 Hello and welcome to NewsClick. We are just days away from the very crucial daily election 2020 and healthcare being a very important issue that has surfaced over the last five years in the electoral campaigns of the BJP, the Ahmadini Party and the Congress Party as well and the significance that it assumes for the citizens of the city. And to discuss this issue we have with us Ritu Priya from the center of medicine and community health at JNU and Rinsh Joseph who is the president of the United Nurses Association in Delhi. We will be discussing greater issues of healthcare that are plaguing the city and what is more importantly the way forward. So the first question to you ma'am is that in the last five years what have we seen in terms of the health expenditure because I think the most crucial thing is how much is our government spending on our health? Well I think Delhi has been relatively privileged in terms of the budget expenditure allocation being about 13 percent which is much higher than most states and yet it's obviously not enough. The citizens of Delhi have a problem of accessing healthcare which is affordable which is trustworthy when they need it and therefore there is a need for much greater allocation to health. What the JSA has been advocating for and that's the calculations that we all seem to come up with is something like 5 to 6 percent of the GDP of the state is what is actually required but since we are at the moment at about 0.65 percent it's going to take us time to get there but there should be the move in that direction with coming up to something like 2 percent in the next five years and then another five years we should reach the 3 percent and then 5 percent. So this is the way forward. At the same time I think another very crucial question is about the conditions of the workers. We've seen a very big strike that the nurses had in the last one month and sustained movement that they've been conducting. So when the government is investing of course in terms of money what is the condition of the workers, what are their demands and about the protests as well that we've been seeing coming from the nurses and healthcare workers. Right. See when we talk about health you know it's always a healthy nation we need a healthy citizen that's very important. So the nurses are the advocates of the patients so we need good advocates for the patient care. So the scenario the nurses are migrating to the foreign countries because of the low wages. That's why the Supreme Court recommendation we united our association you know we are demanding to implement the Supreme Court recommendation as per the best status the nurses wages has to be implemented. For that we have been fighting for since long time. On 28th of you know October we conducted a big mass protestion at Jandamanda and we announced that you know we if the government is not going to implement we will be starting our Satya Grahandaul. Since the direction was given by the Delhi High Court to implement the nurses minimum wages as per the SC recommendation the government has been not taken any steps to implement to make it in the legislation. So we have been you know continuously meeting all the officials and the government you know ministers and chief minister you know unfortunately they couldn't get it done and there was a massive mobilization of the people around 5000 people are on the street. We marched to the United Nurses Association we marched on the working day to the Delhi Secretary on 10th of December that's very you know particular day that is the National Human Rights Day. So after all these things I really upset that we approach all the political parties and everybody was assured that we will do it but no one is included or demand in the election manifesto that is really unfortunate but still we have hope that who is going to come for the you know the newly elected government will surely come you know consider this to implement it and definitely you and I will you know hold for the accountability because they are sure that all the political parties all the mainstream political parties they are sure to United Nurses Association and the nursing community that they are going to implement this. Talking about the numbers the nurses near about 90,000 nurses are registered and asked by the Delhi Nursing Council and most of the nurses are the main earning members in the family and it's near about you know 2.5 to 3 lakh people have the voting power and you know the nurses have you know the part of the you know system the democratic system. Obviously we will be hoping that you know who's going to come for the next newly new government they have to consider this and this will help the help to improve the betterment of the healthcare system if you have a call if a nurse is in the country. And relating to this you know the Jan Swasthya Abhyan has also come up with a manifesto of their own the points that they want the Delhi government and whoever forms the government next to consider and one of the crucial things drawing from the experiences on the ground happens to be the Delhi Health Act so if you could tell us more about what that act actually entails and why it's so crucial for the state of Delhi to have a health care act. Maybe one can start with the fact that the Jan Swasthya Abhyan has been advocating for a long time for right to health and health care across the country which is just as relevant for Delhi as a state. Within that there are a whole set of issues that need to be considered. The first of it would be centering the public system and in that human resources is certainly one of the major issues. I think taking off from what he's saying there is a difference between the way the private sector deals with the human resources and the way the public sector does and there are some differences in the issues there but clearly in the public system if you want to strengthen it filling in all