Rajasthan's Right to Health Act, 2022: Gaps and opportunities.

On March 21, 2023, Rajasthan became the first state in the country to pass an Act implementing the right to health, titled "Rajasthan Right to Health Act, 2022" [1]. This is the realisation of a long standing demand of civil society groups and can be considered a landmark initiative by any state government towards guaranteeing "health for all". While the Act cannot be considered very robust, given some of its shortcomings discussed later, there is no denying that, if implemented in its true spirit, it will give the public healthcare system a huge boost, and lead to reducing out-of-pocket expenditure on healthcare, and safeguarding patients' rights.

'Only parents can understand the problems and needs of children with thalassaemia': parental activism for thalassaemia care in Northern India.

Evolving knowledge of genetics and improved clinical care have re-shaped life choices for those suffering from chronic, incurable conditions and their families. Yet the realisation of care requires complex navigation to access vital therapies which is often difficult for individuals or their family carers. In the article, we explore the struggles and strategies of parents of children with thalassemia (a genetically inherited blood disorder) in a North Indian city, who have come together to ensure better long-term health of their children. A focus on the ways in which families come together and remain apart in their quest for guaranteed access to life-saving substances such as filtered blood, provides insight into the diversity of bio-social strategies at work. It is not only family relationships and kinship, we suggest, but bio-sociality itself which is reshaped with the advent of new rights-based languages, evolving therapies and state support which hold out new possibilities for young people with thalassemia to live as normal a life-course as possible.

Resisting privatization and marketization of health care: Peoples Health Movements experiences from India, Philippines and Europe / Resistindo à privatização e à comercialização dos cuidados de saúde: experiências do Movimento pela Saúde dos Povos na Índia, nas Filipinas e na Europa

ABSTRACT For the last three decades, healthcare systems have been under pressure to adapt to a neoliberal world and incorporate market principles. The introduction of market-based instruments, increasing competition among health care providers, introducing publicly -funded private sector provisioning of healthcare through health insurance financing systems to replace public provisioning of health care, promoting individual responsibility for health and finally, the introduction of market relations through privatization, deregulation and decentralization of health care have been some common elements seen globally. These reforms, undertaken under the guise of increasing efficiency and quality through competition and choice, have in fact harmed the physical, emotional and mental health of communities around the world and also contributed to a significant rise in inequities in health and healthcare access. They have weakened the public healthcare systems of countries and led to commercialization of healthcare. This article presents three case studies of resistance, to the commercialization of health care, by the People's Health Movement (PHM) and associated networks. It aims to contribute to the understanding of the way neoliberal reforms, including those imposed under structural adjustment programmes and some promoted under the Universal Health Coverage (UHC) paradigm, have impacted country-level health systems and access of people to health care, and bring out lessons from the resistance against these reforms.

RESUMO Durante as últimas três décadas, os sistemas de saúde têm estado sob pressão para se adaptarem a um mundo neoliberal e incorporarem princípios de mercado. A introdução de instrumentos de mercado, o aumento da concorrência entre os prestadores de cuidados de saúde, a introdução de prestação de cuidados de saúde do sector privado com financiamento público através de sistemas de financiamento de seguros de saúde para substituir o fornecimento público de cuidados de saúde, a promoção da responsabilidade individual pela saúde e, finalmente, a introdução de relações de mercado através da privatização, desregulamentação e descentralização dos cuidados de saúde têm sido alguns elementos comuns vistos a nível global. Estas reformas, empreendidas sob o pretexto de aumentar a eficiência e a qualidade através da concorrência e da escolha, prejudicaram de facto a saúde física, emocional e mental das comunidades em todo o mundo e também contribuíram para um aumento significativo das desigualdades na saúde e no acesso aos cuidados de saúde. Elas enfraqueceram os sistemas públicos de saúde dos países e levaram à comercialização dos cuidados de saúde. Este artigo apresenta três estudos de caso de resistência à comercialização dos cuidados de saúde, pelo Movimento pela Saúde dos Povos (MSP) e redes associadas. Visa contribuir para a compreensão da forma como as reformas neoliberais, incluindo as impostas pelos programas de ajustamento estrutural e algumas promovidas no âmbito do paradigma da Cobertura Universal da Saúde (CUS), tiveram impacto nos sistemas de saúde dos países e no acesso das pessoas aos cuidados de saúde, e tirar lições da resistência contra estas reformas.

