs and District hospitals to private bodies on ‘PPP’ basis, outsourcing of laboratory services) should be cancelled and replaced by planning for strengthening of these services within a public framework.
- Major increase in state health budget: Only 0.48 per cent of the state’s GDP is spent on public health. Health budget is only 3.64% of the total budget of the Government of Maharashtra. According to the 2018-19 budget, per capita public health spending in Maharashtra is only Rs. 1001 rupees, while the national average is Rs. 1560 per capita. Hence major and sustained increase in public health budget is essential, which must be increased by 50% in the coming financial year. Maharashtra’s health budget is should be increased to Rs 18,000 crores in 2019-20 and similar increase should be continued on annual basis.
- Rights of ASHAs: ASHA workers should be recognized as workers. They should be paid minimum wages of Rs. 18000 per month for full time work; this should be linked to the inflation index. They should receive a pension of 3000 rupees per month, Provident fund, Gratuity, health care cover for family and other social security. The recommendations of 45th Indian Labour Council should be implemented.
- Rights of ASHA facilitators: ASHA facilitators should be recognised as workers. They should be paid Rs. 21000 per month for full time work, this should be linked to the inflation index. They should receive a pension of 5,000 rupees per month, Provident fund, Gratuity, health care cover for family and other social security. The recommendations of 45th Indian Labour Council should be implemented.
- Interim hike in honorarium for ASHAs and facilitators: Until the minimum wage is implemented, the minimum honorarium for ASHA worker should be at least Rs. 10,000 and the ASHA facilitators should be paid a minimum of Rs. 15,000 per month. While providing honorarium, additionally years of service and higher education should be considered.
- Rights of medical officers: Medical officers should be required to work only 8 hours per day. To ensure this, number of posts of medical officers should be increased according to requirement. To ensure career mobility for these serving doctors, Dynamic Assured Career Progression should be implemented.
- Rights of nurses: All vacant positions of staff nurses (in Public health and Medical education departments) must be filled immediately. The post of Sister in charge in rural hospitals (CHCs) has been abolished – these posts should be restored and filled promptly. A special nursing directorate should be set up to resolve the problems of nurses regularly and with adequate priority.
- Rights of pharmacists: The contractual system of appointments should be eliminated and all hospitals should have regular pharmacists. Raise the number of posts of pharmacists according to scale of outpatient flow in facilities. There should be a directorate for management of pharmacy services and proper promotional avenues for pharmacists should be ensured, including supervisory and gazette posts.
- Issues related to veterinary staff and addressing zoonosis: There is need to address various diseases transmitted from animals to human beings (zoonosis). Government should put in place a state level mechanism to prevent, monitor and treat such diseases.