Healthcare for all
India must consider universal healthcare a national mission with the estimated costs of its coverage between 4-6 per cent of the GDP
Despite advances in healthcare, there persist gross inequalities as far as access to it is concerned. Even today, low socio-economic groups have difficulty in getting modern healthcare. Inequalities also persist in terms of geography, caste, religion, and gender. High out-of-pocket expenditures, with the rising financial burden of healthcare, add to these inequalities. Out-of-pocket expenditure by the patient constitutes 63 per cent of Total Health Expenditure. As a result, every year 6.3 Crore people are pushed below the poverty line in India due to health care costs.
The share of Out-of-pocket expenditure on health care as a proportion of total household monthly per capita expenditure is 6.9 per cent in rural area and 5.5 per cent in an urban area. This led to an increasing number of households facing catastrophic expenditure due to health costs. A large proportion of the population still lacks access to food, education, safe drinking water, sanitation, shelter, land and its resources, employment and health care services. It affects both the occurrence of disease and access to healthcare.
The recently launched National Health Protection Scheme (NHPS) reduces universal healthcare to health insurance coverage, and that too for only 50 crore population while the rest 80 crores are left out. Moreover, it covers only in-patient care even though more than 60 per cent of health care cost incurred by the patient is on outpatient treatment. The private health insurance companies and health care providers are already expecting huge windfalls from NHPS. With significant involvement of the private sector, the scheme is a clear indication of a shift from public provisioning of health towards privatisation. These would have far-reaching implications especially in the area of health care.
Health is a social, economic, and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence, and injustice are at the root of ill‐health and the deaths of poor and marginalised people. Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed. It is in this context that the political parties should come forward with promises on healthcare in the coming elections to Lok Sabha.
Political parties have to agree that the attainment of the highest possible level of health and well‐being is a fundamental human right, regardless of a person's socio-economic, and ethnic background, religion, gender, age, abilities, sexual orientation, class or caste. The principles of universal, comprehensive Primary Health Care, envisioned in the 1978 Alma Ata Declaration, should be the basis for formulating policies related to health.
Therefore, the parties should promise to enact National Health Bill as Right to Health Care Act that can guarantee that every citizen shall have right to comprehensive and quality health care at state's expense in a government health facility; and in case of its non-availability, in a private health facility, and include health in the concurrent list of the Constitution. Further, a National Health Policy legally binding on the executive will be adopted.
Other programmes must comprise promise to take positive steps so that governments promote, finance and provide comprehensive Primary Health Care as the most effective way of addressing health problems and organising public health services so as to ensure free and universal access, enhance public spending on health to 4 per cent of GDP and setting up a standing National Commission of Health with judicial powers to which the bureaucracy would be answerably followed by such commissions at state level.
The political parties programme should put an end to privatisation of public health services and ensure effective regulation of the private medical sector, including charitable and NGO medical services, and set up Primary Health Centre at every 30000-population mark, with 24-hour service, a Health Sub-Centre at every 5000-population mark and a fully staffed Community Health Centre equipped with all modern facilities at every 100000-population mark, establish round-the-clock ambulance service at every 30000-population mark, and post women medical and paramedical personnel in all health centres and hospitals in adequate numbers. All Government health facilities should adhere to the Indian Public Health Standard (IPHS) norms.
The programme has to arrange assured safe drinking water supply through piped water in all habitations, total sanitation in all households and localities, and enforce complete safeguards against air, water and soil pollution by industries, mines and other developmental projects. Also, malnutrition has to be estimated by implementing National Food Security Act 2013 which aims to provide subsidised food grains to approximately two-thirds of India's people and Nutrition Rehabilitation Centre has to be set up at each block to address the issue of severely malnourished children. Further people's spending power has to be promoted by ensuring sufficient wages so as to meet their nutritional needs.
Expenditure on medicines constitutes nearly two-thirds (60 per cent) of out-of-pocket expenditure. There is a need to implement a Rational Drug Policy that allows drugs to be sold only under their generic names. Exempt production of generics from patent rules and ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system; through quality conscious pooled procurement systems and promotion of the manufacture of essential medicines.
Public Sector Units have to be strengthened to make cheap bulk drugs and adhere to a policy of cost of production for the ceiling of drug price with no more than 30 per cent trade margin.
A regularly updated Indian National Formulary on the lines of British National Formulary has to be established to provide unbiased prescribing information and rational guidelines for use of drugs.
The estimated costs of Universal Health coverage ranges between 4 and 6 per cent of GDP. This financial commitment is achievable. What is required is political will for this if we want to build a healthy India.
(Dr. Arun Mitra is Senior Vice President, Indian Doctors for Peace and Development. The views expressed are strictly personal)