Millennium Post

Dismal expenditure

Inappropriate and misplaced priorities cannot improve health of our people.

There was much hope that the National Health Policy 2017 (NHP) would give a new impetus to the healthcare delivery system in our country. The Health Policy is a document for assessment of the contemporary health situation, the issues involved and the way forward to ameliorate the prevailing problems so that citizens get the required health care. The NHP 2017 has to be analysed in that context.
The vast majority of our people are devoid of basic healthcare, what to talk about advanced quality tertiary care. The government of India has been a signatory to the Alma Ata declaration whereby we had committed to providing healthcare to all by the end of the century. It is 17 years since the dawn of the new century, but healthcare to all remains a dream for our people. Our public healthcare expenditure is the lowest among the BRICS nations (Brazil, Russia, India, China and South Africa). Our public health spending is around 1.1 per cent of the GDP. In comparison, other members of BRICS spend much higher. South Africa spends around 8.8 per cent, Brazil spends 8.3 per cent and the Russia allocates 7.1 per cent of GDP on health. Even the SAARC countries spend more than us. Maldives spends 13.7 per cent, Afghanistan 8.2 per cent and Nepal 5.8 per cent of its GDP on health. This has caused large scale disparities and inequity on access to healthcare. In many ways our health indicators are lower than other SAARC countries barring Pakistan. But should we always take satisfaction by declaring that we are better than Pakistan on several counts? This at a time when we aspire to be a world leader in economic performance while Pakistan is nowhere near.
The NHP 2017 document admits that our public health spending is very low and talks of increasing it to 2.5 per cent. Various expert groups on health have been demanding that public health spending should be increased to minimum of 5 per cent if we want to achieve at least minimum healthcare facilities for our citizens. Worldwide experience has shown that the countries with higher public health spending have better health indicators. This is because private health sector is profit-based and by its very nature does not have a priority to look after the basic healthcare needs of the lowest strata of the society. Whereas the NHP document analyses the problems in the correct perspective, its approach lacks orientation of comprehensive health care. It harps on public-private partnership to meet the end and talks of medical tourism with an aim to draw in money from patients from outside India. Such advise has been given by the "policy framework for reforms in healthcare, which have been drafted by the Prime Minister's advisory council on trade and industry headed by Mukesh Ambani and Kumaramangalam Birla". This is a totally corporate-driven approach, which considers health as an industry instead of an asset and a social welfare subject.
Encouragement of insurance coverage in the Health policy is in complete variance to the concept of universal healthcare. Insurance is a premium-based system, where one gets facilities based on the premium paid. Therefore, the affluent become entitled to better healthcare facilities. The government's schemes to pay premium for the poor is not based on the actual healthcare needs. Most of these schemes cover very little amount, which hardly serves any purpose in the event of serious illness. Cost of healthcare in the corporate sector hospitals is very high as compared to the government sector. To expect the poor to get care from state sector alone while the economically better off section avails of healthcare from the private sector is not correct. This is particularly so when most of the healthcare, nearly 80 per cent, is provided by the private sector.
The NHP is silent on the drug policy. Expenditure on drugs is around 67 per cent of the total healthcare cost to a person. This cost has to be brought down substantially to make these within the reach of common man. Indian drug companies had made and supplied cheap drugs not only to our population but also to other countries, including some developed countries. The foundation of cheap bulk drugs was laid by our first Prime Minister Jawahar Lal Nehru, who laid stress on the production of drugs by public sector companies. He was of the opinion that drugs cannot be left to private concerns because their sole motive is profit and it will affect affordability by a vast majority of population. This approach led to the opening up of prestigious units like the Indian Drugs and Pharmaceutical (IDPL), which supplied drugs for national health programmes and during national calamities. It is unfortunate that the present government is out to close the public sector pharmaceutical units. Drug prices, particularly of the newer drugs, have already been hit after the WTO regime came into force and product patent became the rule. With the closure of pharmaceutical public sector units (PSU), there will be a total reversal of policies making the task of universal health care even more difficult.
(Dr. Arun Mitra is senior Vice President Indian Doctors for Peace and Development, Former Chairman Ethical Committee Punjab Medical Council & Member core committee ADEH. Views are strictly personal.)

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