MFC landscape "presentation" on advocacy for universal health care in India

1. “Utopia?- Larger Events seem to be Overtaking Us”
- an e-discussion
On 1/2/2012 7:43 PM, Abhay Shukla wrote:
Dear all,
Sorry for my lack of participation in the recent discussions on the annual meet programme.
Overall it looks fine and the main reason for not offering inputs from my side is that I agree
with the way it has evolved.
My main concern is that on the UHC front, larger events seem to be overtaking us and
'Publicly funded commercial health insurance' is rapidly emerging as the official form of
'Universal health coverage'. Following on the heels of Arogyasri in Andhra, we have the
Chief Ministers health insurance scheme in Tamil Nadu, Vajpayee Arogyasri in Karnataka
and now the similar Jeevandayi scheme in Maharashtra. Montek Ahluwalia has already
recently declared (irrespective of the HLEG report) that 'Universal health insurance' will be
the way forward for the Planning commission.
(Attached, see - http://www.thehindu.com/news/national/article2439574.ece )
Given that at least four major states already have such ('popular') schemes in place (along
with the national RSBY) and given the track record of Manmohan-Montek, there is a high
likelihood that a national health insurance scheme of some kind will be launched before
next elections, which will pick up some convenient parts from the HLEG report (e.g.
universal free medicines) but will be primarily based on handing out commercial insurance
coverage for inpatient care to BPL / APL families, who would avail of such care from
private hospitals.
In such a scenario, while we discuss in detail the 'MFC version' of UHC - which is a valid
and important exercise - as MFC we should also be intellectually prepared to challenge the
strongly emerging 'commercial health insurance based UHC'. I hope that in the last session
on advocacy we can plan to prepare some kind of critical document which would draw
upon analysis of Arogyasri, RSBY etc. with this purpose. Perhaps MFC might also catalyse
some 'advocacy oriented' event (in Delhi) which would frontally challenge the emerging
commercial health insurance based model of UHC. Keeping this context in mind I will be
willing to contribute to the advocacy session along with others.
With regards,
Abhay
“Utopia is on the horizon. I move two steps closer; it moves two steps
further away.
I walk another ten steps, and utopia runs ten steps further away.
As much as I may walk, I never reach it.
So what's the point of utopia? The point is this: it makes us continually
advance.”
―Eduardo Galeano

2. On Tue, Jan 3, 2012 at 11:01 AM, Rakhal Gaitonde <rakhal.gaitonde@gmail.com> wrote:
Dear Abhay,
I think what you are saying is absolutely on the nail.... it is a discomfort we as a team are feeling
here in Chennai, even as we see doors open here in Tamilnadu.....
The government has agreed to expand community monitoring to the whole of Tamilnadu and has
invited us to contribute to the planning of the present PIP - at the same time completely ignoring the
concerns of pentavalent and increasing the insurance coverage to 600+ conditions - moving from Star
Insurance to UIA...... and so on.....
I think there is urgent need to use the discussion on the UHC model to broaden our discourse.... I
hope to raise some of these issues in the governance session too.... this is indeed a cross cutting problem....
in solidarity
rakhal
--
Rakhal Gaitonde
Co-Convenor
medico friend circle
+91 9940246089
www.mfcindia.org
Dear Friends,
I was quite excited by the session on political advocacy when I saw it in the time table.At the same time,
looking at Abhay's note and the attachment provided a keen whiff of the kind of reality we are up against.
My feeling -- theoretical understanding and practical observation -- is that the force of neoliberal state
and market configuration can be countered effectively in the long term only by a powerful mainstream political
demand. Advocacy should address all parties, especially the opposition, and also the more people oriented
factions within the Congress. It is important to strengthen marginal and minority parties through providing them
access to demands on health care -- it will speak to their constituency. As communities, each of them have an
investment in the well being of their members, an investment that is rooted in their historical foundations. As
long as there is no pressure from people in asking for what they want, Manmohan-Montek will simply decide
what is good for industry and social welfare, by fiat. True that the people's responses and demands will be
immature, and representatives can be bought -- but that is a beginning we must be prepared to go through --
democracy is never pretty.
In the short run, tactical advocacy needs to put pressure to strengthen those sectors of government that
are socially and people oriented, rather than planning and industry oriented. If one wants to work on the
government, may be Sonia Gandhi, Anthony(?), against Montek-Manmohan? In addition pressure advocacy by
the MFC constituency will work too. Also health care and law. These are practical steps that seasoned activists
like many of you will have some skill at creating.
These are difficult steps that a real politics must take.
Best
Srivats
R Srivatsan
Senior Fellow
Anveshi Research Centre for Women's Studies
2-2-18/49 Durgabai Deshmukh Colony
Hyderabad 500 013
Phone: +91 40 27423690
Fax: +91 40 27423168
Mobile: +91 94404 80762

