SATHI documented overcharging of COVID patients by private hospitals across Maharashtra, while supporting individual patients to negotiate with hospitals for reducing grossly inflated bills. COVID hospitalisation bills for 480 patients were audited, and over 60 patient families received official refunds of excess charges incurred during the COVID second wave. These hospital bills were further analysed, particularly to understand the patterns of overcharging related to spending on medicines during the hospitalisation period.
Simultaneously, SATHI also tracked significant pro-people regulatory provisions related to the private healthcare sector, enacted by Maharashtra government during the COVID epidemic, which were not fully operationalised in a way that benefitted patients.
The study underscored the urgent need to promote implementation of these provisions for patient protection, and to prevent overcharging and patients’ rights violations in the present situation.
Objectives
Expected Outcomes
Background
Under-resourced public health system and unaffordable, unregulated private health sector is an essential context of health care in most South Asian countries. Transparency and accountability deficits regarding public and the private health systems are multidimensional. Unregulated, commercialized and highly privatised healthcare leads to denial and malpractices, which are highlighted during the COVID pandemic. The right to health is impacted by deep inequalities along axes of power and exclusion in the region, including class, caste, gender, sexual orientation, gender identity, and disabilities. Multi-dimensional issues of Health workers also need to be urgently addressed as part of health system reforms in the region.
Towards addressing all these concerns, COPASAH affiliated organisations in South Asia including India have been instrumental in promoting health rights based social accountability initiatives. COPASAH’s legitimacy as a practitioner-led network can be instrumental in highlighting South Asian experiences on health sector transparency and accountability.
SATHI is one of the convening organisations of the COPASAH network in South Asia, and is actively involved in networking within India on social accountability of private healthcare, as well as community accountability of public health services. SATHI has also been part of South Asia level networking by COPASAH, including anchoring Track 4 on Social accountability of private healthcare during the COPASAH global symposium in 2019.
Overall objectives for entire project period (2021-22)
To develop the COPASAH South Asia regional hub, which will work as a knowledge and practice convening forum on social accountability of public and private healthcare sectors in the region, including sexual and reproductive health rights.
Specific objectives in phase 1 (Jan to Apr 2021)
Background
Due to COVID 19 pandemic India is experiencing major shifts in health scenario and health systems. Maharashtra is the worst affected state related to COVID-19, in Indian context. The COVID patients in urban and rural areas are increasing, and along with routine non-COVID patients they need support and facilitation to access healthcare. Maharashtra government has expanded health insurance schemes and entitlements to provide free care for COVID and non-COVID patients, in public as well as private hospitals, particularly expansion of health insurance scheme (MPJAY). The project intervention would be focussed on one urban area (in Pune city) and two rural blocks Pune and Sangli of Maharashtra, including operating a Help desk in the major public hospital serving each area, facilitating people’s access to services related to Health insurance schemes (MPJAY), and publicly created entitlements in private hospitals, outreach activities including orientation of grassroots activists and committee members, strengthening public awareness on health entitlements in context of COVID, dialogue with local health officials to facilitate health care and Documentation of issues and review of processes.
Publishing online platform for health awareness- An online platform in Marathi which would include latest updates and health news regarding the epidemic, popular information about government schemes and measures, interviews of health workers, frontline doctors and social activists doing remarkable work at the grassroots, and editorial type commentary pointing the direction for health system reforms such as Universal Health Care, which need to be socially demanded on large scale in the COVID recovery period. This would be a combination of an attractively designed fortnightly textual bulletin, and regular short videos with interviews, audio-visuals etc.
Objectives
Goal
Ensuring integrated access to Health care for selected urban and rural populations, in context of COVID-19 epidemic in Maharashtra
Outcomes
Background
The first phase of the COVID Rapid response was undertaken from August 20 to January 21 in the first wave of COVID. Due to COVID onslaught patients were running from pillar to post to get admissions in the appropriate setups. Also, in rural blocks there was need to spread awareness regarding COVID and also to assist patients coming to rural healthcare centres to access the COVID related and non – COVID related treatment. This grave need of the society shaped the first phase project. With onslaught of second more infectious COVID wave made it imperative that similar project is re-run as Phase II.
Objectives
Objectives
Background
India has one of the largest private medical sectors in the world – yet this gigantic entity has remained almost completely unaccountable and unregulated until now. Serious problems in this sector include frequent financial exploitation of patients, often accompanied by sub-standard and irrational care in private hospitals and nursing homes. Costs of private medical services have spiraled, having more than doubled in absolute terms between the mid-1980s and the mid-1990s. It is estimated that Health care expenditures account for more than half of all Indian households falling into poverty, with nearly 4 crore Indian people being pushed into poverty every year due to such costs. While ordinary patients are suffering tremendously due to this situation, it should be kept in mind that due to growing corporatisation and commercialization of the entire health care sector, it is also becoming extremely difficult for the dwindling numbers of rationally practicing doctors and genuinely non-profit health facilities to practice ethically.
