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Previous Projects

Social Accountability of Private Healthcare Sector – Previous Projects

Project Title
Analysing medicine expenditures, preventing overcharging and patients’ rights violations in context of COVID epidemic in Maharashtra

Project Period

October 2022 to March 2023

Donor Agency

Thakur Foundation

SATHI documented overcharging of COVID patients by private hospitals across Maharashtra, while supporting individual patients to negotiate with hospitals for reducing grossly inflated bills. COVID hospitalisation bills for 480 patients were audited, and over 60 patient families received official refunds of excess charges incurred during the COVID second wave. These hospital bills were further analysed, particularly to understand the patterns of overcharging related to spending on medicines during the hospitalisation period.

Simultaneously, SATHI also tracked significant pro-people regulatory provisions related to the private healthcare sector, enacted by Maharashtra government during the COVID epidemic, which were not fully operationalised in a way that benefitted patients.

The study underscored the urgent need to promote implementation of these provisions for patient protection, and to prevent overcharging and patients’ rights violations in the present situation.

  • Assessment of overall scale of expenditure on medicines, surgical supplies and biosafety materials provided in private hospitals, for a sample of COVID patients
  • Analysis of possible overcharging on selected medicines and supplies, comparing the charged prices with average hospital procurement costs.
  • Policy recommendations concerning regulation of prices of medicines dispensed in private hospitals.
  • Documentation of status of implementation of Patients’ Rights Charter and Maharashtra Nursing Homes Registration Act (MNHRA), covering sample number of private hospitals
  • Formation of Grievance Redressal Cells as specified under Maharashtra Nursing Homes Registration Act Rules (2021), in selected areas.
  • Capacity enhancement of health activists and civil society groups, enabling them to monitor implementation of mentioned rules and government circulars. Wide dissemination of Patients’ Rights Charter and other materials and tools to generate public awareness.

Expected Outcomes

  • Research brief summarising key findings, lessons and recommendations of the study on charging for medicines during COVID hospitalization.
  • Webinar for sharing key findings from the analysis, with academicians, researchers, civil society representatives, and medical practitioners.

Project Title
Developing the COPASAH South Asia Regional Hub

Project Period

1st Phase – January 2021 to July 2021, 2nd Phase – August 2021 to October 2022; extended upto December 2022

Donor Agency


Under-resourced public health system and unaffordable, unregulated private health sector is an essential context of health care in most South Asian countries. Transparency and accountability deficits regarding public and the private health systems are multidimensional. Unregulated, commercialized and highly privatised healthcare leads to denial and malpractices, which are highlighted during the COVID pandemic. The right to health is impacted by deep inequalities along axes of power and exclusion in the region, including class, caste, gender, sexual orientation, gender identity, and disabilities. Multi-dimensional issues of Health workers also need to be urgently addressed as part of health system reforms in the region.

Towards addressing all these concerns, COPASAH affiliated organisations in South Asia including India have been instrumental in promoting health rights based social accountability initiatives. COPASAH’s legitimacy as a practitioner-led network can be instrumental in highlighting South Asian experiences on health sector transparency and accountability.

SATHI is one of the convening organisations of the COPASAH network in South Asia, and is actively involved in networking within India on social accountability of private healthcare, as well as community accountability of public health services. SATHI has also been part of South Asia level networking by COPASAH, including anchoring Track 4 on Social accountability of private healthcare during the COPASAH global symposium in 2019.

Overall objectives for entire project period (2021-22)
To develop the COPASAH South Asia regional hub, which will work as a knowledge and practice convening forum on social accountability of public and private healthcare sectors in the region, including sexual and reproductive health rights.

Specific objectives in phase 1 (Jan to Apr 2021)

  • Finalization of work plans for the South Asia regional hub during 2021-22, based on organisation of series of virtual meetings and exchanges
  • Determining levels and types of resources required for project implementation in phase 2, including human power support, organizational development and fundraising needs concerning the South Asia hub
  • Initiating formation of the organisational basis for development of hub related activities in the region

Project Title
Ensuring integrated access to Health Care for vulnerable urban and rural populations, in context of COVID-19 epidemic in Maharashtra

Project Period

August 2020 – September 2021

Donor Agency

Association for India’s Development (AID)