3. Discussion on Political Advocacy
8 January, 2012 | 12:45 pm (notes by Devaki Nambiar)
Presentation by Prabir
To begin with I wonder how many of you know about On Democracy Now or saw this onYou Tube:
"Get It Done": Urging Climate Justice, Youth Delegate Anjali ...
► 5:13► 5:13
www.youtube.com/watch?v=Ko3e6G_7GY4
anjali appadurai – Earth in Brackets
www.earthinbrackets.org/tag/anjali-appadurai/
• When Anjali was talking in Durban, she mentioned that she was from a group called “Earth in brackets”
o the 11 points we listed in the last session this morning are a sort of “Consensus in brackets”
• We have 2 MFC bulletins in our hands at this meet.
• Do see the 2012 MFC bulletin 348-50 page 6 Governance Question 1 and 4. Then page 7 second
question.
• Also see 2011 MFC bulletin 342-44 page 34 Thailand- Political Context. And page 65 Brazil -from
Social Security Crisis up to 8th National Health Conference (in the same issue).
• The discussion by Srivats, Rakhal and Abhay on 'events bypassing us' is also relevant.
• There seem to be no other background papers related to political advocacy. Let us start by looking at the
first point on Governance, which is relevant to this discussion on advocacy (MFC bulletin 348-50 page 6
Governance Question 1).
o Rakhal has asked…concretise people-centred system..principles and processes. In the process of
advocacy a set of principles will be agreed upon. A set of processes will start up through
advocacy. These will not stop when you go into UAHC.
o Rakhal has asked … (p4) what are the Institutions to build up consensus- aligning with
stakeholders…we want those fronts to continue acting after the actual thing gets into place.
o Rakhal has asked… (p7) how to convert this to political mobilization and then into political
commitment in the long run. What should the mechanisms be to sustain vibrancy.
o Processes to keep monitoring. You did NRHM you had CBM inside..somehow we formed it
afterwards…I think that is where the question is. This thing should have started earlier.
• 2 relevant papers are found in last year's bulletin. One is from Renu and the other from Abhay…they
refer to similar political processes in other countries.
o Renu wrote about Thailand in a section titled Political Context. One can see that there was a 1997
Economic Crisis, followed by a “30 baht to treat” signature campaign by the TRT party which
got over 50 thousand signatures. 11 NGOs were involved. The Ministry of Public Health was
involved and so were policy researchers. Thus at least 3 to 4 stakeholders were involved. Public
support – political will – technical quality – these were the “triangle that moved the mountain”.
One other phrase to note is Health as a Human Right.
o Abhay wrote on Brazil. The precipitating factor was the1988 social security crisis… obvious
SUS (the Unified Health System) came out of crisis. Health movement mobilization was on two
fronts. In 1976 only 27% of hospital beds were in the public domain. Rest were private. There
was support from the Latin American school of thinking in social medicine and from Professional
groups. The stakeholders met at 8th National Health Conference. Health as a Right is mentioned
here too!
• Organizing Committee had a discussion over email-
o “Are events overtaking us? ” was Abhay's question in the first mail.
o Rakhal pointed to the situation in Tamil Nadu
o Srivatsan followed up
o Some suggestions in this discussion referred to players in the health sector and law sector and

