Education today: moving towards

commercialization and saffronization

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INDEX

Introduction 5
Education today 4
 Health in India: the story of deep neglect
E xtreme inequality in access to health care services and the
poor living conditions of a majority of the people are responsible for
the poor conditions of health in India. While people who can pay are
able to receive world class treatment facilities, for most people in India
a major illness in the family plunges the family into extreme poverty
and destitution.
Not only are healthcare facilities out of reach for most people,
routine public health measures to protect our people are denied to a
majority. India continues to figure among the bottom in global estimates
regarding deaths among infants and young children and among pregnant
women. India lags behind most countries, including many much poorer
than us, even in providing routine immunization to children.
India is also currently experiencing a ‘multiple burden of disease’.
Several preventable infectious diseases are growing unchecked, nutrition-
linked health problems (gross under-nutrition coexisting with a rising
trend of obesity) continue to affect millions, while chronic health
conditions are rising substantially.
Every family in India dreads a medical emergency. When a family
member falls ill, we pay from our pocket – often by selling our assets
or by borrowing. Thus the poor are either denied care because they
cannot bear the expenses or the family gets pushed to further poverty
and destitution. As families cope with health shocks the vicious cycle
of poverty and ill-health continues. Poor health services in the country
5 .................
are a tale of deep apathy of successive governments towards the suffering
of a majority of the poor and the vulnerable. Those in power have
contributed to the systematic neglect of the public health system on
one hand and to an aggressive expansion of unaffordable, often
unnecessary, unethical and low quality private health services on the
other.
In this booklet we highlight some of the key issues pertaining to
health of millions of Indians and raise some of the key demands for
improvement of access to quality health care.
Poor Conditions of Health
One-fifth of world’s children who die before their fifth birthday
are born in India, while the highest number of mothers who die while
giving birth are from India. We perform poorly in comparison to
most countries in the world, including most developing countries. Even
in our region, only two countries lag behind India. See Box 1 to
understand how we continue to be one of the worst performing
countries in the world as regards healthcare and health outcomes. A
survey of 179 countries across the world shows that India is among
the least safe countries to be a mother (Save the Children, 2015). High
undernourishment prevalent among women in the reproductive age
group, coupled with low coverage of care during pregnancy (ante natal
care – ANC) make women vulnerable at the time of delivery and lead
to complications. Millions of children die every year from preventable
diseases because they are not immunized and from hunger and
malnutrition. Over one-third of our children do not get enough food,
a rate that is comparable or worse than some of the poorest countries
in Africa. Children die routinely from common diseases like diarrhea
and pneumonia because of lack of access to safe drinking water, lack
of sanitary facilities and absence of free public facilities for treatment.
Surveys show that only 68.7 % of women have received three
antenatal check-ups, only 26.3% of pregnant women have consumed
more than 100 iron and folic tablets and only 61% of children (12 -23
months) have been fully immunized.
India ranks 119thof 169 countries in Human Development Index
(HDI)

Education today 6
 India ranks 140th of 179 countries as the best place to be a
mother (State of World’s Mother 2015)
India is placed at 67thof 84 countries in Global Hunger Index
(GHI)
More than a fifth of under five deaths per year, take place in
India – the highest anywhere in the world; a majority of these deaths
are preventable
More than 100 million children under five are undernourished,
and 8.5 million suffer from severe acute malnutrition.
Only half of children under five receive routine immunisation
(National Family Health Survey III)
Only about half (52%) of deliveries are safe: (National Rural
Health Mission)
Only one-third of children having diarrhoea receive ORS (State
of the World’s Children, UNICEF, 2011)
Pneumonia: 69% taken to hospital and only 13% receive
antibiotics (SoWC, 2011)
Only half of the pregnant women receive 3 or more check ups
before delivery
Box 1: Where do we stand in protecting our people’s
health?
Table 1: A cross country comparison of key health
outcomes and outputs
Brazil Russia India China SouthAfrica Thailand Sri Bangla