Due to COVID 19 pandemic India is experiencing major shifts in health scenario and health systems. Maharashtra is the worst affected state related to COVID-19, in Indian context. The COVID patients in urban and rural areas are increasing, and along with routine non-COVID patients they need support and facilitation to access healthcare. Maharashtra government has expanded health insurance schemes and entitlements to provide free care for COVID and non-COVID patients, in public as well as private hospitals, particularly expansion of health insurance scheme (MPJAY). The project intervention would be focussed on one urban area (in Pune city) and two rural blocks Pune and Sangli of Maharashtra, including operating a Help desk in the major public hospital serving each area, facilitating people’s access to services related to Health insurance schemes (MPJAY), and publicly created entitlements in private hospitals, outreach activities including orientation of grassroots activists and committee members, strengthening public awareness on health entitlements in context of COVID, dialogue with local health officials to facilitate health care and Documentation of issues and review of processes.
Publishing online platform for health awareness- An online platform in Marathi which would include latest updates and health news regarding the epidemic, popular information about government schemes and measures, interviews of health workers, frontline doctors and social activists doing remarkable work at the grassroots, and editorial type commentary pointing the direction for health system reforms such as Universal Health Care, which need to be socially demanded on large scale in the COVID recovery period. This would be a combination of an attractively designed fortnightly textual bulletin, and regular short videos with interviews, audio-visuals etc.


  • Health activists from the partner organization
  • Members of local committees and elected representatives who are oriented through project activities
  • SATHI team members involved in the project- People who fall ill during this period in the project area and need health services, from public hospitals as well as through insurance schemes would primarily benefit from the project
  • Publishing online platform for health awareness

Ensuring integrated access to Health care for selected urban and rural populations, in context of COVID-19 epidemic in Maharashtra


  • Help desks will become operational in three secondary public hospitals in selected rural and urban areas of Maharashtra
  • Cadre of around 15 health activists in one urban and two rural areas will be developed to work on Help desks, MPJAY, COVID related health entitlements and provisions.
  • Trained health activists will assist around a thousand patients monthly in each of 2 rural blocks and one slum cluster in Pune city, for obtaining adequate health care from respective public hospitals and MPJAY and other health schemes.
  • Trained health activists will create awareness amongst people about MPJAY and COVID related provisions and schemes, in total 40 villages in two rural blocks, and 10 urban settlements in Pune city.
  • SATHI network will produce a document based on regular analysis of information emanating from the help desks and field experiences, including stories of patients who faced barriers in accessing healthcare from the rural blocks and urban areas covered by the project.
  • Published series of articles and videos for health awareness.

Project Title
Covid rapid response project phase II of Rural help desks and Pune urban helpline

Project Period

May, June and July 2021

Donor Agency

Azim Premji Philanthropic initiative (APPI)

The first phase of the COVID Rapid response was undertaken from August 20 to January 21 in the first wave of COVID. Due to COVID onslaught patients were running from pillar to post to get admissions in the appropriate setups. Also, in rural blocks there was need to spread awareness regarding COVID and also to assist patients coming to rural healthcare centres to access the COVID related and non – COVID related treatment. This grave need of the society shaped the first phase project. With onslaught of second more infectious COVID wave made it imperative that similar project is re-run as Phase II.


  • To run help desks in 8 blocks (as against 10 in the first phase) of rural districts of Maharashtra.
  • To run a central telephonic helpline in City of Pune to help COVID patients get information, and assistance to get appropriate services including beds.

Project Title
Promoting Accountability of the private healthcare sector and patient’s rights in India

Project Period

August 2017 to July 2018

Donor Agency

Azim Premji Philanthropic initiative (APPI)


Promoting accountability of the private healthcare sector and implementation of patients rights in India, with a focus on the city of Pune.


  • To develop networking among medical professionals by expanding Alliance of Doctors for Ethical Healthcare and, with the objective to strengthen alternative voice within the medical profession for rational, ethical healthcare while highlighting few key medical issues of national importance and demanding key policy changes
  • To develop a state level campaign in Maharashtra, for ensuring accountability and regulation of the private medical sector, focused on protection of patients’ rights, with emphasis on use of social media.
  • To initiate / foster citizen action group or Citizen-Doctor forum in city of Pune, to develop awareness and local dialogue on key health advocacy issues, while disseminating the emerging experiences to a few more cities of the state.
  • To enable CSOs in Maharashtra to engage with Maharashtra Medical Council regarding enforcement of code of medical ethics.
  • To explore and document various legal options available, with the objective of strengthening patient’s rights campaign, with focus on Maharashtra.
  • To document marketing practices by the pharmaceutical industry and their implications for citizens and patients in India, through a systematic study.
  • To spread awareness about patient’s rights, code of medical ethics, need for standardization of private healthcare and reforms in medical councils by effectively utilizing social media platforms.

