Events & Issues

New Delhi, 2 February 2015                                              

Health Policy 2015

ENLARGE COVERAGE SANS RIGHT

By Dr S Saraswathi

(Former Director, ICSSR)

The Draft National Health Policy 2015 is released by the Government of India for public comments. It deserves to be examined closely in the context of the avowed object of the Government and the people of achieving economic growth with equity. For, physical and mental health of the people is an important component of development in any area of human endeavour.

The World Health Organization has defined health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity”. The definition is so wide that Jawaharlal Nehru remarked that if we could achieve this, every problem in the world would disappear.

The draft policy has come at a time when the time limit (2000-2015) fixed for reaching the Millennium Development Goals is fast closing in another eight months. Three out of eight goals in this document are concerned with individual and public health   and substantially determine a country’s national health and its global rank in the Human Development Index.

Health and development are inextricably interrelated – each depending on and also supporting the other. Good health is indispensable for productive life; development is necessary for maintenance of good health.

The draft policy declares: “The Centre shall enact, after due discussion and on the request of three or more States, a National Health Rights Act which will ensure health as a fundamental right whose denial will be justiciable.  States would voluntarily opt to adopt this by a Resolution of their Legislative Assembly…Such a policy formulation/resolution, we feel, would be the right signal to give a push for more public expenditure as well as for the recognition of health as a basic human right and its realization as goal that the nation must set itself.”

Is India in a position to declare health as a fundamental right of every citizen? The question is relevant, but the answer won’t come quick. We assert with one voice our faith in the right to food. We were bold enough to legislate on the right to education despite several known hurdles in the path. But elevation of health as a right seems on the face of it a difficult task.

Is health a luxury restricted to the well-to-do and those who can afford to pay the cost or is it something basic to normal living of all citizens?  The latter carries a humane approach and hence, we need a policy and programmes, institutional arrangements, trained manpower, and required equipments – all within the reach of all to lead a healthy life.

Health is a State subject under the Indian Constitution. It includes public health and sanitation, hospitals and dispensaries.  Lunacy and mental deficiency including places for reception or treatment of  lunatics and mental deficients, medical professions, prevention and extension from one State to another of infectious or contagious diseases or pests affecting men, animals, or plants are under the Concurrent List. The Constitutional arrangement is such that the cooperation of the States is a prerequisite for the success of the national health policy.

However, the Directive Principles of State Policy contain certain articles that permit formulation of policies and implementation programmes by the Union government. It is directed that the health and strength of workers – men and women – and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength.

Another article provides: “The State shall regard the raising of the level of nutrition and standard of living of its people and the improvement of public health as among its primary duties…” Thus, the Union Government has the constitutional sanction to intervene in health matters without intruding into the State sphere.

The goals, set in the draft policy, are attainment of the highest possible level of good health and well-being through a preventive and promotive healthcare orientation in all development policies and universal access to good quality healthcare services without anyone having to face financial hardship as a consequence. 

The key principles underlying the policy are to promote  equity, universality, patient-centred and quality care, inclusive partnerships among all stakeholders--academic institutions, commercial interests, healthcare industries, etc.,  pluralism in the sense of  encouraging different medical systems in vogue in India – allopathic and indigenous, subsidiary systems  comprising healthcare providers at various levels, and also essential qualities like accountability, professionalism, integrity, and ethics, learning and adaptive systems, and affordability. 

The policy document, like an election manifesto, is no doubt admirable and comprehensive, but seems to be projecting an imaginary world far removed from the real. The current healthcare position gives a totally different picture leaving a stupendous  responsibility on the executors of the policy to reach  the goals offered. Surely, we know how much needs to be done.

Western industrialized nations have enacted laws granting right to health. In the US, Medicaid is a joint federal-State programme devised originally to induce States to take greater share of the financial burden for health. National standards were fixed for State programmes. 

Among developing countries, Brazil and Thailand have progressed towards universal health coverage through different ways that may provide useful models for India.

In Thailand, a number of NGOs are involved in healthcare policy known as “30 baht policy”. They conduct advocacy and awareness campaigns for universal health coverage. These campaigns are considered as significant as political will and medical and health related knowledge to widen coverage.

In Brazil, national health councils and conferences are held at national, provincial, and municipal levels to ensure widest participation in healthcare system. These councils, composed of members from healthcare providers and users in equal proportion, constitute a permanent institutional arrangement and not ad hoc bodies. They meet regularly at least once in every four years to take stock of the national health situation and recommend policy measures.

As these models may show, the goal of improving public health may be better served through a policy for universal coverage of health facilities rather than through enacting a law conferring right to health. There are many laws that remain on paper without being implemented in letter and spirit.  Even the right to education is facing obstacles in implementation and resulting in schooling without learning in some places. 

All rights include duties. If the government were to guarantee right to health, it can impose a duty on citizens to follow guidelines, and prescribe the role of all participants – the medical fraternity including doctors, nurses and all kinds of medical attendants, teachers, teaching institutions, laboratories, medical business and so on. 

Further, if the citizens are granted the right to health, they have the obligation to follow medical instructions on healthy life. Can an alcoholic who refuses to take medical advice on de-addiction claim the right to health when his liver fails? Lifestyle diseases that are growing strong are caused by people’s unhealthy food and other habits despite medical advice. The State in India has neither the resources nor the medical manpower and equipments to guarantee the citizens’ right to health.  The right, if granted, is likely to promote inequalities in medical care.

We can only try to expand coverage under healthcare and make it affordable and available for more and more people. Hygiene and sanitation should get priority for public health. Any achievements made in these will be a big step forward. ---INFA

(Copyright, India News and Feature Alliance)