Lanka desh

Physicians per 1000 population 1.76 4.3 0.7 1.94 0.8 0.4 0.7 0.4
Nurses per 1000 population 6.4 8.5 1.7 1.85 4.9 2.1 1.6 0.3
Hospital beds per 1000 population 2.4 9.7 0.7 3.8 2.8 2.1 3.6 0.6
Institutional delivery 97% 99.7% 73% 99.8% 91% 99.5% 98.6% 32%
Maternal mortality ratio per
100,000 live births 69 24 190 32 140 26 29 170

Life expectancy 73.6 70.5 66.2 75.1 56.1 74.2 74.1 70.3

7 .................
 As we can see from Table 1, India fares poorly in comparison
to even developing countries, including our immediate neighbours Sri
Lanka and Bangladesh.
The state of public health is clearly depicted by the fact that we
are not able to protect a large number of children from vaccine
preventable illnesses. Childhood vaccination is regarded as one of the
most cost effective interventions to prevent child deaths. A third of the
un-immunized children across the world are in India. Large inequalities
in immunization coverage persist in India, across and within states and
according to wealth, caste, religion, location etc. Children from the
richest wealth group are 2.5 times more likely to be immunized than
their poorest counterparts. It is distressing to note that states which had
performed well earlier (as per data available in 2005-06) have slipped
back over the last ten years, including Tamil Nadu, Haryana, Uttarakhand
and Maharashtra (Fig 1). Most significant is the decline in TN. From
being among leading states in terms of full immunisation coverage, the
state has experienced a dramatic 11.2 percentage point decline. The
major reason for stagnation or decline in overall immunisation coverage
is decline in coverage in urban areas. Most noteworthy is the decline in
Haryana (from 82.2 to 57%), Maharashtra (68 to 55.8), Tamil Nadu
(83.7 to 73.3) and Uttarakhand (67.2 to 56.5).
Figure 1 Children below 23 months fully immunized (Total) (%) Source:
National Family Health Survey 2015-16, State Fact Sheets.

Education today 8
Health of Women and Girls
Discrimination faced women and girls have a lasting and tragic
impact on their health status. Data from National Family Health Survey
(NFHS) shows that child deaths rates for girls are 61 per cent higher
than those for boys after the first month, all the way up through age
four. Among 15-19 year olds in the country, complications during
pregnancy are the leading cause of death. As many as two out of three
adolescent girls living in India’s backward districts have experienced
sexual violence.
Maternal death rates continue to be very high (at 190/ 100,00
live births, one of the highest rates in the world). Maternal deaths are
highest amongst young women, while girls continue to be married off
before the legal age of marriage. Too many girls become pregnant
before tyhey are old enough and before their bodies are ready for
pregnancy. This combined with malnutrition and anemias ensure that
young women, many still in their teens, die during pregnancy. Women
also continue to die around child birth because health facilities in many
parts of the country are not equipped to provide emergency care to
them when complications arise, the quality of care during pregnancy
available is inadequate, and safe abortion services in the public sector
are inaccessible for the majority of women. Quality contraceptive
services as are not provided according to what women need. Instead
women are targeted for hysterectomies to achieve family planning
camps. Horrendous accounts surface periodically of how women are
herded into unhygienic and under staffed hysterectomy camps.
The burden of communicable, non-communicable diseases and
mental distress is also seen more in women. Sexually transmitted diseases
amongst women remain undiagnosed, and when diagnosed can have
drastic social consequences for them. Heart attack and stroke are more
lethal for women, and depression twice as common. Women over the
age of 60 years have greater disability and suffer more from ill health
than men of the same age-group, due to delays in or lack of health-
seeking, mismatched care provision (as women are under-represented
in health care delivery systems and in research, particularly related to
chronic diseases).

