RESUMO
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.
RESUMO
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.
RESUMO
Background: To address the acute shortages of health workers in underserved, remote, and difficult-to-access areas, the Government of Chhattisgarh and the National Rural Health Mission (NRHM) launched the Chhattisgarh Rural Medical Corps (CRMC) in 2009. CRMC has enabled provisions such as financial incentives, residential accommodation, life insurance, and extra marks during admission at the postgraduate (PG) level to eligible doctors for the attraction and retention of health workers, i.e., doctors, staff nurses, auxiliary nurse midwives (ANMs), and rural medical assistants (RMAs) in underserved areas. Objectives: This study aims to understand the CRMC scheme in terms of implementation, challenges, gaps, and outcome in achieving the attraction and retention of health workers in the remote and difficult-to-access areas of Chhattisgarh. Materials and Methods: The study adopts a mix of both qualitative and quantitative research methods. The purposive sampling method was used for the selection of three districts having normal, difficult, and inaccessible areas. Data were collected through key informant (KI) interviews with beneficiaries and non-beneficiaries of CRMC or district and state government officials, and reviews of document were analyzed using a thematic analysis approach. Results: CRMC has made positive outcome as 1319 health workers, including doctors, have joined the service in 2010-11, reducing the vacancy of doctors from 90% to 45%. The scope of CRMC was primarily limited to payment of monthly financial incentives. The fund utilization rate of CRMC has increased (from 27% in 2009-10 to 98% in 2011-12), though there are delays in payment of incentives. The majority of staff lack awareness about CRMC during job applications. The payment of incentives based on facility performance has demotivated staff. Conclusions: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC benefits are likely to improve attraction and retention of staff.