IMA Maharashtra State

 

 

Presidential Message

Dear IMA members,

I take this opportunity to once again wish you a very happy, healthy and prosperous 2012 for you and your family. I also take this opportunity to thank you all on your commitments to work for the association and its mission as a team. Through “MAHIMA”, I would like to share my concerns with you on four main issues and would request you to take up these issues as your priority agenda. I would also continue to follow these issues as my mission.

1.  IMA’s Campaign Against proposed BRHC (Bachelor of Rural Health Care)

You are all aware that Government of India is pursuing strongly on starting BRHC course in the country. IMA at National and at state level has already started taking strong actions against this decision and is making all out efforts to continue our advocacy against this decision. You are also aware that Zillah Parishad in Maharashtra is the agency for planning, management and implementation of rural health care through Primary Health centers, which are under the administrative control of Zillah Parishad.  And, now, it has also been experienced that only the medical community fighting for this, will fall short to convince the national government and therefore we need to mobilize elected representatives for this issue.

Many of the members must be having good relations with office bearers of Zillah Parishad. I would request you to contact them personally, appraise them about this wrong decision. Key advocacy points would be:

• Is the national government differentiating between urban and rural population by providing sub standard health care services to rural population by so called medical personnel as against services to urban population by highly competent doctors?
• Is it not against Human Rights and Right to Health?
• Health problems related to communicable diseases and issues related to maternal, infant and child hood mortality in rural/tribal areas especially for the vulnerable population are many folds, where they do require services of qualified medical professionals. And, through such a wrong policy, is it not that the national government is totally giving a blind eye to these problems.

National government is taking a plea that because MBBS doctors are not willing to go to rural areas and serve rural population, the government is coming out with this policy. In this context an independent study commissioned by TISS (Tata Institute of Social Sciences) Mumbai, one of the most prestigious and premiere institute of the country, is an eye-opener for the government. The study has very clearly brought out that MBBS doctors are willing to serve in rural areas, but, it is the poor governance that is depriving them from serving the rural population. I have already shared an abstract of this study with all IMA branches as a good advocacy tool.

Through “MAHIMA” , I once again appeal you to take following actions at an earliest:

• Contact Z.P. members and office bearers through your good offices. Brief them on this issue and request them to take up this issue for discussion in general body meeting of Z.P. to pass a resolution that the Z.P. being the custodian of health of rural population, do not want such sub standard medical professionals to serve rural population. Request them to send this resolution to the state government. If more than 50% ZPs. are able to pass this resolution, health being a state subject, even if the state government wish to adapt to national government’s directives (this is because in Maharashtra and at National level, the same political party is in power), they will have to say  “ NO “ to National Government.
• Mobilize members of Maharashtra Legislative Assembly and Legislative Council and request them to raise this issue on the floor of the House through either LAQ/LCQ or a calling attention and pressurize state government to say “NO” to this proposed strategy of National Government.

The time at our disposal is very short and we need to mobilize all our resources and make all out efforts on above two issues. And, I am confident, with your and other member’s excellent relations with elected representatives, you would certainly win the battle. I would also request you to select 5-10 such influential IMA members as core committee members and assign them this task as a mission for next three months. I look forward to your positive response to fight against the proposed strategy of national government.

2. CLINICAL ESTABLISHMENT BILL 2010

This is the most draconian Bill against the practicing medical community. The Bill is to provide for registration and regulation of clinical establishments in the country. The bill with No. 71/2007 was first introduced in Lok Sabha on 30th Aug., 2007. It was not passed because of lot of objections from the members and was therefore referred to Parliamentary Standing Committee headed by Mr. Amarjeet Singh, then Member of Parliament. Committee interviewed and heard various stakeholders and submitted its draft report. Unfortunately, Committee’s recommendations were not considered and the Bill lapsed due to dissolution of 14^th Lok Sabha. Same Bill without any modifications considering recommendations of the Parliamentary Standing Committee was introduced in Parliament on 3rd May 2010 and was passed by the Parliament in 2010 amidst pandemonium without any discussion. This is an  example of  most undemocratic approach to a serious issue.

