Open Forum

New Delhi, 27 November 2012

Health For All

A TALL ORDER

By Dr.S.Saraswathi

(Former Director, ICSSR, New Delhi)

Health for All, a goal set in the 1970s and not reached, is now rechristened: Universal Health Care.  Which is sought to be achieved through substantial changes in the on-going public and private uncoordinated efforts in health management.  

Importantly, the changes proposed include measures to entrust more areas in   public health to private care than at present. Speaking at a meeting of State Health Ministers, Union Health and Family Welfare Minister Ghulam Nabi Azad cautioned State Governments against under-utilisation of funds on health projects last fortnight. Whereby, he expressed serious concern over the slow pace of work in creating health infrastructure in the States.

Especially against the backdrop of low investment in health care in the country compared to other developing countries. Shocking, was the phenomenon of unspent funds which pointedly showed a serious deficiency in health management. To bridge this widening chasm, Azad counseled State Health Ministers to identify the gaps and formulate plans to improve district hospitals.

But this alone is not what ails the health sector. More important is the increase in multiple organ failure which needs to be thoroughly examined. Constitutionally speaking, health comes under the State list in the distribution of powers between the Centre and State Governments. This includes public health and sanitation, hospitals and dispensaries while drugs and the medical profession come under the concurrent list. 

Significantly, the Millennium Development Goals adopted by 189 countries including India in 2000 placed health as the centre of development. Further, it underscored this by health comprising three out of the eight goals which should to be achieved by 2015. Namely, reduction in child mortality, improving maternal health and combating HIV/AIDS. Also, important are concerns over rise in malaria and other diseases.

Pertinently, the ‘Universal Health Care’ mantra calls for an ambitious plan of providing health care services to all, without discriminations on grounds of income, caste, or gender.  Encompassing, quality, equality, and universality. Indeed, a laudable ambition. 

This is not all. It involves three distinct health stages: Preventive, curative, and recuperative care which means population coverage and spatial coverage besides the more vital medical coverage.

Towards that end, there is no gainsaying that universal health care also requires fundamental improvement in sanitation and hygiene.  Which cannot be achieved without pollution control, clean water supply and manpower to control outbreak of epidemic diseases. This of course, pre-supposes availability of plenty drugs on time and at affordable prices in every nook and corner of the country. Undeniably, a situation unimaginable in India.

Sadly, public investment in health care is absurdly small and lowest in comparison with most countries world-wide. Most scandalously, only about 1 per cent of the GDP, marginally increased by .58 per cent in the 12^th Plan, goes towards health care.

Notably, the 12^th Plan proposes major re-structuring of the health care system.  Its main feature is the private sector’s prominent role and involvement in health management as an equal partner.  Wherein, the Government would remain the manager of a network of health system. 

Interestingly, the Planning Commission wants to establish what it has been advocating for sometime: A strong public-private partnership in health which is in tune with India’s economic liberalization.  

Needless to say, more privatision in health care operations is an ideal strategy provided it can offer care for all and everywhere without discriminations.  Presently, the two (public and private) operate as parallel systems with a belief that Government hospitals are for the poor and private clinics for those who can afford.

Besides, public-private collaboration in health raises the question of division of responsibility.  Reducing the burden of Government simultaneously with increasing health care coverage poses a formidable challenge to private players in the medical field.

Recall, the Government launched the National Rural Health Mission (NRHM) in 2005 to improve access to quality health service in rural areas particularly of women and children.  The object is to provide affordable, equitable, and good health care to the rural population.  Wherein, it aims at making structural changes to integrate the components of health care, pool human and material resources, decentralize management of health programmes so as to bring “health” within the reach of all --- physically and financially.

Further, the 12^th Plan proposes to extend this by launching the National Urban Health Mission to focus on towns and cities. With the aim to integrate both the two missions at a later date.

True, the National Rural Health Mission has brought results but not to the extent required.  Indeed, infant and child mortality have declined on the whole; institutional delivery has become more popular and pre-natal and post-natal care have not only reached villages but their importance widely understood.

What's more, health needs in rural and urban areas are not similar.   Hence, the Urban Health Mission has to be different from the national Rural Health Mission. In this context, the prospects of lessening the role of the Government might not be relished by the “aam aadmi”.

Additionally, emphasis is placed on health insurance, a scheme only known to the upper levels among the well-to-do.  In any case, insurance is not a preventive or curative strategy, but only a means of raising financial resources to build public health institutions and help patients to meet medical expenses.   

In fact, the concept of insurance is still alien to people at large.  Even sections of people who have knowledge about insurance policies have to be persuaded to take insurance cover.  To the already over-burdened middle class, insurance premium is an unwelcome additional burden.

Realistically speaking, State coverage of economically weaker sections in some form of insurance scheme might work, but don’t expect this to work miracles.  The middle class “technically” above the poverty line is practically below the line when it comes to meeting soaring cost of medicines, clinical tests, and treatment.

In the ultimate, health care is fraught with too many problems demanding concerted efforts of many government departments.  Experience shows discussions generally bring out more problems than solutions.

Under these conditions, it is doubtful whether any proposal for greater privatisation in this field would be accepted by the people.  For, privatization brings with it more competition, higher cost, rivalry, and advertisements giving false assurances, and not necessarily better care.

Universal health care is much more difficult to achieve than universal primary education.   In the existing conditions, the Government will have to evolve a strategy for greater involvement of private expertise in promoting public health without shirking its responsibility. ---- INFA.

(Copyright, India News and Feature Alliance)