privatization and high costs of care as well as techno-centric fragmentation of care leading to high levels of inequality in health outcomes. There interventions have focused on discourses and health care for the poor through focus on approaches like;-

• Universal Health Coverage
• Universal Access to Health Care
• Social determination of health MDGs and now SDGs

Participants
The two day meeting in Mumbai was convened by the Thematic Hub on patient’s Rights and Private Medical Sector Accountability associated with COPASAH and organized by Support for Advocacy and Training to Health Initiatives (SATHI) and Centre for Health and Social Justice (CHSJ) with participants from India, Nepal, Sri Lanka, Bangladesh and Kenya- Winnie on behalf of IAP.
Key issues from the meeting
i. Countries have moved to formulate patient’s rights charters as an accountability tool for both public as well as private health facilities to ensure protection and promotion of human rights of the vulnerable groups. However levels of implementation of the same varies from countries, but largely they are ignored and patients have no knowledge of their existence.

ii. Violations of patient’s rights happen in both public and private health facilities-However at the international level treaty protection, the States are required to provide health services and where the private sector and charitable institutions do so, they need to e properly regulated-by law, policies and administrative procedures/standard guidelines/regulations

iii. National Human Rights Institutions have mandates to hold governments accountable on the patient’s rights violations whether in public or private health facilities. Some of the rights highlighted during discussions are right to; information, emergency medical care, informed consent, privacy,
confidentiality and human dignity, right to second opinion, transparency in rates and care in accordance to prescribed rates. Whenever relevant, non-discrimination, safety and quality of care in accordance with standards, proper referral and transfer from clinical trials, protection from biomedical research, to chose source of obtaining medicines or tests and to be heard and seek redress.

iv. National human rights institutions have conducted public hearings on violations of patients’ rights with examples of India, Kenya and Malawi among others.

v. Citizens are generally ignorant of their rights and therefore States require accelerating public education on patient’s rights if accountability is to guarantee redress.

vi. Privatization of health care services has been overtaken by serious commercialization in India and now corporations are exporting it to other regions. Examples given were of Appollo and Fortis chain of hospitals in India. Positive progressive feedback given on citizen accountability is that
Sri Lanka resisted entry of Appollo Hospitals from India in their country (more information and research would be needed to establish how this was done)

vii. Most private hospitals have moved into corporations making their end game as -maximization of profit – thus making health provision a business venture with profit making as the sole objective. Examples were given of how private hospitals in India had grown into large scale foreign Investment. Patient’s rights have totally been compromised.

viii. Within the large Investment schemes professional health providers (medical doctors, consultants, nurses, etc) had become employees of the corporations and compromised on set standards to meet the business goals. Patients were treated as raw materials.

ix. In the last few years, companies trading in the health sector had tripled their profits. Patients were no longer at the centre of health care provision.

x. Mr. Jayant Singh was present in the meeting and gave his experience on the Negligence and violations he suffered at the hands of Fortis Hospital in India whereby his six (6) year old daughter died after 15 days of hospitalization. He believes the main cause of death was due to mismanagement. He was left with unexplained huge bills and his efforts to seek redress have been frustrated by everyone including the India Medical Board. (The phone recording of his experience is available)

xi. Participants agreed that while expansion and privatization of health care is good, corporatization and commercialization is deadly and must not be encouraged. The aspect of privatization that moves into commercialization has huge impact on the health care not only for patients but for their families. It also hurts operations in public and charitable health facilities. By extension the entire society is negatively impacted since it is injurious to health provision.

xii. Unregulated system causes huge inequalities in health care. xiii. Corporatization of health care services must be stopped. xiv. It was suggested that people’s citizen actions should be organized to demand justice.

xv. The consequences of corporatization has led to ; a. Inflated hospital bills b. Overpricing of medicines and medical equipment’s
c. Private hospitals continue to rip of citizens who seek their services
d. Unregulated standards of health care in private facilities
e. In India, there is increase in incidences where patients who feel mishandled are assaulting doctors.

xvi. Questions were posed as to whether we can say private sector has improved health Care provision. Majority felt that it had not.
xvii. Medical Professions are regulated through professional bodies that lately compromise with their masters to deny patients redress on allegations of violations. Professional ethics of practitioners is on trial since many complainants are making their way to seek redress from the courts of law. Present in the meeting were young lawyers who have taken up public interest litigation matters.
xviii. Countries are now legislating on matters of health to increase accountability of medical practitioners i.e. India and Kenya as examples .
xix. Countries need to have laws and policies to regulate private practice engaged in health care services to increase accountability.
xx. Key responsibility to regulate private health care at country level lies with the governments arising from the obligation agreed internationally.
xxi. Unethical practices must be punished and doctors to be faithful to their own profession calling.
xxii. There is need for stringent regulations of private sector actors in health care provision. Private medical sector remains unregulated and ineffective. It was suggested that private person should be forbidden from engaging in Health care provision as a business venture.
xxiii. While universal health coverage (UHC) is mooted, one presenter called for Universal Health Care systems calling it the Canadian and Brazilian health care systems. (Paper prepared by SATHI is available and attached
xxiv. Social accountability interventions are great and should be encouraged as an accountability model for citizens engagement. Participant applauded COPASAH who have initiated the development of the conceptual discourses and framework for social accountability that has led to several campaigns that have called on support for patient’s rights, regulation and standardization of private hospitals along with improved care in public hospitals.