The Politics of Health: Towards Sustainable and Empowering Health Care

A Workshop organised by

Sambhaavnaa Institute together with Health Swaraj Group of SADED

25th-31st March, 2018

Background

The Indian enigma is that India’s health indicators are among the worst in the world despite our being one of the biggest democracies and fastest growing economies. Increasing life expectancy seems to mask the poor quality of life and its health consequences. Our children and adults are more malnourished than the populations in Sub-Saharan Africa. We have a triple burden of continuing communicable diseases such as tuberculosis, malaria and pneumonia, increasing non-communicable diseases such as heart disease, cancers and environmental pollution related problems, as well as increasing injuries due to traffic accidents, social violence and suicides. And access to affordable health care is becoming more difficult. Obviously, Indian development and health policies are not in sync with health conditions of the majority. Even though health and health care are concerns of each individual, we do not seem to give them due public policy attention, either in the overall planning processes for the country or in development of health services.

In the present times, people are facing three crises related to health. One is of changing disease patterns due to rapidly changing environmental, economic, social and cultural conditions for which preventive and therapeutic measures have still to be understood and applied. The second is of the difficulties faced in availing of affordable, safe and dependable health care. The third is the dominant perspective of health knowledge and services that have led to a medicalization and commodification of health, with loss of the capacity for ‘listening to one’s body’ and being involved in decisions related to one’s own health. Thereby, the domain of health and health care have become tools of dis-empowerment at individual, community and societal levels. Government policies have led to building up of a large health services infrastructure in the country, and also contributed to creation of the crises people are facing.

Several government, academic, civil society and social movement initiatives have attempted to address these concerns. These include the Primary Health Care approach adopted internationally as part of the WHO-UNICEF’s Alma-Ata declaration in 1978 and the building of public services since the 1940s in India. In recent decades, there has been the attempt to strengthening of public services through the National Rural Health Mission, the current international approaches of Universal Health Coverage and Sustainable Development Goals, campaigns such as for the Right to Food and Right to Health.

About the Workshop:

In this program, we will examine the public policy and non-government initiatives that have attempted to work towards bottom-up, pro-people and pro-poor health care systems. They will be explored for their approach and achievements against the backdrop of the dominant political economy of healthcare. To understand what the present situation of health care is and how it can be improved from a pro-people perspective we will examine the following questions:

• What all aspects affecting health are included in ‘health care’?
• What affects people’s access to appropriate and quality health care?
• What is ‘quality’ in health care?
• What is ‘medicalisation’ and ‘commodification’ of health?
• What decision-making about their health can lay people do, and what is ‘empowering’ or ‘disempowering’ for them in the context of health care?
• What are the implications of these processes for designing health systems?

In order to answer these questions, we will use available data on health and the experience of attempts to improve health care. While discussing issues informed by global experience, it will focus on the Indian context.

Methodology:  Group Work, Interactive sessions, Presentations, Film screenings and lectures will be used to develop an understanding of the various dimensions of the politics of health. The options available for future development will be the purpose of the course. Sessions will be structured to:

• Explore reasons for inequalities in health status and health care as the ‘Politics of Access’
• Understand pluralism in health knowledge as the ‘Politics of Knowledge’, and the processes of decision-making for health as the ‘Politics of Governance’, with delineation of the linkages between the three.
• Move towards a collective re-conceptualization of what can be the future directions for a people-centered approach to health and healthcare.
• Examine these issues and develop an understanding of what can be done for designing health services that are sustainable and empowering.

Who is this workshop for:  Health activists, journalists dealing with health issues, early and mid-career health care providers (doctors, nurses, paramedics) or anyone interested in people oriented health and health care; anyone interested in contributing to developing a better understanding of how to empower people to deal with health problems and creating social conditions that support the same.

Workshop Facilitators:  The resource persons include:

Madhulika Banerjee (Professor, Department of Political Science, Delhi University)

Rakhal Gaitonde (Umea University, Sweden),

V. Sujatha (Professor, Centre for the Study of Social Systems, JNU),

Ritu Priya (Health Swaraaj workgroup of South Asian Dialogues on Ecological Democracy (SADED) and Professor at the Centre of Social Medicine and Community Health, JNU),

and others from the academic, civil society and movement spheres.

Language: The workshop will be conducted bilingually (English/Hindi)

Contribution towards Programs Costs: We hope that participants would contribute an amount of Rs. 5500 for 7 days/-  towards workshop expenses, inclusive of all onsite workshop costs: boarding, lodging, and all the materials used in the workshop.  Need based partial waivers are available; We have a very limited number of partial waivers so please apply for a waiver only if you really need it. Do remember that there may be others who need it more than you.

Dates: 25th March 10:00 AM to 31st March 5:00 PM 2018.

Venue:  Sambhaavnaa Institute, Palampur, Himachal Pradesh

Contact: For more information please call 889 422 7954 or email: programs@sambhaavnaa.org

 Schedule for the program:

Day 1: Setting the Stage

• National and international health facts and figures, institutional structures and debates about health.
• Data of Health status and inequalities; What is health; Interpreting the data (eg numbers and rates; what indicators-disability-adjusted life year (DALY)
• SDHs; debates about determinants
• What is health care—individual, collective, societal systems; quality of health care, medicalisation and commodification; empowering and disempowering; ICDS and AWCs
• Vaccines— the technology and its role—smallpox and polio, malaria and HIV; commercial interests vs cost-effectiveness and safety

Day 2: Politics of Access

• Structure of health services and implications for access— public/private; traditional / modern; Doctor and hospital centred vs home-community-paramedic-GP-specialist layered continuum; NHPs for delivery of medicines/vaccines/medicalisation of child birth/
• Bhore to PHC to private sector to corporatisation to NRHM and UHC— unregulated medical profession as leader; nurses and caring missing; people’s knowledge and pluralism missing
• Financing— India and other countries; as against GDP but also absolute; Health insurance as option-good idea of risk pooling but becomes a profit making industry; necessity of public i.e. state/philanthropic support. Also non-commercial service and self care.
• Malpractice and over-prescription— medicalisation and commodification; corporatisation
• Rational drug use; Pharma, Patents and Pricing— 80% of OOP expenditure; TNMSC/Jan-aushdhalaya/ generic drugs
• Right to Health; Right to Food campaigns
• Access to medical commodities is not enough to ensure health for all, e.g. anaemia and maternal mortality

Day 3: Politics of Knowledge: Impact of colonialism and responses to it by various health related knowledge systems (Food and nutrition/Health and health care/); Medical pluralism in the present times; Issues of people’s dis-empowerment and empowerment through legitimization of knowledge. Impact of the pharma industry on the creation of knowledge and disease categories.

Day 4: Field visit: To interact with the local community and a range of health care providers.

Day 5: Politics of Governance: Health governance and management structures; Decentralisation v/s the idea of a National Authority; People’s role in monitoring and planning services—CBMP under NRHM; Role of diverse conceptual frameworks for design of health care systems.

Day 6: Re-writing PHC: Alma Ata document on Primary Health Care to be analysed and discussion on how it can be rewritten for people’s health and empowerment in the 21st century. Engaging with range of documents developed in the current context.

Day 7: Presentation and discussion of PHC 2.0  & Panel Discussion by all speakers and open discussion with participants.

Please fill the Application form below to apply