Reorient Gujarat’s public health facilities to meet healthcare needs accountable to communities

healthA Jan Swasthya Abhiyan Gujarat statement on the occasion of the World Health Day, which falls on April 7, 2017

Santokben Baria, 55, years old living in Devgadh Baria block, Dahod district was diagnosed with cervical cancer after complaints about failing health in January 2016. She underwent hysterectomy in March, following which it was found that the cancer had recurred. Due to a financial crisis, lack of support from husband and mental taboos about cancer treatment, Santokben’s further treatment was delayed till December.

She was finally admitted to the Shri Krishna Medical Hospital in Karamsad. She  is a BPL family and also holds a Mukhyamantr I Amrutum Yojna card. Initial tests during this hospitalisation revealed that the cancer had caused an obstructive nephropathy, which unfortunately is not covered by the MA Yojana.

From 27 December 2016 to 5 January 2017 Santokben was in the ICU with high blood pressure, potassium, creatinine leading to several procedures and kidney dialysis. The expenditure for investigations, kidney dialysis and other medical procedures, ICU and medicines till January 2017 was about Rs. 55,000. This was expected to go up as Santokben would need constant medical attention for her kidneys as well as her cancer. The family  could raise only  Rs. 15,000. Santokben‘s family  earns their living from their small agricultural land and migrant work.  Her husband and two sons migrate out for over 6 months to sustain their family of nine including two small grand children and her widowed daughter in law.   The family is in deep debt with an ailing son and now her own  distressing health condition.

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Santokhben is one of the thousands of such women across the ‘developed’ state of Gujarat. National Family Health Survey 2015-16 shows that only 23.1% of all households’ members  in Gujarat  are covered by any health insurance scheme.

On World Health Day 2016, the Chief Minister of Gujarat launched a series of health services including state-wide screening campaign for diabetes, breast and cervical cancer and oral health care along with a complete vaccination campaign. She announced that nearly 10,000 screening and detection centres across the state for each of the NCD – diabetes, breast and womb cancer and oral health care – would be operational from June 1, 2016. Further, over 300 Community Health Centres (CHC) and 308 Urban Health Centres (UHC) would be roped in under this campaign launched by the Chief Minister at Ahmedabad Civil Hospital. However a recent study by the Jan Swasthya Abhiyan across seven blocks in six districts of Gujarat shows that the screening for breast and cervical cancer is still not underway, as promised.

NFHS 4 also shows that almost 70% of the children under five  are anaemic and almost  40% are underweight.  Anaemia in non-pregnant women has not decreased in the last 10 years –  it remains at 55% where it was in NFHS 3. More than half  of the  pregnant women in Gujarat –51% –  areanaemic.27.2% women have low BMIs (below normal).  Contraception in Gujarat has decreased – use of any modern method was 56.5 % in 2005-06 NFHS 3 and in NFHS 4 it is 43.1%.   Unmet need for contraception has increased from 8.4% to 17%.Only one third of all  deliveries have occurred in public facilities (32.6%), full Ante Natal Care has been received only by 30% pregnant women.25% of the girls are married before the age of 18 years.

Gujarat is known as an industrially developed state. This status has been earned on the  blood and sweat of the workers of the state as well as millions of migrant workers. But the ESI health services available for them are  extremely poor. There is 40% of vacancy of the medical officers and experts. ESI Hospitals routinely refer patients to public hospitals, increasing the load at the public hospital. There is a need is to modernise the ESI hospitals to provide  secondary and  tertiary care. In the power loom industry in Surat, millions of workers are denied basic facility of toilets and urinals. We in Gujarat do not take adequate measures to prevent diseases like Silicosis and Asbestosis. We do not even have adequate diagnostic and treatment facilities for these diseases. There is need to take  action to monitor work environment. Our health department shies away from diagnosing occupational diseases, we need to address  this shyness urgently.

An analysis by Pathey Budget Centre shows that the state budget allocation for health  are services is reducing over the years – from 5.59% of the total state budget in 2015-16, to 5.40 % in 2016-17 further reducing to a mere 5.06% in 2017-18. World Health Organisation’s recommendation is that countries spend at least 5% of their Gross Domestic Product on health – in Gujarat this  is less than even 1% of GSDP.

Gujarat, like other states in the country,  is increasingly relying on the private medical sector for fulfilling the health needs of its people.  Jan Swasthya Abhiyan, a campaign of over 100 organisations/individual members across more than 20 districts of Gujarat,  calls upon the Government of Gujarat to strengthen and provide free medicines and diagnostics in all public health facilities, resist commercialization of healthcare and outsourcing of care to private facilities and regulate private health care services and punish those guilty of unethical practices, Stern action along these lines will be necessary for Gujarat to claim its place as a state with a worthy  Human Development index.

 

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