Clinical establishments would include all health facilities providing in-patient and out-patient health services, all laboratories providing diagnostic facilities, maternity homes, nursing homes, sanatorium and even a single doctor providing only OPD services.

The Bill spells out regulatory mechanism, functions and powers of the regulatory body and also penalties for contravening of the provisions of the Act, with district collector as an Appropriate Authority. Government of India has constituted a committee to spell out each component of the Bill so as to introduce it as the Act and Rules.

If one looks at the minimum essential criteria for registration, not a single clinic functioning at present will meet out these criteria and will not get registration. This would be one more Act the medical professionals will have to comply with along with not less than 25 other Acts in force (e.g. consumer protection Act, minimum wages Act, Shops Act, local Acts of Municipal corporations and Municipal councils, waste disposal Act, communicable diseases prevention Act, MTP, PC-PNDT Act, and the list is endless)

I am  just visualizing my medical colleague sitting in his clinic with so many files, records and reports, which he has to maintain to have his clinic compliant to all these Acts in force. Are we making him a “Babu” wasting his time and energy on all these works, at the cost of concentrating on health and wellbeing of the clients. And, I am sure at the end the sufferer would be the client.

Parliament has no power to make laws for the state with respect to health matters except as provided in articles 249 and 250 of the constitution and therefore the Bill shall apply to states which adopt this Act by resolution in the assembly under clause (1) of article 252

Whenever we discuss about this issue, I come across following knee jerk responses from our medical community:

• IMA ne seriously kuchh karna chahiye? (Am I not part of IMA?)
• Aare yaar — Jab aayega tab dekhenge
• Chalo ek din Bandh observe kare, morcha nikale, representations de?
• Aare yaar … Krishna (Dr. Krishna Parate is IMA’s nodal person working on this issue) ko to iski responsibility di hai… kya kar raha wo?

Let us ask this question to ourselves:

• How many of us have read this Bill?.
• Are there still any opportunities for us to intervene?

Clinical Establishment Bill is a very serious issue for each and every one. Sooner or later it will come on the floor of Maharashtra State Assembly for discussion and for passing this Bill. And it is therefore we all need to take following steps proactively:

• Constitute in house core committee. Read the Bill carefully. Read between the lines. Identify gray areas not clearly spelled out. Develop good advocacy material for Members of State Legislative Assembly and Legislative Council.  One to one continued lobbying/advocacy with them.
• One of the advocacy agenda: All government establishments (sub health center to medical colleges) will be under the purview of this Act. Does Govt. has capacity to first ensure that all govt. institutions are Act compliant before the government enforces this Act on private service providers?
• A committee is constituted which is now engaged in formulation of Rules in the ministry? Contact them personally (identify members for this for lobbying with them). Majority of these members are doctors. Establish rapport with them and motivate them to work in favor of medical community and not against them.

Friends, the Mission is full of hills and valleys, some of which would want us to quit along the way, but our  focus is on the finish, not on the difficulties on our ways. Start with, what “I” can contribute to and not what “we-IMA” should do – Everybody’s job is nobody’s job. We are optimistic, we will succeed in our mission with your active support to get away with this draconian Bill at least in the State of Maharashtra.

3. Aao Gaon Chale Project:

Aao Gaon Chale Project was launched across the country in 2007 with a much fanfare with IMA’s Mission  of Improving Health Status of  marginalized community and with an objective to compliment public health department to enhance utilization of Primary Health Care Services in underserved population.

What was expected under this project from each IMA branch was,  selection of a village or cluster of villages deprived of primary health care service, identify health needs and gaps in health care delivery, select priority interventions which are  doable, feasible by IMA, initiate promotive, preventive and curative services to compliment efforts of public health department and most important,  document efforts, lessons learnt, redesign annual plan, and share experiences with key stakeholders.

