Struggle against outsourcing of diagnostic services in government facilities: Strategies and lessons from a campaign led by Jan Swasthya Abhiyan (People’s Health Movement) in Chhattisgarh, India

Abstract

Since 1991, India, like many countries, has undergone a process of ‘liberalisation’ which has entailed an increase in outsourcing of public services through Public Private Partnerships. In December 2012, Chhattisgarh state started the process of outsourcing diagnostics and radiology services in 379 government health facilities. Jan Swasthya Abhiyan (People’s Health Movement) Chhattisgarh mounted a (so far) successful campaign against this move. Drawing on secondary data and the personal experiences and observations of the author, this paper documents Jan Swasthya Abhiyan’s struggle, describing the strategies that were used, their efficacy, the facilitators and challenges. It uses this experience as a basis to reflectively suggest lessons for health activism and the theoretical implications. Jan Swasthya Abhiyan founded its resistance on a detailed evidence-based critique of the proposal that was disseminated, along with demands. The campaign then used multiple strategies, from petitioning the government, to street action, to advocacy with media and bureaucrats. Alliances were built with trade unions and groups working on social justice issues. Privatisation and neo-liberal policies provided a rallying point and framing the issue as a moral argument and in terms of larger concerns for social justice helped build wider solidarity. This experience suggests that the use of evidence and multiple strategies, effective framing of the issue, forging broader alliances, and a sustained campaign can all be important strategies for health activism. It also highlights the need for health activism to continue beyond a single campaign. Staying vigilant, monitoring, evidence building, mobilizing people and continuing to build alliances on such issues are critical tasks for social movements and networks like the People’s Health Movement.