9 .................
 Gender-based violence is extremely high, with as many as 40.3%
of women reporting at least one instance of physical abuse. There
seems to be an epidemic of sexual violence against women in recent
years. Mental and physical consequences of violence against women
need to be addressed by the health sector.
Neglect of public health system
In most countries where people have near universal access to
health care, it has been achieved through a well-functioning public health
system. Here we may note that while a well functioning system to
provide universal access to care is a necessary condition for good health
outcomes, it is not sufficient on its own. Good health is a result of
better nutrition, safe drinking water and sanitation, universal access to
education, gainful employment and equitable and inclusive development,
better working and living conditions, control over addictions as well as
environmental pollution and an end to various forms of discrimination.
Reduction in poverty itself contributes immensely to improved health
outcomes.
A strong, comprehensive public health system is the most efficient
way to provide appropriate health care. It creates a separation between
health care needs and people’s ability to pay for healthcare. It also allows
much stricter control of health care costs, serves as an effective check
on unregulated growth of the private sector and helps prevent unethical
practices in the private
Figure 2 : Government Hospital Beds per 100, 000 people
sector. However, in
India the public health system
has experienced continuous
neglect, systematic under-
investment, provisioning of a
select set of services and a
‘targeted’ approach. The
introduction of National
Rural Health Mission had
introduced some efforts to
strengthen public systems for
a limited set of services;
Education today 10
however recent trends show that there is a reversal already taking place
due to cuts in budgets.
India’s poor investment in health care translates into a failure to
create the necessary health infrastructure, or to build a health workforce,
or to ensure availability of necessary equipment, diagnostic facilities
and medicines. We are just not adding enough beds in public hospitals
or enough doctors and nurses to make public services effective.
After the introduction of some public health measures under
the NHRM, some improvements did take place. Services of close to
23,000 doctors, 35,000 nurses and 70,000 ANMs and 10,000
management staff were added under the NRHM. However as
compared to the government’s own Public Health Standards, this is
less than one-third of the total number of public health workforce
that is required. Further the terms of engagement of these staff were
extremely adverse -- almost all of the additional staff under NHRM is
contractual, with remuneration packages often less than half of the
regular staff that does the same work, and with no security of tenure.
There continue to be substantial shortfalls in the number of Sub-
Centres (SC), Primary Health Centres (PHCs) and Community Health
Centres (CHCs) across states. Nationally, there are only 0.16 facilities
for every 10,000 persons, and there are approximately 5.5 government
beds for every 10,000 persons. Outpatient visits have nearly doubled
from 55 per 1,000 persons in 1995-96 to 100.7 per 1,000 in 2014, with
more marked increases in urban as compared to rural areas. Inpatient
episodes increased nearly three-fold in the same period, from 15 per
1,000 persons in 1995-96 to 44 per 1,000 in 2014. Yet the number of
beds in the public sector, per 10,000 population has remained stagnant
since the 1980s.
For SCs, nearly 21 states had shortfalls ranging from 4.4% in
Jammu and Kashmir to 50.6% in Delhi. Uttar Pradesh (33.9%),
Jharkhand (34.5%), Meghalaya (46.6%) and Bihar (47.7%) also have
high shortfalls in the number of SCs. For PHCs, the states of Uttar
Pradesh, Delhi, Bihar, Madhya Pradesh, West Bengal and Jharkhand
had shortfalls ranging from 28.6-69.8%. For CHCs, states with shortfalls
above 30% included Madhya Pradesh, Maharashtra, West Bengal,
Andhra Pradesh, Karnataka, Sikkim, Assam, Tripura, Uttar Pradesh,
11 .................
 Bihar and Delhi. Nationally, the shortfall was: SCs, 20.1%; PHCs, 24.1%;
and CHCs, 37.9% (GoI, 2011). More than three quarter of Sub-centres
(76.4%) do not have any water supply. Piped water is not available in a
majority of PHCs (63.3%) and CHCs (54.6%). Almost a third of PHCs
(32.5%) do not have a functional labour room for conducting deliveries.
Seven out of every ten CHCs (70.9%) do not have regular power
supply (Concurrent evaluation, NRHM, 2011).
One of the most important reasons for underutilization of
primary health care facilities is the lack of the full range of required
primary care services. Most sub-centers and PHCs provide little beyond
immunization services, some ante-natal care and at best care for normal
delivery. Most treatment of chronic illness like hypertension and diabetes
is referred away and so is the treatment for most infectious disease
except some of those on the national programmes. This would accounts
for less than 20% of all health care needs. Along with expansion of
infrastructure and filling up vacancies of human resources, quality of
care delivered at public health facilities need immediate attention.
Low public spending and consequently high burden of out of
pocket expenses
Public Spending on health in India is among the lowest in the
world - when compared in terms of share of GDP and per capita
spending. There were only few countries in the world which spent
lesser proportion of GDP on health in 2014 (WHO 2016).
Governments in neighbouring countries like Sri Lanka, China, and Nepal
could mobilise more resources towards health than what is done in
India. Per capita public investment on health in India, is almost at the
same level with the average of the low income countries (LICs) and
much lower than the average for low middle income countries (LMICs).
Countries like Brazil, Thailand, and South Africa which have recently
attempted to universalise have stepped up public spending on health to
3-5 % of GDP over the period of a decade or so, while it languishes
at around 1% of GDP in India.
Box II: Health care Financing
 Public spending on health as a percentage of GDP is among
the lowest in the world (1.1%)

