Former Prime Minister Manmohan Singh and current Finance Minister Arun Jaitley have both mentioned provision of ‘free drugs’ in their speeches. The National Health Mission mentioned this initiative as a special focus. Given India’s disease burden and high levels of out of pocket expenditure, this would be a boon to the masses who struggle to afford basic healthcare. However, this promise has remained only on paper as no funds were allocated for it.
India does have price control mechanisms in place, but only for a handful of common drugs. Irrational prescription practices also add to the financial burden of patients and their families. While states like Tamil Nadu and Rajasthan have run successful schemes to provide free drugs at public healthcare facilities, these are yet to be replicated in other states. Central and state government health insurance schemes concentrate only on tertiary healthcare, and fail to tackle illness at preliminary stages.
This analytical feature by public health activist Chhaya Pachauli explores problems surrounding the issue of free drugs. It also examines the effectualness of existing schemes, and what can be done to address the obstacles.
Gender in Medical Education (GME) is a pioneer initiative in India to include gender in medical education. The need to include gender in a predominantly biomedical curriculum which reinforces patriarchal notions was recognised by CEHAT. The GME project is a joint initiative of CEHAT, DMER and MUHS. As part of the initiative, a two-day workshop was held on February 27 and 28 at St. George Hospital, Fort, in Mumbai. It was attended by around 40 mid to senior level medical educators hailing from public hospitals of Mumbai Pune, Kolhapur, Solapur and Miraj.
CEHAT carried out a workshop on building perspective and skill-development on the response to violence against women and children through a survivor-centric approach on January 8-10, 2018 at Bharathiyar University, Coimbatore, Tamil Nadu. The participants consisted of 25 protection officers with upto 10 years of experience from various districts, one counsellor appointed at the OSC (Kanchipuram District) and 7 District Social Welfare Officers. The Social Welfare Department of Tamil Nadu showed its commitment to the issue of VAW and children by deputing senior officers who participated in the 3 day workshop. The purpose of holding the first round of training with this group was to ensure that the state response is sensitive, since they are major stakeholders.
The 2018 calendar uses simple case studies to demonstrate these principles in practice. The cases are adapted from real incidents from CEHAT's research and experience.
The Centre for Enquiry into Health and Allied Themes (CEHAT) is conducting a 1.5 day workshop on ‘Evidence-based Clinical Practices’. This event, organised by CEHAT in collaboration with DMER, KEM and the UNFPA is aimed for senior medical college faculty members of government medical colleges across Maharashtra, such as heads of the department and associate professors of disciplines such as gynaecology, forensic science, internal medicine, community medicine, psychiatry, paediatrics and surgery departments. CEHAT initiated project “Integration of Gender in Medical Education Project (GME)” in select medical colleges of Maharashtra with the aim to sensitise medical students and healthcare professionals to gender inequality and its interaction with health.
Until now, social determinants of health were rarely included in pure medical studies. The need for awareness and sensitivity regarding patients’ gender and social backgrounds among medical practitioners has been acknowledged by the World Health Organization (WHO). Right from the patient’s approach to the doctor’s evaluation and treatment, gender disparity is evident and clearly visible in the medical field, as proved by CEHAT’s ongoing work in this field.
This workshop, sanctioned by Maharashtra University of Health Sciences (MUHS), is a pioneer attempt to include gender as a component in medical education in India, and would dwell on the need for gender in medical education, current efforts, informed consent and communication strategies, privacy and confidentiality, respectful maternal care, care for survivors of violence and clinical checklists for implementing gender-sensitive health care. CEHAT will also release gender integrated medical education modules on Forensics and Toxicology, Medicine, Obstetrics and Gynaecology, Preventive and Social Medicine, and Psychiatry.
The timings for the workshop are as follows:
Friday, November 24: 9:30 am to 5:00 pm
Saturday, November 25: 9:30 am to 2:00 pm
It will be held at the YMCA, Mumbai Central.
The One Stop Scheme by the Ministry of Women and Child Development has presented the opportunity to influence the current crisis intervention services. Through this scheme, crisis intervention centres called One Stop Centres have been established or are underway in various states across the country with the objective to provide integrated support and assistance to women affected by violence, both in private and public spaces and to facilitate immediate, emergency and non-emergency access to a range of services including medical, legal, psychological and counseling support under one roof to fight against any forms of violence against women. For effective implementation of these OSC, counselors must work in coordination with the hospital within which or near which they are located. Violence against women has been recognized as a health issue under the National Health Policy, 2017. The link between violence and health has been acknowledged along with the recognition to create services to respond to survivors. In 2005, The Protection of Women from Domestic Violence Act, was developed to offer civil remedies and reliefs to women facing violence. In 2012, the Protection of Children from Sexual Offences Act was introduced. Both these laws have brought in the role of support persons and Protection Officers, generating a growing reliance on counselling services. It is imperative that counselors be trained to respond to different forms of VAW and children and be equipped with the perspective and skills in responding to VAW.
CEHAT has been instrumental in developing an evidence-based model to respond to VAW and children. In 2014, the MOHFW laid down the guidelines and protocols for medico-legal care for survivors of sexual assault including psychosocial support. CEHAT had the opportunity to present its evidence based work of having established Dilaasa, a hospital based crisis centre in collaboration with the Municipal Corporation of Greater Mumbai. This evidence-based model has also featured in the leading international medical journal Lancet.
CEHAT is pleased to announce its National Course on counselling survivors of violence. The course is aimed at building a critical feminist perspective on the issue of violence against women and children and enhancing skills of the participants in responding to survivors of violence.
Feminist counselling has been accepted as one of the most effective counselling method for women living in abusive relationships as it questions power and inequality within the relationship. It encourages women to understand what they are experiencing in context of inequalities that arise out of larger oppressive structures. This form of counselling is gender-sensitive and has been used effectively while engaging with various vulnerable groups including transgenders and boys.
A key objective of the National Health Policy 2017 is to align the private sector towards public health goals. Its main strategy is to ensure free comprehensive primary care provision by the public sector, supplemented by strategic purchase of secondary care hospitalization and tertiary care services from both public and non-government sector to fill critical gaps. The key mechanism of strategic purchasing is insurance schemes. Thus in the larger context of ensuring Universal Health Coverage, government funded health insurance schemes seek to play a very large role. Services would be strategically purchased from public as well as private sector to improve health outcomes, reduce out of pocket payments and minimize moral hazards for the purpose of scaling up the schemes and made more effective. The policy provides for preferential treatment to collaborating private hospitals/institutes for CGHS empanelment and in proposed strategic purchase by Government. However, we need to ask critical questions such as: What have been the various bottlenecks, successes and failures of the existing national and state level insurance schemes? What are the lessons learnt so far for these to be scaled up? What have been the experiences of the users? What has been the experience of for-profit private health sector? What are the pros and cons for adopting the insurance approach to realise the goal of Universal Health Care? What are the crucial gaps that need to be addressed for health systems strengthening for UHC and how?
Themes for the conference:
1. Critically evaluate the role of government funded health insurance schemes. What has been the experience of the public and private sectors vis-a-vis the insurance schemes?
2. Evidence based learning from the various National level and State level insurance schemes and their role in improving health outcomes, health equity, reducing out of pocket payments and moral hazards to improve scalability and efficiency.
3. Role of State in Health Systems Strengthening for UHC: Infrastructure, human resource, regulations, standardization, quality assurance, etc.
Culminating in the celebration of Human Rights Day, the fortnight from 25th November-10th December 2016 is observed worldwide as a campaign to end VAW.
This year's calendar is aimed at creating awareness about gender in medical education.