Room for health in public debate

A diseased person loses earning, has to spend more on nutrition during the illness and convalescence period as compared to the normal days and has to bear the cost of treatment. Out of nearly 4 per cent of the GDP on health, the government spending is abysmally low to just about 1.04 per cent. As a result, 6.3 crore people are pushed below poverty line every year because of out of pocket expenditure on health. This fact is admitted in the National Health Policy 2017 document of the Government of India. It is a sad state o affairs that people have to borrow money for their medical expenses and even sell their belongings, particularly in case of serious medical problems requiring hospitalisation.

Thus, healthcare is a matter of utmost importance and priority for all the citizens of our country. But it has not taken centre stage in political and social debates. Political parties have failed to make health as an issue in elections in our country. On the contrary, it is well known that Barack Obama won the US elections on health policy issues. Similarly, no party dares to subvert the National Health Services (NHS) in the United Kingdom because of strong reaction among the masses.

In our country, everyday we watch people agitating for their demands. But most of these demands are centered on economic issues. Trade unions generally agitate for increase in wages and changing labour laws. Farmers in their protests focus on remunerative prices. Likewise, the agriculture labour talks of increase in wages and old age and widow pension. Similarly, students' protests are also around local demands.

The same is true for health workers, who in their demands hardly talk of problems in health care system in the country. Most of them, including the India Medial Association (IMA) also, limit themselves to their own issues. There are, however, a few medical organisations, which have been raising the issue of universal healthcare time and again.

Health is Politics

Policy decisions on health issues are taken at political level. Health policy is decided on the basis of political ideology of the rulers. It is, therefore, important that health be debated in public platforms and then it is made a political issue. Lack of activity by the civil society on health-related issues is the reason for government's apathy and skewed priorities towards public spending in the health sector.

The National Health Policy 2017 admits that the healthcare system in the country is faulty because of which low and middle-income group have to suffer. But the government does not think it to be a priority to increase health budget as per the needs. In fact, the government at the Centre reduced the health budget by 20 percent in 2015.

Government's remedy for the ills facing the healthcare in the country lies in the public-private partnership (PPP) model. Under this, there has been outsourcing of the services to the private sector. In Bihar, even the health centers were outsourced to the private sector or the NGOs. This model has not worked for the benefit of the community, albeit it has served the interests of the private sector. Entry of the corporate sector has worsened the situation. The government boasts of advanced medical care in the country but does not give consideration to the number of persons who can have access to these services.

It is, therefore, of utmost importance that health is made an issue of public debate with people's participation to demand health services from the government as per its commitment in the Alma Ata declaration.

The public in our country, even though it feels the pinch, is not well aware of the technicalities involved. Therefore, it is the duty of the concerned medical professionals and their organisations to come forward to inform the public of the issues at stake. These organisations should try to generate debate through interactive sessions with the civil society organisations, trade unions, farmers and agriculture labour organisations, the political parties and people's representatives. Only a broad-based voice of the people will change the situation. IPA