Crying baby gets the milk? The governmentality of grievance redressal for patient rights violations in Karnataka, India

Abstract

BackgroundPatient rights aim to protect the dignity of healthcare-seeking individuals. Realisation of these rights is predicated on effective grievance redressal for the victims of patient rights violations.MethodsWe used a critical case (that yields the most information) of patient rights violations reported in Karnataka state (South India) to explore the power dynamics involved in resolving grievances raised by healthcare-seeking individuals. Using interviews, media reports and other documents pertaining to the case, we explored the ‘governmentality’ of grievance redressal for patient rights violations, that is, the interaction of micropractices and techniques of power employed by actors to govern the processes and outcomes. We also examined whether existing governmentality ensured procedural and substantive justice to care-seeking individuals.ResultsCollective action was necessary by the aggrieved women in terms of protests, media engagement, petitions and follow-up to ensure that the State accepted a complaint against a medical professional. Each institution, and especially the medical professional council, exercised its power by problematising the grievance in its own way which was distinct from the problematisation of the grievance by the collective. The State bureaucracy enacted its power by creating a maze of organisational units and by fragmenting the grievance redressal across various bureaucratic units.ConclusionThere is a need for measures guaranteeing accountability, transparency, promptness, fairness, credibility and trustworthiness in the patient grievance redressal system. Governmentality as a framework enabled to study how subjects (care-seeking individuals) are rendered governable and resist dominant forces in the grievance redressal system for patient rights violations.

Associations, unions and everything in between: contextualising the role of representative health worker organisations in policy

“…Formally, representative organisations might have a ‘seat at the table’ in committees or policy processes, such as price setting or grievance redressal. For example, the Indian Medical Association has a formal seat on grievance redressal committees in Karnataka, India, 35 while in the USA, the AMA is the dominant player in the Specialty Society Relative Value Update Committee, a price setting committee that recommends health service prices for the Centers for Medicare and Medicaid, a standard-setter in the country for prices more broadly. 15 Similarly, the Accreditation Council for Graduate Medical Education (ACGME) mentioned above is made up of member organisations including the AMA and other umbrella RHWOs and has been critiqued for its entanglements with these organisations.…”

Interest Groups and Health Facility Regulation – Future Directions for Health Policy and Systems Research; Comment on "What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms"

“…In the case of one Southern Indian state, civil society vociferously argued that private health sector regulation should be “pro-patient,” opposing the demands of health facility owners and physician interest groups to constrain grievance redressal processes and limit punitive actions for failing to conform to regulations. 13 However, in health sector reform processes, the role of patients’ rights organizations is not well researched, particularly in LMICs. Therefore, the relative power of ‘demand side’ and ‘supply side’ interest groups must be carefully examined, particularly in contexts where the later groups representing health facilities or physicians wield considerable power.…”

“…Conversely, patients’ rights organizations lack representation and voice in policy processes, often due to broader societal factors of marginalization and disenfranchisement. 13 Such power relations within and across constituencies are therefore critical to explore further.…”