Resisting privatization and marketization of health care: People's Health Movement's experiences from India, Philippines and Europe / Resistindo à privatização e à comercialização dos cuidados de saúde: experiências do Movimento pela Saúde dos Povos na Índia, nas Filipinas e na Europa

ABSTRACT For the last three decades, healthcare systems have been under pressure to adapt to a neoliberal world and incorporate market principles. The introduction of market-based instruments, increasing competition among health care providers, introducing publicly -funded private sector provisioning of healthcare through health insurance financing systems to replace public provisioning of health care, promoting individual responsibility for health and finally, the introduction of market relations through privatization, deregulation and decentralization of health care have been some common elements seen globally. These reforms, undertaken under the guise of increasing efficiency and quality through competition and choice, have in fact harmed the physical, emotional and mental health of communities around the world and also contributed to a significant rise in inequities in health and healthcare access. They have weakened the public healthcare systems of countries and led to commercialization of healthcare. This article presents three case studies of resistance, to the commercialization of health care, by the People's Health Movement (PHM) and associated networks. It aims to contribute to the understanding of the way neoliberal reforms, including those imposed under structural adjustment programmes and some promoted under the Universal Health Coverage (UHC) paradigm, have impacted country-level health systems and access of people to health care, and bring out lessons from the resistance against these reforms.

RESUMO Durante as últimas três décadas, os sistemas de saúde têm estado sob pressão para se adaptarem a um mundo neoliberal e incorporarem princípios de mercado. A introdução de instrumentos de mercado, o aumento da concorrência entre os prestadores de cuidados de saúde, a introdução de prestação de cuidados de saúde do sector privado com financiamento público através de sistemas de financiamento de seguros de saúde para substituir o fornecimento público de cuidados de saúde, a promoção da responsabilidade individual pela saúde e, finalmente, a introdução de relações de mercado através da privatização, desregulamentação e descentralização dos cuidados de saúde têm sido alguns elementos comuns vistos a nível global. Estas reformas, empreendidas sob o pretexto de aumentar a eficiência e a qualidade através da concorrência e da escolha, prejudicaram de facto a saúde física, emocional e mental das comunidades em todo o mundo e também contribuíram para um aumento significativo das desigualdades na saúde e no acesso aos cuidados de saúde. Elas enfraqueceram os sistemas públicos de saúde dos países e levaram à comercialização dos cuidados de saúde. Este artigo apresenta três estudos de caso de resistência à comercialização dos cuidados de saúde, pelo Movimento pela Saúde dos Povos (MSP) e redes associadas. Visa contribuir para a compreensão da forma como as reformas neoliberais, incluindo as impostas pelos programas de ajustamento estrutural e algumas promovidas no âmbito do paradigma da Cobertura Universal da Saúde (CUS), tiveram impacto nos sistemas de saúde dos países e no acesso das pessoas aos cuidados de saúde, e tirar lições da resistência contra estas reformas.

Universal access to medicines: evidence from Rajasthan, India.

India has outlined its commitment to achieving universal health coverage and several states in India are rolling out strategies to support this aim. In 2011, Rajasthan implemented an ambitious universal access to medicines programme based on a centralized procurement and decentralized distribution model. In terms of the three dimensions of universal health coverage, the scheme has made significant positive strides within a short period of implementation. The key objectives of this paper are to assess the likely implications of providing universal access to essential medicines in Rajasthan, which has a population of 70 million. Primary field-level data were obtained from 112 public health-care facilities using multistage random sampling. National Sample Survey Organization data and health system data were also analysed. The per capita health expenditure during the pre-reform period was estimated to be ₹5.7 and is now close to ₹50. Availability of essential medicines was encouraging and utilization of public facilities had increased. With additional per capita annual investment of ₹43, the scheme has brought about several improvements in the delivery of essential services and increased utilization of public facilities in the state and, as a result, enhanced efficiency of the system. Although there was an attempt to convert the scheme into a targeted one with the change in government, strong resistance from the civil society resulted in such efforts being defeated and the universality of the scheme has been retained.