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Thread- NFHS5 results show increasing private expenses by service users in govt. facilities. Center declared 'ZERO expense' by users, on anything related to childbirth in public hospitals in 2011(JSSK). What happened then? Some answers from my doctoral study- @MoHFW_INDIA
1. Resources in public- JSSK specified resources like drugs, tests, transport, USG are sub-optimal in numbers and quality. Allocation and use is mismanaged and is driven by political interest and powers of bureaucracy to health managers and doctors.
2. Private shops outside public hospitals control tests, medicine prescriptions. Larger the hospital size, higher the chances of outside shops draining visitors for one or other things.
Doctors' and middle class visitors' preference for branded drugs and consumables plays.
Doctors' and middle class visitors' preference for branded drugs and consumables plays.
3. Multiple referrals (necessary and un-necessary) increase transportation costs-possibly contributing to more complications too. Govt. ambulances including 108 leave out a good proportion of users unattended.
4. Less powerful user is less likely to avail full benefits of JSSK. A few well meaning service providers and managers help them individually. Some payments are well accepted by economically better to do families, at times they don't trust in generic JSSK and hospital USG.
5. Public health system does not routinely measure the OOPE by users. Most states wait for the surveys or small scale studies. JSSK reporting from facility to state to central level, doesn't consider user feedback or measurement of OOPE.
6. There are no accountability mechanisms in the system, that ensure that users don't end up paying money, at least against a promised service. Grievance handling processes work occasionally in favor of users.
7. Many of the above are results of several center (NHM) vs state dynamics and overall weak policy intent. The vested interests for kickbacks, authority, promotions, growth etc. of doctors, managers, bureaucrats, politicians weigh heavily, with individual exceptions and efforts.
8. Not being able to manage outside prescriptions, USG and multiple referrals are straightforward causes. Without urgent political action on ensuring resources in public facilities and ensuring interests and accountability of state-district-facility actors, OOPE will continue.
@ChhayaPachauli @RemaNagarajan @docVRK @NITIAayog @amitabhk87 @sanjayjavin @abantika77 @AnantBhan @george_matsajo @jsa_india @Kullu_arp @Lucy_Gilson @dranadigupt @malini_aisola @namita_kohli
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