Project Title
A consultancy project on National consultation on regulation of private medical sector and patients rights

Project Period

27th January and 28th February 2014

Donor Agency


India has one of the largest private medical sectors in the world – yet this gigantic entity has remained almost completely unaccountable and unregulated until now. Serious problems in this sector include frequent financial exploitation of patients, often accompanied by sub-standard and irrational care in private hospitals and nursing homes. Costs of private medical services have spiraled, having more than doubled in absolute terms between the mid-1980s and the mid-1990s. It is estimated that Health care expenditures account for more than half of all Indian households falling into poverty, with nearly 4 crore Indian people being pushed into poverty every year due to such costs. While ordinary patients are suffering tremendously due to this situation, it should be kept in mind that due to growing corporatisation and commercialization of the entire health care sector, it is also becoming extremely difficult for the dwindling numbers of rationally practicing doctors and genuinely non-profit health facilities to practice ethically.

How can we start changing this situation? Located within the broader context of need for strengthening public health services and rolling back privatisation, comprehensive social regulation of the private medical sector is an outstanding need today. In this context, with support from Oxfam-India, SATHI has organized a series of regional workshops on regulation of the private medical sector in Southern, Eastern, Northern and Western regions of India during August to November 2013. During these workshops, experiences of patients regarding private hospitals have been shared and overall justification for regulation has been discussed, existing Clinical establishments acts have been analysed, core desirable features of a pro-patient regulatory framework have been proposed, and some state level action plans have been developed. At the same time, a range of suggestions and inputs regarding both possible campaign strategies and issues to be addressed in the regulatory process have been shared.

Further we need to keep in mind the context of the national Clinical establishment act (CEA) which has been adopted in 2010, followed by related rules in 2012. The central government is now pushing state governments to adopt this act in existing form. Although the central CEA has some positive steps like mandatory minimum standards, standard treatment guidelines, regulation of charges and consumer representatives in national and state councils, it has several major lacunae like no provision for ‘patient’s rights’ in the entire act, no provision for grievance redressal mechanism for patients, and no scope for complaints by citizens regarding implementation of the act. Since this central act is being used as a kind of ‘framework legislation’ by various states, and some states are adopting it in existing form, it is essential to develop a national consensus among civil society organisations regarding this framework and to develop an effective national advocacy strategy regarding this framework.

Keeping this context in mind, SATHI facilitated in organising a ‘National consultation on regulation of private medical sector and patients rights’ in collaboration with the Jan Swasthya Abhiyan network.

Project Title
Promoting a discourse about regulation including standardization of rates in private medical sector, with focus on selected states in India

Project Period

1st April 2015 to 31st March 2016

Donor Agency

Oxfam – India

SATHI has been at the forefront for advocacy on social accountability and regulation of private medical sector in India. Some recent developments provide an opportunity for advanced advocacy for rate standardization and rate transparency in private hospitals. These developments are as below-

National Clinical Establishment Council is the governing council for developing standards for implementation of national Clinical Establishment Act 2010 and Rules 2012. This council has formed a sub-committee for rate standardization under CEA-2010. Recently, Dr Arun Gadre from SATHI and JSA has been appointed as a member of this sub-committee. This has provided a unique opportunity for SATHI to build a discourse around provisions like rate transparency and rate standardisation. This process will have significant implications for states like Rajasthan, UP, Bihar, Jharkhand, and Himachal Pradesh, who has adopted national CEA, and collateral effect on states that have their own CE Acts or are in process of drafting it. Based on membership of this national committee, we would propose and widely publicise a framework for regulation of rates in private hospitals.

We are now interacting with a widening section of rational doctors, some gave testimonies for the book ‘Voices of conscience’ published by SATHI with support from Oxfam India, and more are coming forward after the book release to discuss seriously about rate transparency and rate standardisation issues, which is a welcome step forward.
There has been significant media coverage book following the release of ‘Voices of conscience’, which can give a boost to public discourse around regulation of private medical sector.

Recently, Maharashtra Government has agreed to a delegation of health activists in Maharashtra to kick start a public dialogue process around the issue of rate standardisation in the context of Maharashtra Clinical Establishment Bill.

Objective- To promote large scale public discourse around regulation of private medical sector, with focus on standardisation of rates in private hospitals. This would be done at national level with focus on states like Rajasthan, UP, Bihar, Jharkhand, and Himachal Pradesh who have adapted CE Act 2010, and also some states who are in process of drafting their state level act or who have their own CEA like act.

