Kolkata, February 20, 2014
Doctors, public health experts, policy makers, development practitioners and activists who gathered for the eleventh Kolkata Group workshop here over the past three days have stressed that healthcare should be recognized as a fundamental human right.
"Furthermore, there is an essential need for (i) an integrated approach to healthcare, with guaranteed access for all to qualified doctors trained in modern medicine, and (ii) a comprehensive understanding of healthcare that must, among other things, include the provisioning of clean water, nutrition, sanitation and waste disposal," the 50 participants from different walks of life said in a statement at the end of the worshop.
The three-day event was held from February 17-19 at the National Library here on the theme, "Curing India's Health System: Learning from Asian Experiences".
The workshop was chaired by renowned economist Amartya Sen and was held to discuss the dismal state of health services in India and to learn from the experiences of other Asian countries in introducing health systems reforms.
Health experts from China, Thailand and Bangladesh shared their experiences with participants of the workshop.
Thailand has generated several health innovations like the universal insurance system and regular Health Assemblies for public discussion. Bangladesh has shown the importance of drawing on women’s agency through female community health workers as well as school teachers and the constructive role of NGOs. China has embarked on a massive reform of its national health care system, not only involving near universal coverage but also showing the possibility of rapid change given public commitment.
The statement said single payer national health insurance must be an essential component of healthcare financing. Current financial allocations are massively inadequate. In addition, the recently introduced public subsidization of expensive hospital care (private or public), without guidance from primary care doctors, could be both wasteful and injurious to the health of patients subjected to such procedures without assessing the exact medical need. New avenues of public support such as the Rashtriya Swasthya Bima Yojana (RSBY) should be incorporated within an integrated healthcare system, it said.
Relying on private medical care, without the availability of public health services, allows extensive exploitation of vulnerable and under-informed patients and their families, because of the asymmetric nature of healthcare knowledge, it said.
The statement said this had been noted across the world both by professional economists and by public health experts. In fact, no country in the world has achieved universal health coverage based on private healthcare only or even on private commercial health insurance, it said.
"There is an imperative need to ensure responsible behaviour by public servants in terms of presence and engagement throughout the full working hours in healthcare facilities," it said.
"Professionalism with ethics is required among doctors and other healthcare workers in a labour-intensive industry where the technical, social, and geographic attributes of health workers matches health service delivery needs. Medical education, a national subject in India, should be revamped to produce workers suited to achieving comprehensive primary healthcare," it said.
The statement said healthcare reform is a complex, long-term process that requires sustained leadership and attention. Arbitrary transfer of well-performing senior public servants leading the necessary reforms of healthcare jeopardizes effective long-range planning and implementation. Sustained leadership is needed, it said.
The Kolkata Group participants included Isher Ahluwalia, Montek Singh Ahluwalia, Sabina Alkire, Sudhir Anand, Louis-Georges Arsenault, Shabana Azmi, Pranab Bardhan, Afsan Bhadelia, Sugata Bose, Achin Chakraborty, Anirban Chattopadhyay, Lincoln Chen, Seema Chishti, Abhijit Chowdhury, Mushtaque Chowdhury, Asim Dasgupta, Antara Dev Sen, Jean Dreze, Dilip Ghosh, Gopalkrishna Gandhi, Shaibal Gupta, Raunaq Jahan, Pratik Kanjilal, Suneeta Krishnan, Manabi Mazumdar, Surjya Kanta Mishra, Nachiket Mor, Poonam Muttreja, Vikram Patel, Asadur Rahman, N Ram, Mariam Ram, S Ramadorai, Kumar Rana, Tejinder Singh Sandhu, Sujatha Rao, Ram Manohar Reddy, Srinath Reddy, Sunanda Reddy, A. K. Shiva Kumar, Shantha Sinha, Rehman Sobhan, Samrit Srithamrongsawat, Ramya Subrahmaniam, Min Yang and Winnie Yip.
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