Education today 12
  India is among the most privatized health systems -- out of
100 rupees spend on health more than 70 comes from people’s
out-of-pocket expenses (OOPs).
 Every year some 55 million people are pushed below poverty
line - this is more than the population of 177 countries in the
world
 Expenses on medicine alone lead to impoverishment of some
34 million people.
 During 2004 (latest data available), nearly 30 percent in rural
India and 20 percent in urban India who were ill but did not
seek care because of financial barrier.
 Socio-economically deprived groups tend to suffer greater
impoverishment due to OOP spending on health care.
In the absence of adequate public spending households are
forced to buy healthcare services from the market – either in private
facilities or through expenses they incur even in public facilities. What
people pay directly while accessing care is called ‘Out of Pocket’(OoP)
expense. In India the share of OoP in total healthcare spending is around
73% - which is one of the highest in the world. Thus in India, out of
every 100 rupee spent on healthcare, the government spends only 27
rupees. Such a subsystem where access to care depends on ability to
pay leads to inequality in access, untreated ailments and preventable
deaths; and pushes people towards poverty and indebtedness. Numerous
studies indicate that the poor in India are often required to borrow and
sell off household assets to finance their health-care needs. The burden
on OoP is largely on account of outpatient expenses but recently we
also see a steep rise in hospitalisation expenses that are borne by patients.
Recent National Health Accounts estimates show that the share of OoP
has increased to 72.9% of total health expenditure, and public spending
is a mere 1.1% of GDP.
Growing private sector and expansion of public funded
insurance
Over the years, as economic policies have slashed expenditure
on public services like health and education, dependence on private

