A long way to go before we achieve 'health for all'

The theme for World Health Day this year is 'Health for all.' Affordable healthcare is still a long way off in Bengaluru and Karnataka, say activists.

Akhila Vasan, co-convenor of NGO Karnataka Janaarogya Chaluvali, says the rally for affordable health is not new.

"It came with the Alma Ata Declaration of 1978 that sought to make healthcare accessible for all by 2000. But this was systematically dismantled by governments across the world, including ours at the centre and the state," she says.

Karnataka tops the list of maternal deaths in south India. "This is a litmus indicator. It tells us that our public healthcare system is being destroyed while a large segment of the private sector has turned predatory," laments Akhila.

Bengaluru's healthcare system is even more fragmented, she observes. "Many government agencies are providing healthcare with no coordination."

Dr Vasu HV, state executive committee member of Karnataka Janashakti, agrees the government has no clarity about the medical system. "When there is private business running, a successful public medical system cannot be in place," he says.

Bengaluru has five to six lakh software professionals but three times as many workers in the construction and garment industries. "These people need affordable healthcare. In Bengaluru, Victoria Hospital, Jayadeva Institute of Cardiovascular Sciences and Research, K C General Hospital, Bowring & Lady Curzon Hospitals and Nimhans are overburdened. The corporation hospitals only provide maternity care," he says.

Bengaluru, with 12 to 13 percent of the state's population, should have a separate healthcare plan for primary and tertiary care hospitals. When people from across south Indian come here for healthcare, proper plans for affordable healthcare need to be in place, Dr Vasu urges.

Asha Kilaru, an independent public health researcher, points out, "There is always a gap between things put down on paper and practice. The last year was a big one for the state as the Karnataka Arogya Bhagya scheme was launched under the universal health coverage programme by the state government."

This was to cover farmers, the unorganised sector, sanitation workers and public servants, and everyone eventually. "Coverage is another word for insurance and many would like to see coverage without buying insurance but paying for it through taxes," she says.

Varying eligibility criteria also make it difficult for citizens to access healthcare. "If one qualifies for a government scheme, one should automatically qualify for other government schemes, but this isn't the case," she says.

What you can do
Exercise your right as a citizen and demand accountability from local health centres.
Every BBMP hospital has a Board of Visitors. Work with its members to get
healthcare.

C-section deliveries
A woman living in a northern district who earns Rs 200 a day has to shell out Rs 48,000 at a private hospital for a C-section delivery and Rs 18,000 for a normal delivery, despite the existence of the National Health Mission and several state and
central government schemes.

"The scene is no different in Bengaluru. Most women are pushed to private clinics," says Akhila Vasan, co-convenor of Karnataka Janaaroyga Chaluvali.
She calls for a small change: "Doctors being available in government hospital OPDs
from 4 to 9 pm would make healthcare more accessible and affordable."

Reluctant doctors
Medical graduates are not willing to work in government hospitals, and that is a hurdle in achieving affordable healthcare. "They are influenced by cultural and economic factors, and won't work for lower salaries. Also, many are not satisfied
with the work environment in government hospitals."
DR VASU HV, Karnataka Janashakti

Arogya Karnataka
Health schemes like Vajpayee Arogyashree, Yashaswini, Rajiv Arogya Bhagya Scheme, Rashtriya Swasthaya Bima Yojana, Rashtriya Bala Swasthaya Karyakram,
Mukhyamantri Santwana Harish Scheme, Indira Suraksha Yojane, and Cochlear Implant Scheme converge under one scheme.
The scheme will be rolled out in phases. In the first phase, 10 major hospitals
have been chosen. They include KC General Hospital, Jayadeva Institute of Cardiology, and Victoria Hospital.

HOW TO ENROL
Go to a PHI (public health institution).
Enrolment staff sign you up for 'Arogya Karnataka' and generate a unique ID
called ArKID.
The enrolment requires an Aadhaar number.
The patient's biometric impression is captured on a device and authenticated on the Aadhaar server.
While alternative IDs can be used for enrolment, an Aadhaar number is mandatory for any referral to a private hospital.
Applicants for 'Arogya Karnataka' must declare they are not under any other insurance scheme.