Last month, a protest by tribals and activists at Azad Maidan in Mumbai went almost unnoticed. What were they asking? Only the basic amenities such as medicines and good toilets in the tribals' part of the country. Pity they didn't know they weren't in the same country anymore.

The broad four lane highway takes you to Shahpur, about 100 km from Mumbai and as you turn into the narrow road which leads to the cramped town, there is a forewarning of things to come. Shahpur is among the poorest tribal dominated talukas in Thane district and as a recent public hearing on health, part of the community based monitoring programme of the National Rural Health Mission (NRHM) showed, the problems of the people have not changed.

Sixty-six years after Independence tribal people in this country probably have the poorest health services and access to health care cannot still be taken for granted. Having attended a few such hearings in the past, I had an idea of the kind of grievances to expect. They would be of a basic nature as always, but this time, one of the NRHM workers raised the issue of the lack of toilets outside the labour room at the sub-district hospital.

Few will realise what a calamity this could lead to and the health worker narrated a story of a woman in labour who had to use the toilet and since the two outside were unusable, she had to walk a little distance by which time the baby's head started coming out. The woman ended up in a civil hospital in Thane, a three and a half hour drive away by ambulance and had to be there for a week.

The stories were the same, the lack of medicines at primary health care centres, the lack of water, even though pipes had been laid, the contractor had run off in one instance without building a storage tank, corruption, mismanagment of funds and so on. Thanks to the community based monitoring, these issues have been exposed since a while but the government seems rather inured to correcting basic problems.

For instance: why is the supply of medicines inadequate? The medical officers often have to buy them. For four or five months there were no folic acid tablets, crucial for women during pregnancy, available in the taluka.

Then there are no doctors or radiologists to attend to patients. The sub-district hospital has not had a radiologist since it was upgraded one and a half years ago. So the women wait for the once-a-month check up when a radiologist comes from Thane or pay Rs. 700 at a private clinic, which they can ill afford.

Similarly, the sub-district hospital in Dharni in Amravati district didnt have gynaecologists some years ago and the High court had to order the appointment. The hospitals lack medical and technical expertise in most cases. Few doctors are willing to serve in the backward regions of the state despite a bond of two years. They pay up the fine to avoid it. And this gives the government a good excuse to privatise services as is being proposed for radiology, which is being opposed vehemently.

Last month, a protest by tribals and activists at Azad Maidan in Mumbai went almost unnoticed. Dr Abhay Shukla of the Jan Arogya Abhiyan (JAA) said that the Maharashtra government needs to act immediately to make policy changes to ensure the poor get access to safe health care. The Abhiyan or movement has been working for health rights for people for over a decade.

The Centre had already passed the Clinical Establishments Act 2010 with provisions to regulate the fee structure and other protective measures but there was no mechanism to implement this in the state. The Maharashtra government can pass its own law which can ensure strict regulation of private hospitals and also protect patients’ rights. Kerala has already done this and there was no reason for this state not to do it now.

A JAA statement said that more than 80 per cent of patients in Maharashtra seek care in private hospitals and clinics. However, this sector is today characterized by large scale commercialization and overcharging, lack of effective self-regulation by medical councils, frequent irrational procedures, and violation of patient’s rights.

If the state has such a law, for the first time in history, private hospitals will be under regulation, Dr Shukla said. In addition, states like Tamil Nadu have set up autonomous corporations to procure medicines which functioned in a transparent manner. This was also worthy of emulation, he said.

He criticised a decision by the Maharashtra government to privatise radiological services in public hospitals and said this was even resisted by the radiological workers. The health sector needed serious interventions in terms of policy and regulating the private sector, ensuring patients rights and not privatising vital services was important. The JAA demands multi-stakeholder review bodies at district level, including patient’s rights activists and civil society organisations, to ensure accountability and functionality of regulatory authorities.

This not asking for too much considering the pathetic delivery of health systmes in rural areas. What will it take the state to be responsive...