13 .................
sector for healthcare has progressively grown. Dependence of people
on private facilities for short duration treatment was higher compared
to public services, even in the mid 1980s. By the mid 1990s more than
80% of short duration illnesses were being treated in the private sector.
The public sector used to be the main source of care requiring
hospitalisation in the mid 1980s. By the mid 1990s there was a reversal
in the situation and the private sector became the main source of
treatment for hospitalized cases as well. In the next decade or so the
spread of private sector got reflected in even greater utilization of
private facilities for hospitalisation. By 2004-05 almost 60 per cent of
total in-patient care (hospital care) was covered by the private sector.
Table 2: Share (per cent) of private sector in total hospitalized
episodes and short duration ailments
Hospitalisation Short Duration
(in-patient) ailments (out-
patient)
Year Rural Urban Rural Urban
nd
1986-87 (42 round) 39.97 39.56 74.29 72.79
1995-96 (52nd round) 54.71 56.93 80.29 81.65
2004-05 (60th round) 58.39 61.76 77.72 80.83
st
2014 (71 round) 58.1 68 71.7 78.8
Source: Based on NSSO estimates, 42nd, 52nd, 60th and 71st
round.
In the past decade a new trend has emerged, led by changes in
the government’s overall economic policies and priorities. The
involvement of the private sector in providing services while using
public funds is being promoted under the guise of improving efficiency
in the delivery of health services. This can be seen in the outsourcing of
health facilities in states such as Arunachal Pradesh and Karnataka; and
outsourcing of various critical services in public hospitals like diagnostics
in Bihar and West Bengal. Insurance schemes like the Rashtriya Swasthya
Bima Yojana and Arogyasri are another mechanism to pump public
funds into the private sector. However, the dreadful implications of
this strategy on the public health system, quality of services and access
of the poor to health care services is slowly becoming apparent.
Education today 14
Experiences of outsourcing, like of diagnostics in Bihar, has shown
that it has led to decreased access to services and even denial of services
for the poor, increased out of pocket expenditure and decline in the
quality of services.
Despite its rapid growth and large size, the private medical sector
in India suffers from a wide range of serious problems. It is widely
acknowledged that these arise due to its commercial interest to maximize
profits, along with an almost complete lack of effective regulation.
This has led to a huge urban-rural divide, massive wastage, exploitation
due to excessive/irrational medications, and frequent exploitation of
patients by overcharging and unnecessary interventions, major variations
in quality and overall substandard care, and violation of patients’ rights.
This is compounded by the exploitation by the drug industry through
manufacturing and sale of irrational medicines and irrational drug
combinations, promotion of costly brands, and overpricing. In addition,
during the last 20 years there has been proliferation of private medical
colleges. Thus overall, barring some centres of excellence, private
medical care in India is substandard and unnecessarily costly. There has
been a complete failure of regulatory agencies like the Central Drug
Standards Control Organisation (CDSCO) and the Medical Council
of India, accompanied by a complete lack of self-regulation by
professional bodies like the Indian Medical Association (IMA).
Despite these known problems related to the private sector,
public money is now being pumped into the sector in the name of
providing financial protection to the people. There has been an increase
in the number of publicly-financed insurance schemes floated by central
and state governments, with the stated aim of protecting the poor and
the informal sector workers from catastrophic expenditures on health.
The Yeshasvini Health Insurance Scheme in Karnataka in 2003 and the
Rajiv Aarogyasri Scheme in Andhra Pradesh in 2007 are the precursors
to the Rashtriya Swasthya Bima Yojana (RSBY) launched by the Ministry
of Labour, in 2007 as a Central scheme. The schemes (state and central)
claimed to cover an estimated 302 million people in 2010 -- roughly
one-fourth of the population (as we shall see later these claims are
inflated). However, in terms of the benefit package available through
these insurance schemes, only limited secondary and tertiary level
hospitalisation cover is provided (with the exception of the much older
15 .................
Employees’ State Insurance Scheme (ESIS) and Central Government
Health Services (CGHS)).
Though these insurance schemes continue to remain popular
among policy makers and politicians, evidences suggest that impact on
financial protection has been minimal if not detrimental. As per the
latest National Sample Survey Organisation Survey on Health and
Morbidity (2014) only 13% population is covered under various
government funded insurance schemes. Coverage among the poorest
sections, in both rural (10.6%) and urban areas (8.6%) is even lower-
leaving out huge sections of intended beneficiaries.
But what happens to those who are covered and access
hospitalisation services? In contrast to what is promised, free care is
very rare - only 3 out of 100 hospitalisation cases with coverage receive
free care. The actual benefits to those who do of facilities under these
schemes is not very high. Data suggest that on an average those who
are not covered under any insurance scheme spend around Rs.14,400
for one hospitalization episode compared to the government funded
insurance schemes where average cost is Rs.10,900 -- a far cry from the
promise that these schemes would provide free care. Thus the poor go
to private hospitals, in the hope of free care and end up paying for
care that of dubious quality and which may not even be necessary (see
Figure 3).
Figure 3: Average expenditure on hospitalization (in Rs.)

