The National Democratic Alliance government began its term in 2014 with a flurry of progressive announcements to improve healthcare, coining the phrase "health assurance for all." It signaled a move away from reliance on traditional medical insurance and suggested that assuring good health outcomes depends on the provision of universal healthcare, and also on two critical and complementary factors: addressing the social determinants of health and putting in place mechanisms to guarantee quality and redress grievances to ensure accountability.
Over the past year, the ministry of health and family welfare has announced several new initiatives, including measures to reduce neonatal mortality and achieve universal immunization coverage. It also released India's first national mental health policy and issued a draft national health policy for comments in December 2014.
This burst of enthusiasm seems to have died down in recent months. In November 2014, the minister of health was suddenly replaced. There is no indication of increasing public spending on healthcare, which remains grossly underfunded. On the contrary, the Union Budget of India for 2015-2016 has cut allocations to the social sectors that are unlikely to be offset by the marginal increase in the central transfer of funds to state governments. Increasing dependence on the private sector and private commercial medical insurance seems inevitable, even though no country has been able to establish universal health coverage by taking such a route and without a strong public sector. There has been little discussion about introducing a much-needed regulatory framework to improve quality, efficiency, and accountability of healthcare delivery. Nothing more is known about "health assurance for all." Much less is known about the fate of the national health policy.
After one year, expectations remain high. For the first time, the government of India's Economic Survey 2014-15 questions incentives and rewards that are provided to local bodies for their performance and that are euphemistically described as "promotional and motivational" measures to encourage family planning, particularly sterilization. The government is expected to announce free diagnostic tests for those visiting public health facilities. After being elected president of the World Health Assembly in May 2015, India's minister of health fully endorsed universal health coverage.
Looking ahead, the key question to ask is: Does this government have a strategy and the political determination to back universal health coverage?
(AK Shiva Kumar is a policy adviser and teaches economics and public policy.)