Current Projects under Public Health Programme
Reconstructing Health Systems beyond COVID: Critically analysing official transnational investments, shaping policy discourse to promote Right to Healthcare (RTH) in Maharashtra.
Project Period: January 2022 to December 2022
Donor Agency: Rosa-Luxemburg-Stiftung
The COVID-19 pandemic has acted as a powerful ‘MRI scanner’ helping us to scrutinise India’s health system, starkly revealing the architectural weaknesses of the under-resourced, atrophied public health system, along with exposing the predatory nature of unregulated, commercialised, hypertrophied private health care. During this period poorly staffed public hospitals proved insufficient compared to the population’s health requirements resulting in inadequate facilities for COVID-19 patients, while many corporate and large private hospitals engaged in massive overcharging and profiteering.
Within India, Maharashtra state has suffered from not only the largest number of COVID cases and deaths compared to any other state, but strikingly also had one of the highest case fatality rates (among COVID cases, the proportion who died) compared to major states in the country.
The cross-state differences in COVID outcomes among major Indian states seem to be primarily related to differences in effectiveness of public health systems; Maharashtra with one of the highest COVID case fatality rates among Indian states has a highly privatised health system, with inadequate public health services. Compared to this, Kerala has much lower COVID case fatality rate, associated with a robust public primary healthcare system.
With such catastrophic impact of the pandemic, the stage has been set for healthcare and health systems to emerge as an agenda for urgent policy attention. In this setting, on one hand regressive solutions are being promoted by the establishment focussing on further privatisation, corporatisation, private sector oriented transnational investments, and securitisation of healthcare. On the other hand, there is high degree of social receptivity for progressive proposals centred on major strengthening of public health services, regulation of private healthcare providers, and fulfilment of health rights through a democratised healthcare system, based on public-centred universal health care. There is no doubt that the COVID-19 pandemic can become a critical turning point for the health system in India, and especially in states like Maharashtra. This is an opportune time to reimagine health systems and powerfully build socio-political will from below for comprehensive, people centred, rights-based health system change.
Given this context, SATHI proposes to conduct activities on two complementary fronts during the COVID recovery situation, which can help shape the policy discourse in the health sector in a pro-people direction. The first component would focus on studying and deconstructing official transnational development investments in the health sector, with focus on German development agencies, to understand the impacts which these influential investments have on health systems and access to healthcare for deprived and marginalised populations in India. The second component would be focussed on the state of Maharashtra (the second largest state in India, which has suffered the worst during the COVID pandemic), towards shaping policy discourse to promote major strengthening of public health systems and operationalisation of Right to Healthcare.
- People-centred Maharashtra Right to Health Care bill, and legal brief outlining steps for operationalisation of such bill is available in the public domain, publicised widely in media, and discussed with policymakers.
- Series of broad-based consultations on UHC in Maharashtra culminated in set of Policy briefs on critical health system themes which can be used for policy-level advocacy.
- A policy brief on innovative health system financing for Maharashtra aligned with the UHC objectives, with clear articulation on sources of additional resources for public health systems, is published and widely circulated among diverse stakeholders.
- Concrete evidence on patterns of inadequate remuneration and various key concerns related to ASHAs is placed in the public domain, gaining media attention and further opening space for policy-level dialogue and improvement in status and role of ASHAs.
- Contemporary status update and analysis of ESI health services in Maharashtra is shared with trade unions, employee associations, and activists working with the informal sector workers
- Discourse on equity-oriented, tax-based, public health system centred Universal Health Care is amplified and provides a necessary counter-narrative to privatisation oriented, commercial insurance-based ‘Universal Health Coverage’ models.
- Draft people-centric right to healthcare bill and concrete proposals for raising additional resources for the UHC influences processes of enactment of state-level right to healthcare act.
- Trade Unions and other stakeholders use ESI-health services related updated information to strengthen demand for improved ESI health services. Similarly, ASHA associations use study findings to demand improved working and employment conditions for ASHAs, with positive implications for all frontline health workers.