Third National Health Assembly Concludes, Demands Health Care as Fundamental Right

The Third National Health Assembly (NHA), which is a biannual meeting was organised by Jan Swasthya Abhiyan (JSA) at Ravindra Manch in Raipur, Chhattisgarh, on September 22-23, 2018. The objective of the Assembly is to evaluate and critically analyse current processes and policies that impact health and healthcare at the national, regional and local levels. The Assembly concluded with the presentation of a People’s Health Manifesto.

Day-1

“Kamaney wala khayega, lootney wala jayega, naya zamana ayega” (a time will come when the working people will earn, oppressors will suffer, and a new era will emerge) …. This was the call of over 2000 health rights activists from 24 states, declaring that the time has come to make health and health care a fundamental right.

The inaugural plenary session on ‘Defending Public Health Systems: Emerging Challenges’ saw Amit Sengupta, Sulakshana Nandi, Raman Kataria, Malini Bhattacharya and Sarojini N. speak on the immediate necessity to protect Public Health Systems. Dr. Amit Sengupta, Global coordinator of People’s Health Movement, debunked the hype created by the Union Government around the National Health Protection Mission as being the panacea of all that ails our health sector. He asserted that health is not just an economic, but also a political and social issue.

Sulakshana Nandi, Co-ordinator, JSA-Chhattisgarh, said that for most of the marginalised, vulnerable and weaker communities residing in the remote areas, government facilities are the only refuge. She pointed out that public health systems are being weakened by diverting public funds towards subsidies to the private sector, mainly through public private partnerships (PPPs) and insurance schemes.“People in small places, do not have small problems. The private sector does not enter the difficult terrain where complexities of public health issues are graver,” asserted Dr. Raman Kataria, founder-member, Jan Swasthya Sahayog, an organisation of health professionals running a low cost health facility in Bilaspur, Chhattisgarh.

Sarojini N., National Co-Convenor, JSA, highlighted that the recent incidents of removing egg from the mid-day meals, not including non-vegetarian food in pregnant women’s diet, rising prices of food grains, and cow vigilantism have to be looked at as issues contributing to the public health crisis. Revisiting the debate on Health for All, she said that “All” in this context should explicitly include Muslims, Adivasis, Dalits, sexual minorities and others. 

Malini Bhattacharya, President, All India Democratic Women’s Association, stated that for more than a decade, all the indicators of health have been stagnant and the outlook of the government has become regressive. The session ended with a play by Mitanins, that showed how a simple case of jaundice which does not usually require either hospitalisation or expensive medicines, cost the patient’s family Rs. 55,000.

Later in the day, sub-plenaries, parallel workshops and cultural activities were organised. The sub plenaries of the first day were- 40 years of Alma-Ata Health for All declaration, Private sector participation in Public Health System through insurance schemes and PPPs, Gender Dimensions of Health, Challenges for Access to Medical Products, and the Role of Corporations in Harming Health of the Population. 

Later in the evening, a power packed plenary, “Successful Peoples’ Struggles for Health” was held, where the speakers including- Jibin spoke about the nurses’ struggle for basic wages in Kerala, Ajith Nawale on the farmers’ long march, Comrade Surekha on the struggles of the ASHA workers, and Amulya Nidhi on the legal battle of persons affected by silicosis and illegal clinical trials. The first day of the assembly ended with a stirring song presentation of ‘Relaa’ by Kaladas and team.  

Day-2

Gaon chodab nahi, jungle chodab nahi, mayemaati chodab nahi, ladayi chhodab nahi (we will not leave our village, we will not leave our jungle, land and soil, we will not leave our struggle), was one of the songs sung by the indigenous people at the start of day 2 at the NHA, echoing the struggles of the tribal and indigenous communities to unite and fight for the forest, land, river, and village where they have been residing peacefully for decades.

The theme of the third plenary session, on the second day of NHA was about social processes and conditions influencing people’s health. K. B. Obalesh, State Convener of Safai Karamchari Kavalu Samiti, Karnataka, shared the issues and challenges faced by the manual scavengers in India. Highlighting the adverse impacts of discrimination, he said that due to untouchability practised by the doctors and paramedical staff, health care needs of manual scavengers remain largely unaddressed. In the absence of affordable and accessible health care facilities, people are forced to opt for self-medication.

Referring to the recent deaths of 11 Sanitation workers in a week in Delhi, he stated that “these are government sponsored killings”. He further elaborated that the Swachh Bharat Abhiyan (SBA) has failed to address the problems of manual scavenging and sanitation workers. The household toilets constructed under SBA are not mechanised and require manual cleaning which is to be carried out by manual scavengers.

Speaking on the issue of inaccessible health services among religious minorities, Dr. Shakeel Ur Rahman said that Muslim women face triple burdens of poverty, gender discrimination and religious discrimination. He elaborated that when a pregnant Muslim woman goes for institutional delivery in a government hospital, she is subjected to verbal abuse by the medical worker and is blamed to have given birth to many children. This attitude discourages such women from availing public health facilities. He said that decentralised data from sub centres in Bihar shows that while the population of Muslims is 15%, only 3% health facilities are present in those areas.

Legal expert Usha Ramanathan talked about the dangers of Aadhar and UIDAI. She said that by linking Aadhar to health services, government is collecting digital footprints of the Indian population which can then be used by private companies to make business. She asserted that the “fundamental rights are being jeopardised in the name of promoting economy of the nation.”

“Before independence, tribals had rights over the forest and used to take care of forests, but post-independence, the forests were taken over by the government, which planted Eucalyptus trees that depletes the nutrients and moisture reserves of the soil,” stated Gangaram Paikra, an eminent Adivasi activist from Sarjuga, Chhattisgarh. He said that the food habits of the tribals are being altered, impacting their nutrient intake adversely. A situation is being created where they are turning into vegetarians, but traditional food items like local millets are extinct from the market. Promotions of hybrid seeds for high yields have diverted the agricultural practices and indigenous plantations are under threat.

Rinchin said, “In the name of development, pollution has been poisoning our health and lives. The ponds and rivers are polluted with mine water and the same water is being consumed for drinking by communities in Raigarh district of Chhattisgarh.” Raigarh is among the foremost mining districts of the state.

Talking about environmental as well as health damage, she said that coal ash- which is banned from being disposed off in the open- is being dumped in forest areas, covering trees in their entirety. From there it enters the environment of residential areas of the tribals. The coal ash has been found to contain heavy metals, carcinogens and other poisonous metals which affect people’s health adversely. She said that all these activities are happening in full knowledge of the government. Rajani Soren from Human Rights Law Network also spoke on the legal struggles being fought by the people in Chhattisgarh.

The second day also witnessed discussions and debates on different issues of health and healthcare at five sub-plenaries: Health systems strengthening, voice of health workers, emerging issues in women’s health, child health and nutrition, and regulation of private healthcare sector. Several workshop sessions were held in the afternoon by various organisations.

Later, the NHA saw the endorsement of a People’s Health Manifesto, to be issued to all political parties in the run up to the state and national elections. This was followed by a speech by Lalit Surjan, who spoke on the necessity to struggle for health and the larger social conditions in which health can be placed. The Assembly came to an end with the entire gathering lending their voice to songs by Charul and Vinay. 

The third NHA was successful in revitalising the participating activists, delegates and their organisations to carry forward the spirit of struggle for Right to Health.