Events
& Issues
New Delhi, 8 May 2019
Right To Health
NEW GOVT MUST REFLECT
By Dr. Oishee Mukherjee
Health care comes
into sharp focus this General election. While the BJP already has its ambitious
Ayushman Bharat scheme in place, the Congress
has sought to counter it by promising ‘Right to health care’ in its 2019
manifesto. This is in continuation of the rights- based laws enacted under the
Manmohan Singh government, such as Right to Education and Right to Information,
which were milestones in the history of public welfare in India.
‘Three things we are
considering for our manifesto’, had said Party Rahul Gandhi while interacting
with health care professionals in Chhattisgarh, before the polls were
announced. ‘Right to health care’ which will guarantee a certain minimum health
care to all Indians, increasing the expenditure on health to 3 per cent of the
GDP and training doctors and health care professionals”, he added was the
party’s “top priority”.
Recall, Modi
government had launched the Pradhan
Mantri Jan Aarogya Yojana, last September. However, health experts including
those in public hospitals pointed out that this does not cover the cost of
outpatient services (OPD), diagnostics and medicines -- the biggest source of
patient expenditures. And so, the Congress seeks to improve on it and commits
that health care professionals would work out an effective model for the right
to health care.
Its justification
being in its belief that be it any government, it has to do three things -- “one,
fix the problem, two, provide low cost, high quality education and three,
ensure that people are protected as far as health care is concerned”.
And while time will
tell whether Congress will get an opportunity to fulfil its commitment, the
Centre and some States are trying to improve the present health facilities. A
decision has been taken to allow dentists to practice general medicine, in view
of the acute shortage of doctors in the country. It is said that the first two
years of MBBS and BDS courses are more or less the same, and the decision may
to some extent help tackle doctors’ shortage, in rural and semi-urban areas.
Then there is
Maharashtra government which has recently drafted a bill to create special
reservation quota up to 10 per cent in undergraduate (MBBS) and 20 per cent in
post graduate (MD) medical seats for those who give a commitment to work in
tribal and rural areas. Candidates must serve for a period of 7 years
immediately after completion of MBBS and for 5 years after completion of
MD.
The health care
situation in rural Maharashtra is dire need of over haul. Though there is a
huge network of 1816 primary health centres, 400 rural hospitals, 70
sub-divisional hospitals and 26 civic hospitals, these are largely rendered
useless because of lack of manpower. A similar situation prevails in some North
Indian States.
In Odisha, the
situation in the tribal belt is worse. A new scheme of incentive policy has
been introduced since mid-April in the 1750 government hospitals, wherein
doctors posted in vulnerable and backward areas are being given maximum
incentives.
In Jharkhand, where
65 per cent of women are anaemic and cases of vector borne diseases like
malaria, kala azar and Japanese encephalitis
are above the national average, the shortage of doctors in rural areas remains.
Though three new medical colleges have come up during 2017-end at Palamau,
Dumka and Hazaribagh, of the sanctioned strength of nearly 11,000 doctors in State
health service, 6000 are said to be vacant. Obviously, this is because doctors
do not want to work in CHCs and even in district hospitals. Similarly, in
Uttarkhand, medical students do not honour terms of the bond signed to work in
rural areas. Recently, the State’s medical education department issued legal
notices for recovery of money to 383 doctors for not keeping their commitment.
It is a well-known
fact that resources allotted to health are quite meagre. While 10.6 per cent of
the total amount in the Interim Budget is allocated to defence, only 2.2 per
cent was given to healthcare. Funding need not be redirected from current
allocations to preventive care, but surely India can make health spending a
priority, much like defence? Despite several innovations in the healthcare
sector in recent times, the Government remains woefully short of its ambition
to increase public health spending to 2.5 per cent of GDP. At present, health
spending is even below 1.5 per cent of GDP.
Last year, it was
announced that nearly 1.5 lakh health and wellness centres would be set up
under Ayushman Bharat, with the
mandate of preventive health and community-based management of basic health
problems. But this should have included health education and holistic wellness
integrating modern medicine with traditional Indian medicine, which is not the
case. Both communicable disease containment as well as non-communicable disease
programmes should be included. An estimated ₹250 crore has been allocated for
setting up health and wellness centres under the National Urban Health Mission
while the National Rural Health Mission received ₹1,350 crore. The amount is
undoubtedly meagre considering the increase in both population and diseases in
recent years.
Malnutrition and
under nutrition has added to the problem as directly or indirectly these relate
to health problems. On the other hand, in urban India the over dependence on
fast food has aggravated diseases like obesity, diabetes and even cancer. In
2017, dietary risks were the second biggest factor behind deaths and
disabilities in 2017 in the country, close on the heels of malnutrition.
Dietary risks also increased by 35 per cent in a decade since 2007 when it
ranked fourth after malnutrition, air pollution and the risk of water,
sanitation and hygiene (WASH).
In spite of all this,
the allocation for the non-communicable diseases programme of the National
Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases and Stroke has been allocated just ₹175 crore, which is much less, or
as estimated by experts, to be even 50 per cent of the actual need. While the
rich and the middle income sections have the financial means for treatment, the
poor and even the low income sections cannot carry on with such treatment after
a period of time, or some can’t even start it.
It is distressing indeed,
to note that the policy makers of the country have yet to understand the
importance of health in social and economic development of the country. The big
question to ask them is whether they are even aware of the living conditions of
the poor, the backward sections and do they have genuine concern for their
welfare? Whichever government comes to power, must make a note that as the
nation celebrates the 150th birth anniversary of Mahatma Gandhi, it is critical
to make health a fundamental right and thus ensure that in the next two years each
sub-division should have a well-equipped hospital. It must realise that only a
healthy people can ensure a healthy nation. ---INFA
(Copyright, India
News & Feature Alliance)
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