Source: Business Line, 2016

Education today 16
 Government funded insurance schemes cover only a select set
of in-patient procedures and surgeries while households spend two-
third health expenditure on outpatient care and particularly on medicines.
In most states more private than public hospitals have been empanelled
for providing services under such insurance schemes. These private
facilities are concentrated mainly in cities, with very few in rural, tribal
and remote areas. Beneficiaries thus are concentrated in the easier to
reach villages and left out in the hard to reach villages or hamlets.
Further, these insurance schemes focus on specific treatment
procedures rather than on treatment of all illnesses, and therefore
conditions treatable at primary level end up being hospitalised (for
example, for uncomplicated anemia or diabetes) or transferred to
secondary/tertiary levels. This also results in public funds being shifted
from primary level care to secondary and tertiary level care, or to private
providers.
Patients also receive care of bad quality through the insurance
schemes. Many unnecessary procedures like hysterectomies (removal
of uterus) had been performed by the private sector hospitals in order
to benefit from the insurance money; thousands of such instances have
been documented in Bihar, Chhattisgarh and Andhra Pradesh. There is
no real choice for the beneficiaries in terms of which hospital they can
go to; as it is the hospitals that dictate what conditions and which patients
they wanted to treat. Thus, while private hospitals ‘cherry pick’ the
most profitable conditions/procedures to treat, public hospitals end
up treating the more complicated and difficult cases. In rural areas,
especially remote places, public facilities are the only ones available.
The nest result of public funded insurance is that public money is being
transferred to private facilities, thus further depleting the already meager
resources available to strengthen public facilities. There is also a
continuous demand from the private sector to increase the
reimbursement they receive for providing care as part of the insurance
schemes. Reports from Chhattisgarh and Andhra Pradesh have shown
that RSBY and Arogyashri schemes were facing financial problems as
demands from private providers for higher reimbursements had
increased and some hospitals had even stopped providing services.
Clearly, commercial and profit motives guide healthcare provision,
leading to unnecessary procedures, wastage of resources and no
17 .................
improvement in health outcomes. Their goal clearly is to profit from
ill-health. Only a strong public sector can function as an effective check
on the vast unregulated private sector, where it is forced to compete
for quality of services with the public sector.
Access to medicines
Access to essential medicines is an integral, and often crucial,
component of health care. The World Medicine Report of the World
Health Organization finds that India is the country with the largest
number of people (649 million) without access to essential medicines.
Given that India today is one of the largest producers of drugs (by
volume) in the world and exports medicines to over 200 countries, this
is clearly an unacceptable situation. In an ideal situation all medicines
that are researched and marketed should enhance therapeutic goals and
should be available to all those who require these medicines.
Unfortunately the actual situation in the medicines market is much more
complex. There are several issues that need to be addressed in order to
ensure access to all medicines that people need.
The drug industry is rapidly transforming with increasing mergers
and takeovers by multinational corporations. The government’s new
policy of allowing 100% FDI in the drug industry has become an
instrument to acquire Indian companies. Without investing anything for
manufacturing or establishing any plants the MNCs are capturing the
existing Indian drug companies. While this may be in line with the
Government’s ‘make in India policy’ (where the only consideration is
that companies shift production to India irrespective of ownewrship
of the companies involved), it is starting to choke the domestic industry
built and nurtured over decades.
Medicine costs are the major component of out of pocket
expenses that we talked of earlier. Changes in the Drug Price Control
order in 2012 have converted the price control of medicines into a
cruel joke. Essential drug prices are now fixed on the basis of their
price in the market, which is inflated, rather than on actual production
costs. Many studies have shown that market prices of drugs are often
10 or even a 100 times that of the production costs.

