Civil voices on the rise

It is good to note that for the first time the civil society, professional bodies, human rights activists and, even, school children are actively taking up with political parties and aspiring MPs to include people's rights, healthcare, education and climate protection as part of their election manifestos. One of the groups — Civil Society Forum (CSF) — has prepared a draft manifesto for consideration of all major political parties. Its demands include the abolition of a host of antiquated and draconian laws that have been widely misused to curtail personal liberty and intimidate political activists. The Forum has sought reforms to repair the damage done to anti-corruption institutions, putting in place institutions to deal with the grievances of the public.

Other major demands include reforms making the judiciary more independent, accessible, efficient and accountable. It wants electoral reforms to reduce the influence of money in elections and make the electoral system more democratic and health reforms to ensure an efficient public health delivery system that makes healthcare affordable and accessible to all. Interestingly, on a different platform, a group of schoolgirls in flood-prone Assam has approached politicians to include concerns such as flood-resilient infrastructure in election manifestos for the 2019 general elections.

The CSF wants policies and programmes to ensure the health, education, employment and social security especially to disadvantaged groups such as the disabled, SC and ST communities, women, and minority communities. It wants the government's healthcare expenditure to be accelerated to a minimum of three per cent of the GDP, with three-fourths of the additional increase set aside by the union government. "Almost two-thirds of all health spending in the country is out of the pocket. It is estimated that expenditure incurred on health has resulted in seven per cent of the population falling into poverty. A large proportion of catastrophic health expenditure falls on the poor and is spent on outpatient care and medicines…. There is a need to establish a people-centric system of universal healthcare based on the strong foundations of primary healthcare," says Dr Karpagam, one of the campaigners at the Forum.

She feels the government has to be the primary provider and regulator of all levels of healthcare. "The thrust must be on public provisioning for health services and infrastructure, rather than the current trend of the introduction of insurance-based models where the government pays premiums while healthcare provisioning is left to the private sector, with investments in public provision declining over time," she says. The draft manifesto states: "These proposed policies and programmes are neither optional nor unaffordable for an economy of our size. We have examined the financial costs involved in providing such welfare measures and are of the opinion that additional costs involved can be mobilised with the help of small turnover tax, wealth tax and inheritance tax, besides doing away with many irrational corporate subsidies. A substantial part of this additional spending is likely to come back to the government as indirect tax revenue."

Interestingly, the Delhi-headquartered Indian Medical Association, a national organisation of 'doctors of modern scientific system of medicines' boasting over 2.5 lakh members, has released its own health manifesto ahead of the Lok Sabha polls urging all political parties to give priority to the health sector. The IMA manifesto contains various suggestions to improve public health, change policy directions, streamline medical education and improve medical research. "There is insufficient funding in the healthcare sector and the GDP in healthcare is at a dismal rate of 1.2 per cent. The out of pocket expenditure is one of the highest for our country and every year over 3.3 per cent of people are pushed below the poverty line due to expenditure on health," says Dr Santanu Sen, IMA's national president. "In order to improve the overall healthcare sector and cope up with the out of pocket expenses, the GDP must be increased to at least five per cent," he says. The IMA plans to launch a countrywide 'Health First' campaign to propagate its manifesto among the candidates, political parties and the public.

Its local units will conduct public meetings and seminars in which Lok Sabha candidates will also be invited to speak. "The primary and preventive care should be given top priority. Wellness centres have to be reconceived and they have to be manned by MBBS graduates," regards Dr R V Asokan, IMA's general secretary. "MBBS doctors are ready to work in rural areas and the IMA can facilitate the availability of manpower to the primary care centres. There should be recruitment boards to recruit MBBS graduates for primary care," he says.

Healthcare seems to have become a big poll issue. Most professional bodies and NGOs feel that without more easily affordable medical education, state-managed colleges, hospitals and health centres, affordable medicines and treatment, the public healthcare through initiatives such as privatisation of health education and healthcare facilities and random public health insurance coverage will be meaningless. Despite the so-called free care across the country, tuberculosis is taking a toll on patients' finances.

One in four TB patients has to spend out of his/her own pocket to access treatment. 'Out of pocket expenditure on TB in India: Do households face hardship financing?' published in Indian Journal of Tuberculosis is the first-ever analysis of how much TB patients in India spend on treatment. According to Denny John, a Delhi-based Health Economist, and co-author of the paper, "25.9 per cent of the general population had to sell assets or borrow for financing TB hospitalisation expenses. This even after promises of free care for TB are made by the government." Hardship financing includes borrowing on interest and/or sale of physical assets to fund treatment. The authors referred to the NSSO data that focusses on the 'Cost of Treatment,' to analyse data of 799 individuals who were afflicted with TB during the survey. The civil society wants the next government to act.

(The views expressed are strictly personal)