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How Much Have India’s Poor Benefited From Its Privatised, Globalised Healthcare?

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India, though still a developing nation, has achieved a lot in improving its healthcare sector since Independence. The impact of the efforts in the sector have had both a positive as well as negative impact. Several government policies and regulations have been both praised and criticised for their pros and cons.

The stride of globalisation, which started in India in the early 1980s and intensified in the 90s, severely influenced the policies affecting India’s healthcare sector. With structural adjustment programmes, the Indian government at that time started withdrawing public expenditure on core sectors including healthcare, education and food, which were seen as ‘non-productive’.

The argument given was that privatisation would lead to competitiveness and better utilisation of services. It was also argued to help enable more people to benefit from modern healthcare services. All policy and executive changes led to a severe impact on people, especially from rural India. According to the World Bank, in 2007, rural areas, which reside 70% of our population, have only 20% of India’s total hospital beds.

During the advent of privatisation in India, it was said that this process would lead to competitiveness and better utilisation of services.

Negative Impact Of Globalisation On Healthcare

Some of the major impacts that the healthcare sector has had on India’s poor are:

  • User charges were introduced, which meant that people had to pay to use healthcare facilities. It was argued that this would promote responsible use of facilities by reducing purposeful misuse. Arguments were also given that this would generate revenue that would help in the betterment of the sector’s infrastructure. But later, it was found that user charges contributed to only 2% of the total expenses. One more argument from the supporters of this policy was that as people pay for the services, they will demand better quality. This would promote community engagement. But according to many critiques of neo-liberal policies, this reform just widened the gap between the poor and rich.
  • People had to pay extra for several other facilities as well. This overburdened the poor who were left with no choice.
  • People were also forced to buy drugs, syringes, bandages on their own, thus, again increasing their out-of-pocket expenditure on health. It is an estimate that out-of-pocket expenses account for more than 5% of India’s GDP.
  • The government started focusing more on preventive and promotional services such as safe drinking water, basic sanitation, etc. This forced patients to go to the private sector for curative services. Even today, the public sector doctor to person ratio stands above 1:10,000.

The World Bank asked countries to promote health insurance, thus making health more of a personal responsibility. Insurance companies started their business and their high premium packages were really difficult for the poor to pay for. In recent times, some affordable insurance schemes have come up, including Rashtriya Swasthya Bima Yojna (RSBY) by the government, and Yeshasvini and VimoSEWA by co-operative societies, but they lack grassroots penetration.

Many poor people have been deceived by various fake insurance agents and have lost trust in them. All this makes it even more difficult for affordable insurance coverage for all, which could have been an alternative to direct public spending.

The process of globalisation has devastated the poor. The feminisation of poverty is what can explain the situation better. The poor, without any resources, have been further denied access to healthcare services. The introduction of user fees has not affected government expenditure, but has killed all prospects to access healthcare services for many.

These policy changes were accompanied by changes in patenting laws that benefited MNCs by providing significant concessions to corporates — this meant that the companies should have at least provided cheaper medicine at least to the deprived sections of the society. But without proper regulatory mechanisms from the government, prices of medicines have skyrocketed. Hospitals were provided with heavily subsidised land and in turn, expected to provide free services to the poor.

Supreme court
The Supreme Court in 2011 ruled that at least 25% of out-patient department capacity and 10% of beds should be reserved for the poor.

However, findings reveal that 10 out of 37 hospitals that had benefited from subsidised land by the government provided absolutely no services to the poor. The Supreme Court in 2011 ruled that at least 25% of out-patient department capacity and 10% of beds should be reserved for the poor. But in 2014, the Delhi High Court quashed a policy enforced by the Union Government that had made it mandatory to reserve facilities for the poor (even if the land agreement didn’t contain any such clause). Conditions more or less remain the same with no concrete step in this direction till now.

Issues related to food security also sprang up during the time:

  • Cutbacks in food subsidies
  • PDS becoming ineffective
  • Double pricing system with BPL/non-BPL added with manipulation
  • Compromise with quality and quantity
  • Affected nutritional status

Positive Impact Of Globalisation On Healthcare

With all the negative aspects, globalisation also brought some positive aspects to healthcare in India. It created an opportunity in terms of medical tourism, which is growing with time. Medical tourism can contribute as much as 25% of the GDP. A specific disease approach such as with polio, HIV/AIDS, cancer, etc. helped India fight these diseases more efficiently. It opened doors to foreign funding agencies.

But in conclusion, the effects have led to more neglect of the poor. Pressure from international organisations and funding agencies has led to a shift in focus and priority areas, leaving India’s poor entirely at the mercy of politicians, bureaucrats and market forces. The focus has shifted from basic needs and services to what international policy prioritises. This ultimately leads to policies inconsistent with the needs of India’s poor.

To serve all segments of Indian society, we need differential investment at different levels, with an emphasis on planning led by stakeholders. Even considering the current coronavirus outbreak, it is recommended that there should be larger investments in public health infrastructure in rural areas, mobile units should be made operational and the current system be improved with the help of relevant training programmes for health workers.

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Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
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Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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