Education today 18
 Patients in India are also affected by a huge market, promoted
by unethical marketing practices of drug companies, by the marketing
of irrational and harmful medicines. Doctors are bribed by companies
to prescribe such medicines. Following adverse comments by the
Parliamentary Committee on Health the government, in early 2016,
issued notifications banning over 300 irrational medicines. The medicines
of many large companies, including top selling products of multinational
corporations were affected.
The major reason why people in India cannot access medicines
is that they are forced to buy them from the market. Even public
facilities often do not stock all essential medicines and ask patients to
buy them. A few state governments have started free medicines
schemes to supply all essential medicines free of cost to patients
attending public facilities. The schemes are running successfully in a few
states, notably Tamilnadu and Rajasthan. However, most states are yet
to effectively implement such schemes. Neither has the central
government lived up to an earlier promise to support such schemes in
all states.
Urgent measures to address the Health Crisis in India
Based on the discussion above, the following steps are urgent
and necessary:
Act on the Social Determinants of Health: This would
include promotion of food security by universalisation and expansion
of the Public Distribution System. It would also include providing safe
drinking water, sanitation facilities, full employment to all, education
for all and decent and adequate housing.
Address the Gender dimensions of Health: Guarantee
comprehensive, accessible, quality health services for all women for all
their health needs which includes but is not limited to maternal care.
Abolish all coercive laws, policies and practices that violate the
reproductive, sexual and democratic rights of women, including
coercive family planning measures.
Immediately reverse Caste Based Discrimination: Take
immediate and effective steps to entirely reverse all forms of caste
based discrimination, which is one of the most important social

19 .................
determinants of ill health. Immediate ban on manual scavenging should
be implemented.
Enact a Right to Health Act which assures universal access to
good quality and comprehensive health care for all for the entire range
of primary, secondary and tertiary services, and that makes denial or
non-availabilityfor reasons of access, affordability or quality a justiciable
offence.
Increase Public Expenditure on Health to 3.6% of GDP
annually (Rs 3000/- per capita at current rates) with the central
government’s contribution being at least 1% of GDP (Rs 1000/- per
capita). All public health expenditure to be tax financed. Progressively
increase public health expenditure of the government to at least 5% of
GDP.
Ensure quality and assured availability of health care:
Quality of care to be ensured in all health facilities. Public health facilities
to be entirely free of user fees and the entire range of services to be
provided directly by government run facilities and not through Public
Private Partnerships (PPPs).
Stop both Active and Passive Privatization of health care
services: Necessary measures to stop active privatization in the form
of transfer of public resources or assets to the private sector. Measures
to stop passive privatization (where private facilities fill the gap left by
inadequate public facilities) by increasing investment in public health
facilities.
Training of Health workforce: Increase public investment in
education and training of the entire range of health personnel. Ensure
that government run colleges to train a range of health workers, nurses
and doctors are located in areas where they are needed most.
Well Governed, Adequate Public Health Workforce: Create
adequate posts for the entire range of health personnel in the public
health system. Regularize contractual employees and provide ASHAs,
ANMs and all levels of public health system staff with adequate skills,
salaries, and decent working conditions.
Secure access to quality assured essential medicines and
diagnostic services in all public health facilities, free of charge.
Education today 20
 Reverse Exploitation by private hospitals practitioners: The
national Clinical Establishment Act should have provisions for:
observance of patient's rights in all clinical establishments; regulation
of the rates of various services; and elimination of kickbacks for
prescriptions, diagnostics and referrals.
Absorb, over a period, existing publicly funded health
insurance schemes (RSBY and different state health insurance
schemes) into an expanded public health system publicly financed
through general taxation.
Ensure access to essential and safe Drugs & Devices: Cost-
based price-control of all medicines need to be re-established. Measures
are also necessary to ensure banning of all irrational medicines and
irrational combinations.

21 .................
Education today 22