Report of Health services in Tamil Nadu Citizen consumer and civic Action Group has been involved in investigation

and research on various public issues affecting the daily lives of citizens. In 1997 CAG conducted a study on health services to address issues such as, deteriorating quality of services and the lack of accessibility and accountability in the current health care system in India. The main objective was to study the existing legislation governing the medical profession, medical council and medical association in order to recommend amendments, to bring about accountability and the system of self regulation and ultimately to develop the model law to regulate hospitals and nursing homes in all aspects of health care delivery and to make the health care system deliver quality care at affordable costs. This particular study aimed to understand overall experiences of women who had used the maternity services provided by public and private hospitals, and the nature of private and public hospitals providing maternity services in Tamilnadu. The study also focused on facilitating such inter-professional endeavour and effort to identify reasonable minimum standard. This is necessary from the point of view of protection of patient rights. Ultimately, the law must strike a reasonable, fair and pragmatic balance between the competing and conflicting interest of the patient. Findings of the study Infrastructure in hospitals 50% of the private hospitals surveyed in Madras operate in their own premises and 65% of the private hospitals have an emergency ward. Access to drinking water: About 50% of users of public hospitals said they had access to clean drinking water and in private hospitals, more than 90% had access to drinking water in Madras as well as Chidambaram-Cuddalore. Cleanliness of consultation rooms: More than 70% in private hospitals and 90% in public hospitals in both study areas said that they found the consulting rooms very clean. Toilets: In Madras, more than 70% of users found toilets clean in both private and public hospitals, whereas in Chidambaram-Cuddalore, 20% users of private hospitals said the toilets were clean and only 2% users of public hospitals said the toilets were clean. Nearly 100 % of users in private hospitals found garbage bin for use, while 80% in public hospitals had access to garbage bins. All the private hospitals in Madras had back up for power, while none of them in Chidambaram- Cuddalore had. Most of the hospitals private and public in both the areas of study had drainage connection. None of the private hospitals in Chidambaram- Cuddalore have a designated area for washing patients clothes.

Costs for delivery

A caesarean costs about twice that of a normal delivery in private hospitals in both the study areas. There are considerable variations in the cost, across private hospitals for caesareans (the maximum observed in Madras was about Rs 30,000 per delivery) Relative financial burden per caesarean is evidently highest amongst the poorest income groups. Regional differences exist, where financial burden is higher in Madras than in Chidambaram- Cuddalore region. About 16% in Madras and 88% in Chidambaram had paid for services that were not billed. Respondents experiences at the hospital Waiting time for anti-natal checkups: A considerable number of respondents (33%) in Chidambaram expressed that they had to wait for longer hours in private hospitals, where as in Madras, they spent less than 15 min. It was found that more users of private services in Madras (33%) paid an advance before admission than users in Chidambaram- Cudddalore. Very few users of public hospital services in both the study areas paid an advance. Respondents felt that in most of the private hospitals the staff were helpful. Where as staff in the public hospitals in Madras were found more helpful. It was found that more number of users of public hospitals in Madras felt that the overall experience was good. Users in both the study areas identified that hospital authorities should do something about maltreatment of patients in both private and public hospitals.

Recommendation Suggested are 1. Registration of all hospitals, clinics, nursing homes and laboratories must be made mandatory. Here specific standards (quality and quantity) for ranking of services in health care should be established on the basis of socio economic status of service seekers. 2. A steering committee should be set up to revamp the role, status and power of Medical Council by making necessary amendments to existing Act. 3. A mediator/ ombudsman need to be set up to deal with claim of negligence or deficiency of service 4. Legal requirement prior to the treatment (except first aid) of accident and emergency cases need to be reviewed 5. Regional/zonal panels of doctors, lawyers and representatives of consumer groups should be set up with adequate representation to encourage information exchange, in order to suggest guidelines for improving standards of medical care