Article by: Dr. Nitin Jadhav
About 40 km from Pune city, a well known and technically competent gynaecologist is appointed in the rural hospital (RH – equivalent to Community Health Centre) and he also runs his private hospital in another nearby town. He has been diverting pregnant women who had registered in the RH, asking them to get their delivery conducted in his private hospital, and was charging Rs. 5,000/- for normal delivery and Rs. 18,000/- for a caesarean section. This issue was raised in the multi stakeholder block level monitoring and planning committee (BMPC) which has been formed during the community based monitoring and planning (CbMP) process. This committee has taken action against the doctor and as a result of this, he has recently returned Rs.38,000/- to the patients, whom he
had charged after diverting them from the RH to his private hospital. While this action exemplifies the activeness of monitoring and planning committees, especially highlighting the proactive role of elected representatives, it also underlines the ongoing failure of the public health system in Maharashtra to control illegal private practice by public health system doctors.
On 21st August 2012, in the first meeting of Maharashtra State Monitoring and Planning Committee (SMPC), the issue of illegal private practice by doctors in the public health system was discussed.
The Directorate of health services clarified that a Government Resolution (GR) has been issued, in which it is clearly mentioned that Non-Practicing Allowance (NPA) for all doctors who are appointed in RHs and higher levels has been increased by 35% and now they are not allowed to do any kind of private practice. However, despite issuing of this GR, in reality in many areas of Maharashtra, illegal practice by government doctors has not stopped. Hence, as decided in the State MPC meeting, implementing organisations have identified such doctors in CbMP areas who continue to do illegal private practice, and the list including documentary evidence of such doctors has been submitted to state government, but unfortunately, the state government has not yet taken any action against
them.
As mentioned, in this block of Pune district, overall CbMP process is being implemented by MASUM (Mahila Sarvangin Utkarsh Mandal); the issue of illegal practice by the RH gynaecologist was identified by BMPC during data collection as part of the CbMP process. Subsequently, this issue was discussed in the BMPC meeting, which was conducted in April 2013; the committee asked the concerned gynaecologist to give justification regarding this issue. The doctor accepted his „mistake‟ and committed that he will
not do it again. The committee members observed that despite the commitment given by this doctor, he continued his private practice and was taking illegal charges from patients. In order to take definitive action, the monitoring committee decided to collect concrete evidence; committee members visited villages and talked with persons who had made such payments. In total 55 cases were identified and 12 cases were interviewed. Based on concrete evidence, this issue was raised in the district level Jan-Sunwai (Public Hearing).
As part of the follow up of Jan-Sunwai, the committee concluded that in spite of continuous dialogue with the gynaecologist, he had not stopped illegal charging. Keeping the seriousness of this issue in mind and lack of prompt action by health officials, the committee decided to take direct action and informed the doctor that he should reimburse money that had been illegally charged from patients.
Under pressure, especially from the PRI members who took a strong stand on this issue, the gynaecologist accepted the decision of the community monitoring committee; on 20th June 2013, the doctor reimbursed Rs.38,000/- to the committee. It was decided that this money will be given back to the respective patients in their villages itself, to help people become aware about their rights. The gynaecologist has assured that he will not take any illegal charges from now onwards and also that he will provide services to patients in the RH only. He expressed certain problems related to functioning of the RH such as vacant post of anaesthetist as well as other staff, lack of equipments, quarters for staff, etc. The community based block monitoring and planning committee has decided to organise a meeting with the deputy director and civil surgeon of the district for resolving these issues.
This incident illustrates how the routine administrative processes could not take action on an outstanding issue, and on other hand,
how the community monitoring process has empowered the local community, especially PRI members to take decisions on their own and bring about a positive change.
This article is taken from the 3rd edition of COPASAH Communique, the newsletter of COPASAH. To read the full newsletter CLICK HERE