COPASAH THEMATIC HUB ON PRIVATE MEDICAL SECTOR ACCOUNTABILITY
A N CH O R E D B Y S A T H I
Hosting Learning Exchange Workshop
'PATIENTS' RIGHTS AND ENTITLEMENTS'
on January 23-24, 2018, at YMCA, Mumbai, India
ACCOUNTABILITY OF PRIVATE MEDICAL SECTOR
Background of the Private Medical Sector in lMICS: Private Medical – ‘All is Not Well’ with the Unregulated Giant
The private sector in healthcare, and privatization of health systems are becoming important issues today in the context of most LMICs (Low and Middle Income Countries). As pointed out in a recent Lancet series: ‘The private sector in health care is not going away. Indeed, it has a large and expanding part to play in the health systems of all low-income and middle-income nations’. There is also increasing concern regarding regulation of the private sector, in context of mixed systems comprising both public and private segments: ‘The task of those concerned with health should be to subject the private sector to scrutiny—description, analysis, and evaluation…; the evidence on which to make wise policy decisions concerning the private sector is often weak or absent. That situation must change’.
In this section we will take a brief review of the private segment of healthcare systems in several South Asian countries, followed by a quick look at the current status of regulation of this sector.
Horton, R. and Clarke, S. (2016) The Perils and Possibilities of the Private Health Sector. The Lancet 388: 540-1, Published OnlineJune 26, 2016, http://dx.doi.org/10.1016/, S0140-6736(16)30774-7
 Same as in footnote 1.
The Private Medical Sector in South Asia (Bangladesh, India, Nepal, Pakistan,
The private health care sector is tremendously heterogeneous, ranging from independent informal and formal practitioners to small, medium and large hospitals, charitable hospitals and corporate hospital chains and diagnostic centres. While there are similarities among all the five countries as far as presence of a private sector goes, there are also significant differences among them with respect to the size, nature, and importance of the private sector, and the relationship between the private and public healthcare segments.
Performance of The Private Healthcare Sector – Blind Optimism Belied
by Troubling Reality
It is useful to recall the arguments that were made by international institutions such as the World Bank and some policy makers since the early 1990s, favouring growth and increased participation of the private sector in health care. It was claimed that private services are better in terms of efficiency and quality etc. However increasing number of studies and accounts point to the myriad problems with the private medical sector. While the Oxfam report is one important reference, studies have shown that the public sector provided better quality care than the private sector (Footnote 5). Studies on performance of health insurance programmes and other forms of PPPs demonstrate a range of problems with private providers. The path breaking book ‘Dissenting Diagnosis’ published in India based on testimonies of 78 ‘whistleblower’ doctors has ripped the lid on the myriad malpractices in the commercialised private medical sector, including unnecessary treatments and interventions, and irrational care driven by profit seeking by large hospitals, pharma industry – doctor nexus, institutionalised system of kickbacks, and inflated, arbitrary costs of care.
Oxfam (2009) Blind Optimism.
 Dissenting Diagnosis - by Arun Gadre and Abhay Shukla, Penguin Random House India, 2016
Danger of Ineffective or ‘Captured’ Regulation, Imperative of Social Accountability
Given this context of large and often dominant private sectors within the health systems of many LMICs, the mechanisms for regulation are often weak, under-resourced, bureaucratic and inadequately effective. There are major gaps in policy design and implementation, human resource constraints, problematic organizational relationships, and major risk of ‘capture’ of the regulatory bodies by private interests.
Forging a People-Centred Approach to Private Healthcare: Integrating Social Accountability and Regulation in A Rights-Based Framework
In order to tackle the widespread problems faced by ordinary people concerning private health care, there is need for health system initiatives, combined with large scale social action. Building effective regulatory frameworks must go hand in hand with developing a climate of social accountability and patients’ rights. We must recognise that current weak regulation, or gaps in regulation of the private medical sector in many LMICs is linked with minimal political will to regulate this sector, since the private healthcare industry often has significant financial and political clout.
Example of Campaign Experiences From India – Developing A Three Pronged Strategy
Documented personal experiences of patients, specific studies, and testimonies by ethical doctors have established that unnecessary procedures and medications, perverse system of kickbacks, super profiteering during hospital supply of stents, implants etc., and other malpractices are rampant in private hospitals in India.
Introduction to The Thematic Hub on Accountability of The Private Medical Sector
Today despite massive growth of the private medical sector across the world including LMICs, and major social evidence of the negative consequences of market failure, regulation of private medical sector remains patchy and weak in most LMICs. Despite large scale dissatisfaction related to malpractices, unethical practices, overcharging, and violation of patients’ rights, movements around these issues are often non-existent or very small.
Proposed Activities of Accountability of The Private Medical Sector Thematic Hub
The thematic hub will work through organising global thematic webinars, networking and alliance building in South Asia, regional consultations, and capacity building of activists. Key activities would include...
Core Group Members of Accountability of The Private Medical Sector Thematic Hub
Core Group Meetings of Accountability of Private Medical Sector Thematic Hub
The first conference meeting of the Core Group was held on October 7, 2017 in which the participants included Dr. Abhay Shukla, Adv. Moses Mulumba, Dr. Abhijit More, Ameer Khan and Deepika Joshi. The basic idea of the thematic hub and the proposed functions of the hub were discussed in this meeting. The Core Group was later expanded after confirmation of members from Sri Lanka, Bangladesh and Nepal. Akhila Vasan of the Karnataka Janaarogya Chaluvali – KJC (India) KJC is a people’s struggle for health rights, dignity and well-being of all citizens, with a focus on the most disadvantaged and marginalized communities). Akhila Vasan from KJC will support the thematic hub as a supporter outside the core group.
In Karnataka, revamp of medical regulations in the name of citizens is only hurting their interests