JAAK-BU Public consultation – Recommendations

A public consultation on ‘Health Care in Bangalore city – need for a participatory comprehensive health plan’ was organized by Janaarogya Andolana Karnataka – Bangalore Urban (JAAK-BU) at the Urban Health Research & Training Centre (BBMP), Malleshwaram, Bangalore on March 9th, 2012. The BBMP Commissioner, Mr. Shankarlinge Gowda, was the chief guest and officials from BBMP and the Karnataka Health & Family Welfare Department also participated. JAAK-BU members presented an overview of the present health scenario. Representatives of NGOs, associations, hospitals etc. and individuals working in this field attended the event, shared their experiences and provided suggestions.

Discussion points

The importance of primary health care and a public health approach in planning health services was reiterated by a number of speakers, including officials.
ñ The JAAK-BU presentations showed unserved wards and the insufficiency of available services. BBMP officials talked about the donor-driven approach of building Maternity Homes and the focus on reproductive and child health.
ñ A comprehensive, population-based health plan has not been developed for the city.
ñ Coordination between the various departments providing health services in Bangalore city is very limited and must increase. After the BBMP expansion in 2007, no joint planning has been undertaken and many areas in the BBMP limits have insufficient or no access to health services.
ñ The need for giving nurses and other medical staff more responsibilities in providing primary health care was discussed – 24/7 PHCs have been running successfully largely due to nurses and that model can be used in Bangalore city.

ñ Health insurance through schemes such as RSBY and Vajpayee Arogyasri is being expanded and workers in the unorganized sector are being enrolled into these schemes. But it was emphasized that these schemes are increasing the fragmentation of health services (now the Labour department is also involved) and are not a substitute for the public health system.

ñ The needs of vulnerable groups, such as the homeless and disabled, were also raised. Screening of newborns for disabilities etc. has begun in 7 Maternity Homes and should be extended to all hospitals. Mental health services must be available at the primary level, given the high incidence of mental health problems and suicides in Bangalore.

ñ Public participation and grievance redressal was extensively discussed. Some civil society organizations have set up Monitoring Committees of community members in Maternity Homes to provide an interface between the MH administration and the community. This program should be extended to all MHs.
ñ For grievance redressal, it was suggested that the BBMP 24-hr call centre at 22660000 be contacted to register complaints. Also, health services should be brought under the Service Guarantees Act (Sakala), so that the responsible officials are penalized every day a guaranteed service such as scanning is not available.
ñ There are problems in accessing schemes such as JSY and BBMP has made plans to have an ANM available at each centre to register BPL patients.

Decisions
The following decisions were taken by the officials present:
ñ BBMP will take initiative in coordinating with other departments providing health services in order to come up with joint plans
ñ Referrals for scans and other diagnostics will be done to Victoria hospital and other government institutions instead of sending patients to private labs.

JAAK-BU Demands
Based on its work in Bangalore city and the inputs provided through this public consultation, JAAK-BU makes the following demands:

ñ A population-based health plan must be developed for Bangalore city
ñ A comprehensive PHC that will meet all primary health care needs of the population should be available for every 50,000 people; preferably 1 PHC should be available in every ward.
ñ All government bodies providing health services in the city must coordinate their activities and make joint plans, with sufficient budgetary allocations for:
◦ Covering unserved wards
◦ Addressing gaps in services, staff, equipment, infrastructure etc.
◦ Setting up a functional and robust referral system
◦ Ensuring effective grievance redressal

ñ Unit-level budget and expenditure details of all health units should be made publicly available by all concerned departments

ñ The needs of vulnerable groups such as the homeless, HIV +ve community and the disabled must be addressed
ñ Health insurance is NOT a substitute for the public health system. We strongly urge the government to strengthen public health services to reduce the demand on hospitalization and expensive tertiary care.