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What's Inside

Kindly click here and here to access the Press release by Jan Swasthya Abhiyan dated February 2, 2022 on the Union Health Budget 2022-23.

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The COVID-19 pandemic has devastated families and communities and disrupted societies and economies. Patients had to endure various indignities in both public and private hospitals without protections or recourse to adequate preventive and redressal mechanisms. While the COVID-19 vaccine is seen as a solution to the pandemic, its roll-out has also been rife with inequalities. However, many of the problems we have seen at this time stem from the deep-rooted problems in the public health system. A critical look at India"s health system from the perspective of its patients is overdue.

Oxfam India undertook two rapid surveys on Patient"s Rights Charter and COVID-19 vaccination through self-administered questionnaires, covering 28 states and 5 Union territories; as such, this bears the limitations arising from it being a self-selected sample. The former was done between February and April 2021 and received 3890 responses while the latter was done between August and September 2021 covering 10,955 respondents. Given the distinctive focus of each survey, both are presented separately.

The key findings of the survey on Patient's Rights done for Oxfam India report titled Securing Rights of Patients in India: Lessons from rapid surveys on peoples’ experiences of Patient’s Rights Charter and the COVID-19 vaccination drive (released on 18 November, 2021) are as follows (please click here to access): 

• This captures some of the experience of patients with both the public and private healthcare system over the last decade with a focus on the provisions of the Patients "Rights Charter. 

• Right to Confidentiality, Human Dignity and Privacy: Over a third of women (35 percent) said that they had to undergo a physical examination by a male practitioner without another female present in the room.

• Right to Information: 74 percent of people said that the doctor simply wrote the prescription or treatment or asked them to get tests/ investigations done without explaining their disease, nature and/or cause of illness.

• Right to Informed Consent: More than half of the respondents (57 percent) who were themselves/ their relatives had been hospitalised did not receive any information about investigations and tests being done.

• Right to Second Opinion: At least a third of respondents who had themselves/ their relatives hospitalised said their doctor did not allow a second opinion.

• Right to Non-Discrimination: A third of Muslim respondents and over 20 percent Dalit and Adivasi respondents reported feeling discriminated against on the grounds of their religion or caste in a hospital/ by a healthcare professional.

• Right to Choose Source of Obtaining Medicine or Test: 8 in 10 respondents reported being asked to get tests/diagnostics from one place only.

• Right to Transparency in Rates and Care According to Prescribed Rates: 58 percent of people of those who had themselves/ their relatives hospitalised, said that they were not provided with an estimated cost of treatment/procedure before the start of treatment/procedure. Three in every 10 people surveyed reported being denied case papers, patient records, investigation reports for treatment/ procedure by the hospital even after requesting the same.

• Right to Take Discharge of Patient or Receive Body of Deceased from the Hospital: 19 percent of respondents whose close relatives were hospitalized said that they were denied the release of the dead body by the hospital

The COVID-19 pandemic has deepened existing structural inequalities in the healthcare system. The report recommends:

• The MoHFW should set up a mechanism to review the present status of adoption of the Patient"s Rights Charter (PRC) in all states and UTs and order its immediate adoption. It should include the PRC in the Clinical Establishment Act (CEA) and issue a letter to the states and Union territories (UTs) for displaying PRC in all private and public hospitals in view of the unprecedented crisis induced by the COVID-19 pandemic, particularly for hospitals taking part in the Pradhan Mantri Jan Arogya Yojana (PMJAY).

• The State and UT governments should issue orders to display the PRC in all private and public hospitals irrespective of adoption of CEA and ensure grievance redressal mechanisms for patients, through the appointment of an internal grievance officer within every public and private clinical establishment.

• The National Medical Commission should introduce mandatory modules on patients "rights in the healthcare curriculum.

Some of the key findings from the survey of the experiences of the vaccination drive were:

• Eight out of 10 people said that they do not think that the government will be able to vaccinate all adults by December 2021.

• 80 percent of people believed that it is more difficult for a daily wage worker to get the vaccine as compared to a salaried, middle-class person. Most did not think that the experience was equitable.

• With respect to how the government should address inequity in vaccination, some specific suggestions were: 

- 83 percent believed that all vaccination should be done completely free of cost through the government, like previous vaccination drives.

- Only 2 percent of respondents were in favour of a tax on essentials like fuel to fund the vaccination. 55 percent believed that imposing a one-time tax of 1 percent on the net-worth of India"s richest 1000 families was the best mode of funding.

- 89 percent of people said that the operational hours of vaccination centres should be expanded beyond 9 AM-5 PM.

- 95 percent of people from all age categories felt that vaccination must be brought closer to the elderly, persons with disabilities and informal sector workers by making use of mobile vans, vaccination camps and home-based vaccination.

- 88 percent believed that the government must ensure that marginalized groups such as street dwellers, migrant workers, immigrants, refugees and asylum seekers are given access to
vaccination without having to furnish documentation.

- Improve information about vaccination. 74 percent of respondents earned less than INR 10,000 per month and over 60 percent of respondents from marginalized and minority communities felt that the government has failed in informing them about how and when to get vaccinated. Eight in 10 felt that the government had been changing its COVID-19 vaccine policies too frequently.

- 89 percent of people said that the government must do more to ramp vaccine production, especially through public sector companies.

- The experiences of vaccination show the

-- Challenges with vaccination:

---29 percent said that they either had to make multiple visits to the vaccination centre or stand in long queues.

---22 percent faced issues in booking the slot online or had to try for multiple days ahead to get a slot

---9 percent people said that they had to lose a day's wages to get themselves vaccinated.

-- Reason for not getting vaccinated:

---43 percent respondents stated that they could not get vaccinated because the vaccination centre had run out of vaccines when they visited the centre.

---12 percent did not get vaccinated because they could not afford the high prices of vaccines.

The lessons from the COVID-19 vaccination drive, would not only help to improve the current response but can derive learnings improving equitable administration of any vaccine in future.

-All vaccination should continue to be done completely free of cost through the government system; avoid the use of private hospitals to deliver vaccination;

-Proactively release timely information on vaccination strategies, modalities and accomplishments in disaggregated, user-friendly and open source formats;

-Prioritise allocation, distribution and administration of vaccines for marginalized, poor, vulnerable, excluded communities first, of course along with for those who are at risk;

-Maintain record and release disaggregated data on vaccination coverage based on social and economic groups including Dalits(Scheduled Caste), Adivasis(Scheduled Tribes), Muslims, and Persons with Disabilities (PwD);
 
-Bring vaccination closer to the vulnerable and extend operational hours of vaccination centres beyond 9 AM-5 PM to allow for vaccination without a loss of wages;

-Improve information dissemination about vaccination; existing technology-based mechanisms for disseminating information about vaccination centres locations and availability of vaccines is not sufficient. It would be important to build robust and functional grievance redressal mechanisms, from national to local, to address emerging challenges. Adequate flexibility must be given to local health administrations to adapt to local circumstances;

-Further ramp up vaccine production, especially through the use of public sector companies.
 

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