the vacancies that exist which still do in Delhi even in something like Delhi it's not rural areas only where there are those vacancies. The recruitment and posting mechanisms are something which certainly need rationalization and making more transparent so that people are enthused to come. The contractualization of workers was a great demotivating force and people would be looking for something else as he says it's the wages and the contractual nature these two together which demotivate people from coming. The government this present government has to some extent regularized some contractual workers but there's still much more to be done in that direction and vacancies remain so that's a major area but beyond I think we need to acknowledge the fact that this government also did attempt to increase the access to services for example the mohla clinics that's something that's a model that's being looked at across the world by public health people to see what it actually will mean we're not yet sure how far it'll go because it has weaknesses and we can you know discuss those maybe at some point but then there are other issues of therefore since we've got a large private sector regulation of the private sector becomes a second major area you know so public sector strengthening private sector regulation and then when we're talking of right to health and health care not just health care the other dimensions that affect people's health and in this city we know air pollution is clearly one access to water sanitation sewage services all of those are issues which are very much part of the right to health and health care and the fourth I'm just sort of trying to cluster the whole set of issues that are there in the manifesto that the JSA has prepared and the fourth one would look at is really the issues of specifically socially vulnerable groups and social violence and to discuss that like somewhat in more detail the first thing being that there are gaps in the functioning of the health care system that we currently have as you rightly pointed out so when we look at the public sector as we've discussed the private fund but when we look at the public sector in terms of mohalla clinics what all can be done to further strengthen this model which is being applauded of course one is the fact that it's still got very limited coverage and therefore you can't really see impact at a population level in the city yet because even the program as the government has stated it is to create thousand mohalla clinics by 2020 they've been able to do 450 because land is an issue you know construction all of those issues and then again manpower becomes a barrier but what we actually need is not just something like 450 or a thousand even to cover about one third of the population of Delhi if we take the most vulnerable as the needy then they need at least 4000 and therefore it is to be more aspirational than that that's why the budget is required to increase well beyond what it there is yeah definitely you know we're talking about the mohalla clinic and the same time we have the public sector you know we need to strengthen the quality of the public so you know hospital facilities why the people are going to the private because they have been feeling that if I go to the five star hospital you know jc accurate hospital I will be treated well so the government also should think that the strengthening of the facilities and the betterment of the healthcare system in the public sector and when we look at the manifestos like you earlier mentioned that no party is discussing actually the issues of both the workers in the healthcare sector and healthcare sector generally as well for the elections the BJP has been constantly advocating for the PMJ scheme so if you can tell our viewers more about what this scheme is and why JSA is also not really supporting this and what loopholes does it actually have I think this government prison government needs to be congratulated for at the moment rejecting to bring PMJY on and that's something it's getting flagged for from the other parties the basic argument against the PMJ which is premised on the fact that the government will pay premium for insurance for the 40 percent below poverty line and they would be then take a maximum of five lakhs per year per household and go to either a public or a private of their choice which is empaneled by the program and therefore can get treatment from whichever their institution of choice through the insurance system where they don't have to pay and the government will put that five lakh in the there are several issues which are problems with that we've already seen with the previous social insurance schemes like the RSBY there are Swastvima Yojana that it tends to distort the practice of health itself because all these are hospitalization you will get the money only if there is hospitalization so a whole lot of things which could be done as outdoor procedures start becoming indoor whether it is public sector so it distorts the whole nature of healthcare and unnecessary things start being done which don't need to be done to it is public money taxpayers money going to private institutions so instead of that money going to strengthen the public system and for example have more mahala clinics or improve the quality of the public hospitals it goes into the private coffers and adds there so those are really the major problems it also leaves out since it's the bottom 40 percent yeah and you let's say the top 5 percent can cater to themselves but it leaves a big chunk of 55 percent with really no access to quality care so on that note these were systemic changes that are being actively suggested to whoever forms the government next but also issues that need to be on the agenda of both the government and the citizens thank you so much both of you for joining us and flagging these very important issues we'll end on that note thank you