Recently when the government of India allowed compulsory licensing of two hugely overpriced cancer drugs, the jubilation was not confined to India alone. Along with their Indian counterparts, public health activists across the world hailed the decision.
That is the relevance of India and its scale for the healthcare of the poor in the world. In fact, the government hadn’t done anything extraordinary. In quiet and gingerly steps, it decided to break the patents of two life-saving drugs with abusive prices.
One of them, that costs about Rs. 2.8 lakhs is available at less than Rs 7,000 now. The other one is yet to be made in India, but when it is available, it shouldn’t cost more than 10% of its current price.
The point CIPLA’s Yusuf Hamied made in a farewell interview with Business Standard is hugely relevant here: India’s policies should be suitable for Indians and the country should have an automatic right to break patents in the case of a national emergency.
As an example, he refers to multi-drug resistant TB (MDR-TB) as a national emergency and the need to make generic versions of available MNC drugs against it. He says that an MNC was working on a drug to sell in India and CIPLA wanted to join hands, but the former was disinclined. According to him, this is an ideal situation for the government of India to issue compulsory license (break the patent) and let Indian companies make generic copies that would not cost more than a fraction of the the original drug.
That is, if the Indian government is interested in the health and welfare of its people.
MDR-TB is certainly an emergency. India has close to a third of the world’s TB population and about 100, 000 of them are untreatable because the disease they have is resistant to the available drugs now. The solution is new generation of drugs, which are branded and prohibitively expensive. Without these drugs, not only these patients will suffer and die, but they will also infect others who will also become untreatable. The cycle will fast-breed more people who are terminally ill.
MDR-TB is just one of the health emergencies in India. The truth is that the country’s entire public health system is in a state of emergency.
India, with more than a billion people, has the largest number of sick people in the world for any disease - both communicable and non-communicable -, but the central and state governments don’t even attempt to acknowledge more than 20 per cent of them. The majority is dumped and doomed!
End of last year, an outspoken Jairam Ramesh said exactly this, when he deplored that the country’s public health system had collapsed. He said even Bangladesh and Kenya were better than us and that medical cost was the biggest reason for indebtedness in rural areas.
He also said what public health activists have been saying for long - “India is a unique country” where 70 percent of the health expenses are bourn by the people themselves. Some say, it is not 70 percent, but 80.
But does his UPA government care?
Forget the ideal universal public health systems in countries such as the UK, France and Canada where the State takes care of its sick, even a terribly greed-driven America is changing its ways with Obamacare. Any sensible government knows that bad health of its people is a national security issue.
The AIDS epidemic in many sub Saharan African countries, where every socio-economic indicator including the GDP, drastically fell over a short period of time is a grim reminder that if your citizens are sick, the country is sick. Even MDR-TB had similar impact in countries such as Haiti. India has several health emergencies - ranging from killer communicable diseases to lifestyle illnesses - rolled into a single behemoth, but the government doesn’t care.
The reason is not resources, but politics. Health is the most neglected and politically low- profile ministry that no ambitious politician wants to touch. Some time back, a prominent Congress woman politician, reportedly sulked for long when she was made the health minister. Both the UPA and the NDA had assigned the ministry to low-weights and junior allies, whose prime occupation was to clear medical colleges and framing policies to help pharma industries and hospitals profiteer. It’s this neglect that resulted in a booming and rather unregulated private health sector, and the collapse of the public sector.
As an article in the latest issue of Outlook magazine, notes, the government seems to have abandoned healthcare to the private sector. The article quotes Amartya Sen: “India is the only country in the world that’s trying to have a health transition on the basis of a private healthcare that does not exist...It doesn’t happen anywhere else in the world. We have an out-of-the-pocket system, occasionally supplemented by government hospitals, but the whole trend in the world is towards public health systems. Even the US has come partly under the so-called Obamacare.”
With examples from different parts of the country, the article establishes how our public health system has collapsed and how endangered are the lives of millions of poor people. It shows that even the vertical programmes funded by the Government of India and the state run programmes are poor and hugely inadequate. It’s absolutely justified to note that during the nine years of the UPA regime, public health sector has shrunk further and the private sector boomed.
The UPA government has to certainly own up this mess. It has been irresponsible to its people and doesn’t seem to be in no mood to change its policy. A High Level Expert Group (HLEG) of the Planning Commission had clearly suggested that India needed to move towards universalisation of healthcare and that it had to raise its health expenditure to 2.5 per cent during the 12th Plan period. The HLEG also said insurance was not the model that the country should adopt.
The HLEG report was a remarkable piece of policy advice, but the Planning Commission and the UPA were not interested. It committed less money, half-hearted attempts and also proposed more privatisation through the backdoor in the form of PPP. The CPI leader A Raja, quoted in the Outlook article is bang on when he says that “the government is working as a facilitator for the private sector.”
Such a pity that less than a year ago, Manmohan Singh committed to his countrymen that the 12th Plan would be a health and education plan. The PMO had said that if all went well, the health-spend of the government would triple during the plan period.
Look where he, his Planning Commission and government are now. Even countries such as Thailand, or even Philippines to some extent, know that the State can’t look away when its people are sick.
Indians are in deep trouble. They will have to spend more and more non-existent money for healthcare because the only option available to most of them (70-80%) is the private sector, which is a greedy and self-contained domain by itself.
What the mandarins of the Planning Commission and the UPA bigwigs do not understand is that ultimately bad health of our people will catch up with them as well. We have lost important people to diseases of the poor that scaled their high walls. Unless they build impossible green-houses at sea, they will not be safe.
What prevents the country, which doesn’t mind struggling over an impossible UID scheme, from implementing a cashless, universal healthcare system?