Project Title
Ensuring Social Accountability and Multi-Stakeholder Regulation for Advancing Universal Health Coverage in India”

Project Period

17th September, 2019 to 17th December, 2019

Donor Agency

World Health Organisation (WHO)

India has a fragmented and pluralistic health system, where inadequately resourced public health services coexist with a largely unregulated, commercialized private healthcare sector, the latter being responsible for spiralling costs of healthcare and variable quality in service delivery. Further, the private healthcare sector is well known to be engaged in irrational procedures and practices on a significant scale. The burden of such practices may be disproportionately borne by the poor, due to lack of knowledge and bargaining capacity. Well-known examples of such irrational care, which is both wasteful and potentially damaging to health, are unnecessary medications, injections, saline infusions and diagnostic tests.

Regulation of treatment practices through standard protocols is effectively absent in the Indian context, leaving the field open for such gross medical irrationality and exploitation of the most vulnerable.

Linked with this, there are widespread violations of patients’ rights and lack of effective grievance redressal mechanisms. Patients, especially those suffering from serious illnesses being treated in hospital settings, form an exceptionally vulnerable group who face huge asymmetries of knowledge and power, while often dealing with life and death situations and decisions. Denial of various patients’ rights including rights to basic diagnosis and treatment information, access to records and reports, transparency related to treatment expenses, option of second opinion, confidentiality and privacy, protection during clinical trials etc. are extremely widespread.

Objectives To promote and strengthen multi – stakeholder dialogue involving civil society organizations, private health sector representatives, Patients’ rights groups and Government agencies to maximize their engagement and contribution to policy development processes around social accountability and multi-stakeholder regulation of healthcare providers with focus on private sector, through a series of two workshops.

Key Activities of the project

  • Workshop on ‘The imperative of involving multi stakeholder platforms to ensure responsive governance while moving towards UHC’, during The Global Symposium organized by Community of Practitioners on Accountability and Social Action in Health (COPASAH) which was held from 15-18 October 2019 in the India Habitat Centre, New Delhi, India.
  • One National level workshop on ‘Ensuring Social accountability and Responsiveness of the Private Healthcare sector for Moving Towards UHC’ on 26 – 27 November 2019 in New Delhi.

Project Title
Promoting Private sector regulation and accountability through regional and multi-state processes

Project Period

1st April 2014 to 31st March 2015

Donor Agency

OXFAM – India

Objective – Promoting awareness and advocacy on ‘participatory, multi-stakeholder regulation of private healthcare sector in India’ at both regional and state levels. This would be furthered by the following areas of activity

Capacity building of civil society activists towards demanding social accountability of private healthcare sector by conducting regional workshops on ‘Social Accountability of Private Medical Sector and Clinical Establishment Act’ in Northern, Eastern, Western and Southern regions of India in the first half of year 2013-2014, one workshop in each region. It is expected that civil society organisations from 2 to 3 states in each region would participate in each of these workshops. Each workshop would be for 2 days, with the objectives of –

  • Orienting civil society activists towards conceptual understanding of private medical sector in India and issues related to it like commercialisation, patients rights violations etc.; need for social accountability of private medical sector; and practical steps towards building such accountability mechanisms in the context of Clinical Establishment Act etc.
  • Imparting activists with an approach to document cases of patient’s exploitation and violation of their rights in private medical sector in such a way that issues emerging from these cases can be highlighted in future as basis for advocacy for regulation Providing guidance and helping pro-active civil society organisations in strategising advocacy on social accountability of private healthcare sector.
  • Developing quality information material on contemporary issues related with the regulation of private medical sector for civil society activists A policy brief / advocacy document would be prepared on ‘Regulation of private medical sector and Clinical Establishment Act’
  • Multi-stakeholder advocacy meetings would be conducted at different levels in the pilot state of Maharashtra, where a civil society coalition is quite active on this issue, which in itself is a pioneering example in the country. Experiences gained through activities in Maharashtra will feed into civil society processes at national level, to actively promote patients’ rights with focus on multi-stakeholder participatory regulation of private medical sector in the context of Clinical Establishment Act. Multiple stakeholders to be involved include representatives of doctors associations and hospitals associations, socially prominent individuals and political representatives, and a wide spectrum of civil society organisations.
  • Bringing private healthcare related issues under public scrutiny by documenting and publicizing major problematic experiences of patients and testimonies of doctors.