After teasing the country with an Obama-esque promise of better healthcare early this year, Prime Minister Manmohan Singh, the UPA government and their hallowed Planning Commission are set to cheat their fellow-citizens of their right to a healthy life.
Earlier this year, Manmohan Singh had said that the country’s 12th Plan will be a “health and education plan”, which meant that health and education would drive the development agenda of his government in the next five years. He also promised that his government’s health spending will rise from a silly 0.9% of the GDP to a reasonable 2.5%
If all went well, the health-spend of the government would triple during the plan period, the PMO had said. People would have had at least a semblance of a free, cashless, universal healthcare system in the country.
That is what the High Level Expert Group (HLEG) of the Planning Commission had recommended and public health specialists went gaga about. The HLEG, in unequivocal terms, had suggested that the government should guarantee cashless, in-patient and out-patient, and free healthcare to all its citizens whether it’s primary, secondary or tertiary.
The Group also advised the government to simultaneously address the social determinants of health, which meant addressing the fundamental inequalities that kept most of the Indian’s desperately poor and sick.
Perhaps this was the most forward-looking and comprehensive social sector document of recent times, since instead of the routine short-cuts or window-dressing attempted by government committees, it offered a clearly-laid out road map for Universal Health Coverage (UHC) and an essential health package.
It addressed sources of financing; strengthening health systems, mainly sub-centres, primary health care and facilities in the districts so that bulk of the burden could be addressed locally; capacity building of healthcare workforce; healthcare infrastructure; standards for care, regulation and management; drug procurement and distribution; grievance systems and so on.
There was considerable chatter among the public health and development specialists in India and elsewhere where many thought that India had finally got its priorities right. Bad health is a poignant indicator of a country’s overall social development and India has tonnes of them.
It’s not without reason that Obama is betting his life on the health of his country’s poor although his country is in a totally different orbit.
However, after all the initial enthusiasm and expectations, the Planning Commission has gone back to its old ways. According to latest reports, the 12th Plan document, the blueprint for country’s development for the next five years, will not offer what the PM had promised the country. Neither will it raise the GDP-share on health-spend to 2.5%, but probably to a meagre 1.5 percent.
What was on offer was a way to at least begin the transformation of the lives of Indians, most of whom are poor, who spend 75 percent of their health expenditure from their pockets. According to the National Rural Health Mission’s framework document, this is about Rs 100,000 crores every year, more than three times what the government spends. For the entire plan period, it would be Rs 500,000 crores.
Harnessing a part of this money, could have funded the UHC. A part of this money could have equalled the tripled-resources that the PMO had promised.
It’s such a pity that a country that has no qualms on spending on missions to the moon and Mars, let alone its reckless spending on defense and fragmented popular schemes, but goes cold when it comes to the legitimate rights of its people. Equity in healthcare is not a revolutionary idea, but a basic entitlement that a democratic republic needs to offer its citizens.
And when the country has the expertise, the roadmap, the money and even the social, economic and political climate, it lets down its people.
Although there is no final official word on the fate of the UHC, indications are that the Planning Commission will severely compromise on its initial plan. There are also apprehensions of increased public private partnerships (PPP), the euphemism for backdoor privatisation, in the health sector as against the advise of the HLEG, which wanted assurance than insurance.
Even the ministry of health has communicated its displeasure to the Planning Commission.
As things stand today, at best some elements of the HLEG will be incorporated in the Plan document, but not the entire framework for UHC.
A great opportunity lost.
Are Manmohan Singh and the Planning Commission really serious about the health of the nation? Their words do not seem to match their deeds.