4. social science sectors, also economic sector. The media sector was not mentioned but is also
important.
o Who are these groups?
o In Health College students, researchers, Planning commission, HLEG group
o In Law: Courts, lawyers, legislators
o In Parliament Opposition legislators, sections of ruling party, marginal and minority parties (who
want issues that bother their constituencies). You can’t ask a mainline party if majority are in
Bombay or Calcutta…but if you ask party in Jharkand or Bihar…they will be very demanding…
this makes sense. Trade unions
o In Media Press, other media…writers like Dickens in Britain who brought social issues into the
limelight..Upton Sinclair in the USA…”The Jungle” by Sinclair on the processed meat industry
was responsible for the legislation that brought about the Food and Drug Administration; films
like Aarakshan orTare Zameen for education.
o What are the types of Movements?
 Health Health for All in 1980s and NRHM,
 Law Bhopal mobilization, Bellary mining issue - law is highly mobilized
 Consider Mainstream Demands like the women's struggle against alcohol in Andhra.
 Another mainstream demand which seem to work is Lokpal and at the centre of that the
issue of Corruption.
 Remember the history of Regime Changes....
 After 1977 in Jayprakash’s time…CHWs were started,
 But then look at Obama…Guantanamo hasn’t gone.
 Or the TMC in West Bengal was a major ballotbox regime change. But the health
department is going downhill…regime change may not be the answer.
 Jharkhand is good example where there was a bigger regime change..splitting of state…
but health or roads are not much better.
 Bangladesh separated from Pakistan in 1971. This was a split in a country. Regime
change again. But while this may be necessary, is this regime change enough to ensure a
good health system/ universal health care/ health as a human right?
Comment from Abhay
• MFC cannot necessarily lead a campaign but as members, in different states, try to catalyze broader
action…promote broader bodies like JSA take this agenda forward. – base for suggestions
• Have to encapsulate UHC into a few slogans. Operationalize later.. main points
o Free healthcare for all – or health rights for all
o Social responsibility of private medical
o Community control
o health of our people, Health of our system – lok swasthya,
• Has to be some social climate for that.
• Key messages based on slogans
• Alliances and Fronts
o Potential partners: unorganized sector, mass organisations, trade unions, Public Health
professionals and employees in Public Health system who are dissatisfied and facing threat of
privatization, and rational private doctors – who will stand up
o Sociopolitical spaces –2014 elections – likely they will come up with a scheme called Universal
Health something…either RSBY with mirch masala….
 To say this is not enough – what you need is …use those spaces
• Next steps
o Simple booklet or leaflet on UHC which an ordinary grassroots person can understand in
vernacular language.
 Have started a FAQ at CEHAT
o State-level meetings/consultations – invite the HLEG to present its report. Now has official
status, but it becomes a peg for larger group of stakeholders – can be done in near future…so idea
starts circulating.

5. o Opposing various kinds of direct and indirect privatization going on in various states, which may
accelerate with Aarogyashri types of systems. New constituencies can also join…we can think of
broader alliances on that front. And good booklet on critiquing Aarogyashri.
o More coherent way of taking up campaigns etc can be done by larger groups like JSA, etc.
o Clear slogans are. better to do advocacy.
Discussion
• Innovative mechanisms in field level like lessons from NRHM – that should not be missed out.
• Making the public system responsive and responsible…it has to be both public and private.
• GOI has MOH issued direction to do PIPs for next year. Urban Health Mission…how is HLEG
standing…with respect to new PIPs…this has not been communicated to the states…they have prepared
3-4 page note on PIPs which will lead planning…date bound in mid Jan…they will have a meeting and
e/thing will be accepted…next year’s budget will be done. Ministry has not taken this up. – bit late in the
day, no?
o People in states are intervening based on same principles…can directly use it now.
• Hindi booklet…another area is social media which has huge presence and those active in world of
web…same kind of campaign in language accepted there…
• How to make government players understand this issue…when NRHM came up PHRN did a course on
District Health Action Plan. Capacity building necessary to help people understand - plan with some
agencies some capacity-building.
• Thailand had economic downturn - Slogan relate it to lokpal – healthy people, health system; opposition
starts now – with the pharma policy
• Without insurance mechanism – what are the ways – have to think about this.
• Bring up issue just raised…citizen’s charter and grievance redressal…we’ve been addressing that issue
but without actually putting it in context of current crisis…lists of departments liable for citizen
charter…none have reference to PH system or education!!? This is right up our alley…one of the
important issues to concentrate is to have citizen’s charter and grievance redressal systems incorporate
health care systems.
• Re: grievance redressal…part of a meeting on this issue…Mutreja, Amarjit Sinha, Mirai Chatterjee –
created a subgroup without meeting and there is a note being put up on MOHFW – this was done in light
of sewa-uttam compliance – the scene is that..nobody is interested in grievance redress…but this bill is
already on the lok sabha website…you can look at it more and nothing related to health – already passed.
• Future alliances…generally youth are one. A key one.