How can we start changing this situation? Located within the broader context of need for strengthening public health services and rolling back privatisation, comprehensive social regulation of the private medical sector is an outstanding need today. In this context, with support from Oxfam-India, SATHI has organized a series of regional workshops on regulation of the private medical sector in Southern, Eastern, Northern and Western regions of India during August to November 2013. During these workshops, experiences of patients regarding private hospitals have been shared and overall justification for regulation has been discussed, existing Clinical establishments acts have been analysed, core desirable features of a pro-patient regulatory framework have been proposed, and some state level action plans have been developed. At the same time, a range of suggestions and inputs regarding both possible campaign strategies and issues to be addressed in the regulatory process have been shared.
Further we need to keep in mind the context of the national Clinical establishment act (CEA) which has been adopted in 2010, followed by related rules in 2012. The central government is now pushing state governments to adopt this act in existing form. Although the central CEA has some positive steps like mandatory minimum standards, standard treatment guidelines, regulation of charges and consumer representatives in national and state councils, it has several major lacunae like no provision for ‘patient’s rights’ in the entire act, no provision for grievance redressal mechanism for patients, and no scope for complaints by citizens regarding implementation of the act. Since this central act is being used as a kind of ‘framework legislation’ by various states, and some states are adopting it in existing form, it is essential to develop a national consensus among civil society organisations regarding this framework and to develop an effective national advocacy strategy regarding this framework.
Keeping this context in mind, SATHI facilitated in organising a ‘National consultation on regulation of private medical sector and patients rights’ in collaboration with the Jan Swasthya Abhiyan network.
Background
SATHI has been at the forefront for advocacy on social accountability and regulation of private medical sector in India. Some recent developments provide an opportunity for advanced advocacy for rate standardization and rate transparency in private hospitals. These developments are as below-
National Clinical Establishment Council is the governing council for developing standards for implementation of national Clinical Establishment Act 2010 and Rules 2012. This council has formed a sub-committee for rate standardization under CEA-2010. Recently, Dr Arun Gadre from SATHI and JSA has been appointed as a member of this sub-committee. This has provided a unique opportunity for SATHI to build a discourse around provisions like rate transparency and rate standardisation. This process will have significant implications for states like Rajasthan, UP, Bihar, Jharkhand, and Himachal Pradesh, who has adopted national CEA, and collateral effect on states that have their own CE Acts or are in process of drafting it. Based on membership of this national committee, we would propose and widely publicise a framework for regulation of rates in private hospitals.
We are now interacting with a widening section of rational doctors, some gave testimonies for the book ‘Voices of conscience’ published by SATHI with support from Oxfam India, and more are coming forward after the book release to discuss seriously about rate transparency and rate standardisation issues, which is a welcome step forward.
There has been significant media coverage book following the release of ‘Voices of conscience’, which can give a boost to public discourse around regulation of private medical sector.
Recently, Maharashtra Government has agreed to a delegation of health activists in Maharashtra to kick start a public dialogue process around the issue of rate standardisation in the context of Maharashtra Clinical Establishment Bill.
Objective- To promote large scale public discourse around regulation of private medical sector, with focus on standardisation of rates in private hospitals. This would be done at national level with focus on states like Rajasthan, UP, Bihar, Jharkhand, and Himachal Pradesh who have adapted CE Act 2010, and also some states who are in process of drafting their state level act or who have their own CEA like act.
Background
India has a fragmented and pluralistic health system, where inadequately resourced public health services coexist with a largely unregulated, commercialized private healthcare sector, the latter being responsible for spiralling costs of healthcare and variable quality in service delivery. Further, the private healthcare sector is well known to be engaged in irrational procedures and practices on a significant scale. The burden of such practices may be disproportionately borne by the poor, due to lack of knowledge and bargaining capacity. Well-known examples of such irrational care, which is both wasteful and potentially damaging to health, are unnecessary medications, injections, saline infusions and diagnostic tests.
Regulation of treatment practices through standard protocols is effectively absent in the Indian context, leaving the field open for such gross medical irrationality and exploitation of the most vulnerable.
Linked with this, there are widespread violations of patients’ rights and lack of effective grievance redressal mechanisms. Patients, especially those suffering from serious illnesses being treated in hospital settings, form an exceptionally vulnerable group who face huge asymmetries of knowledge and power, while often dealing with life and death situations and decisions. Denial of various patients’ rights including rights to basic diagnosis and treatment information, access to records and reports, transparency related to treatment expenses, option of second opinion, confidentiality and privacy, protection during clinical trials etc. are extremely widespread.
Objectives To promote and strengthen multi – stakeholder dialogue involving civil society organizations, private health sector representatives, Patients’ rights groups and Government agencies to maximize their engagement and contribution to policy development processes around social accountability and multi-stakeholder regulation of healthcare providers with focus on private sector, through a series of two workshops.
Key Activities of the project
Objective – Promoting awareness and advocacy on ‘participatory, multi-stakeholder regulation of private healthcare sector in India’ at both regional and state levels. This would be furthered by the following areas of activity
Capacity building of civil society activists towards demanding social accountability of private healthcare sector by conducting regional workshops on ‘Social Accountability of Private Medical Sector and Clinical Establishment Act’ in Northern, Eastern, Western and Southern regions of India in the first half of year 2013-2014, one workshop in each region. It is expected that civil society organisations from 2 to 3 states in each region would participate in each of these workshops. Each workshop would be for 2 days, with the objectives of –