When I look at the present status of this project, I notice that, barring few branches, the project is not implemented in its true spirit. Majority of the activities have been one time activities just focusing on organizing group meetings, community Shows, important Days celebration, health Camps without any follow up or immunization Camps. I may dare to say that in majority of the branches this project is looked as “Aao …. Gaon Chale …. Health Camp Kare .. Pleasure trip kare … Wapas Laute …”

When I look towards the annual report of this project published by IMA-HQs, I notice wonderful work done by some of the states like Kerala, Goa, etc, where major thrust has been on early detection of breast, cervical, oral cancers, which are the health priority areas for these states. Through IMA’s initiatives of monthly visits, awareness activities, early detection, referral linkages for laboratory services, investigations, treatment and follow up, excellent work is being done in these states which is also recognized by public health department. If these states can effectively contribute to through the project, why IMA Maharashtra with its most active branches and a team of committed members should lag behind?.

I would therefore urge you to have a relook in to the project being implemented by you and if required redesign the project on following lines:

Select cluster of villages (a sub health center with poor performance in consultation with DHO – within easy reach of IMA ). Initiate a quick Base line assessment to compare our efforts after 1-2 years. Select priority areas, interventions – considering what is possible for us in view of our busy schedule?. IMA’s Resource Mapping – IMA’s Team – Who, what, How? – visits expected – once a month. Make efforts to mobilize resources from  health department , corporate sector, and civil society along with very little IMA’s financial support from our core budget. Develop joint work plan in consultation with health department, implement and monitor our action plan, systematically document our efforts and results and organize experience sharing  with stakeholders and media(Advocacy to show our commitments towards society).

I expect from you that IMA’s Vision should be an  Ideal Sub Health Center (cluster of villages), and Aao Gaon Chale – Now Onwards – For our Mission .. And not for Chale…. And…. Wapas Laute…..

4. Declining Child Sex Ratio and response from the medical community:

Although I am expressing my views about this issue and expectations from medical community in the end, to me it is the most serious social issue which is going to adversely affect the social fabric of the society, and we being an integral part of the society, we all would be definitely affected adversely due to unhealthy social structure of the society. We are proud to claim that IMA Maharashtra State Branch was the first branch in the country to understand seriousness of declining child sex ratio and started sensitizing medical community on this issue from 2005 onwards under the leadership of Dr. Ashok Adhao as our team leader and mentor. Our initiatives and efforts have been recognized at National level and this issue is being seriously addressed at the national level also.

However, 2011 census for Maharashtra is an eye-opener for us. The child sex ratio has further declined to 883 as against 927 in 2001. This clearly speaks that our efforts has not reached to a very few of our colleagues who are still engaged in sex determination practices followed by sex selective elimination of the female fetus. This unfortunately maligns the image of medical community and the society is looking towards us with doubts and suspicion.  We all need to rejuvenate DASS (Doctors Against Sex selection) committees and implement its activities in true spirit. It is high time now to bring those medical professionals under the purview of PC&PNDT Act for contravening provisions of the Act. Whispers against few doctors , whom we strongly suspect that they are engaged in sex selection practices, need to be converted in to concrete actions and we have to become bold while initiating such actions. Else, government, through its desperate attempts and by taking recourse of the Act, my start unnecessarily harassing good doctors, file cases against them for trivial or procedural gaps, for contravening provisions of the Act, and, IMA may not be in a position to support in such cases. I would conclude by recapitulating IMA’s Four Pronged Approach propagated by Dr. Ashok Adhao (Bat, Mulakat, Hawalat and Boycott). It’s high time for all of us now to get away from organizing sensitization workshops as the first approach and seriously move forward and take actions for next three approaches.

You all deserve heart-felt congratulations on your contribution for successful implementation of RNTCP in the state, the Best example of Public-Private Partnership, which has been recognized and appreciated by the state and national government. I would request you to continue your efforts for further improving implementation of RNTCP, through early detection, prompt treatment and ensuring regularity of treatment.

Friends, I take this opportunity to once again thank you all for bestowing upon me the responsibility as IMA President for Maharashtra State Branch and with your continued support, I promise to work for IMA’s mission during the year to keep IMA’s Flag flying high in the state of Maharashtra.

 

With regards

 

(Dr. Milind Naik)