Symptoms of a terminal decline
If India is to achieve universal healthcare 10 years from now, the process must begin today, writes Jean Dreze.ht view Updated: Oct 10, 2014 01:39 IST
The economic policies of the new government seem to consist mainly of pressing the accelerator on the previous government's policies, without any change of direction. This is not surprising, since the ruling classes are much the same, with some reshuffling as in a game of musical chairs. In fact, their hold on public policy is now stronger, and this helps to explain not only the government's passion for business-driven growth but also its lethargic social policy.
Health is a prime example of this lethargy. India has paid a heavy price for neglecting the health sector from independence onwards, and despite some useful initiatives (such as the National Rural Health Mission), the UPA government did not fundamentally alter this trend. Perhaps it is not an accident that India now has a higher infant mortality rate and shorter life expectancy than any other South Asian country except Pakistan. Yet the new government seems barely aware of the problem.
For want of other hints, we can try to guess the new government's health priorities from four recent speeches: the prime minister's maiden speech in Parliament (May 21), the President's address to Parliament (June 9), the finance minister's budget speech (July 10) and the PM's Independence Day speech at the Red Fort. Each of these high-profile speeches is partly aimed at defining the new government's policy priorities. It is a reasonable expectation that they would give us an idea of what the government has in mind as far as health is concerned.
Alas, no clear message emerges. In the first speech, "health" is mentioned only once, as follows: "I was thinking of Atalji's health. Had his health been good, he would have been with us today and his presence would have completed this moment." It was kind of the PM to spare a thought for Atalji's health, but one wishes his concern had extended a little more widely. Of course, one cannot expect the PM to cover every issue in every speech.
Let us turn, then, to the President's speech. This one includes a whole paragraph (yes) on health. It begins on a lofty note: "Our country needs a holistic healthcare system that is universally accessible, affordable and effective". So far so good. The rest of the paragraph, however, just makes passing mention of a New Health Policy and National Health Assurance Mission, on par with equally fleeting references to the promotion of yoga and AYUSH. Only the last sentence is specific: "AIIMS-like institutes will be established in every state in a phased manner".
Google searches for the 'National Health Assurance Mission' fail to clarify the thinking behind this project. According to one report, "medical experts are hoping for a countrywide implementation of the Gujarat model." The Gujarat model, hazy enough in general, is a truly mysterious term in the context of health. Indeed, Gujarat's health indicators are not much better than the national averages, despite its high per-capita income.
What about the Union finance minister's speech? It begins, again, on a positive note: "To move towards 'Health for All', the two key initiatives i.e. the Free Drug Service and Free Diagnosis Service would be taken up on priority". These sound like useful steps, though they would inspire more confidence had Rajasthan's BJP chief minister Vasundhara Raje not diluted the state's free drugs scheme as soon as she came to power. And again, there are no specifics, let alone a budget. The real priorities become clearer in the next paragraphs, mainly focused on the AIIMS project which gets Rs 500 crore.
Finally, we have the PM's recent speech at the Red Fort. Like his maiden speech in Parliament, it mentions "health" only once, in the following sentence: "If we create a network of telemedicine in the places where there is a shortage of doctors, we can have a clear guideline of the way in which health facilities have to be provided to the poor people living in those areas." Telemedicine may not be a bad idea, but this is hardly an answer to India's healthcare crisis.
Taking the four speeches together, the dominant impression is that the new government has no plan for the health sector. The speeches do not even suggest any awareness of the dreadful state of India's health system or the urgency of change. All we get is a series of fleeting bites on different aspects of health policy, from free drugs and AYUSH to telemedicine. The only consistent theme, backed with funds, is the need to create more AIIMS-like institutes. India can certainly do with more world-class public hospitals, but how about fixing the primary health centres and expanding public health measures? Here as in other fields, our policy-makers have an odd habit of trying to climb the ladder from the top.
Meanwhile, many other countries have built unified health systems based on the core principle of free and universal healthcare: Not only the rich countries (with the notable exception of the United States) but also Brazil, China, Cuba, Mexico, Sri Lanka, Thailand, among other developing economies. In fact, almost half of the world's population now lives in a country with universal health coverage, or something close to it. If India is to reach that goal 10 or even 20 years from now, the process must begin today. This requires a commitment to health that is wholly lacking as things stand.
(Jean Dreze is visiting professor at the Department of Economics, Ranchi University)
(The views expressed by the author are personal)