Ideas
Health care in India. /gettyiamges
The first two years of the National Democratic Alliance (NDA-2) government did see some positive changes like better immunization coverage, better drug price control for access to essential drugs, and a higher insurance cover for poor families, not to mention the Swachcha Bharat Mission. The government began with three good policy documents -- the National Health Assurance Mission (NHAM), the draft National Health Policy (NHP-2015) and the National AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) Mission 2014, but then the momentum was mysteriously lost.
The ambitious NHAM was probably shelved for financial constraints, though it has some connection with the new health insurance cover. The draft NHP is on the backburner, apparently because it ‘rather boldly’ optimises and defers state commitment on rights-based health care, something socialist groups would find a soft target.
The United Progressive Alliance government, through its flagship National Rural Health Mission (NRHM), mainly focused on mother and child care (in line with UN’s Millennium Development Goals) and attempted a revamp of peripheral health facilities. NRHM talked of a rights-based health care without its enactment. It covered some ground but corruption, shortage of medical personnel and a patently bureaucratic design maligned the mission.
The harsh reality of India is that about 60 percent specialist positions in rural and district hospitals continue to remain vacant. Health care is a state subject but policy, disease control programmes and regulation of medical education are central subjects. Yet the UPA could not reform the Medical Council of India (MCI) and the medical education sector. These problems still haunt us.
The UPA had appointed a committee for Universal Health Care (UHC) which recommended a rights-based UHC, raising tax-financed public health spending to at least 2.5 per cent of GDP from the chronic 1 per cent level, a medical college and better health infrastructure in each district and a universal health cover package for families.
However, the UPA shrank away from this, given the daunting personnel and finance implications. On health care the left leaning groups’ demands are: health care as a justiciable right, higher public spending on health of 2-3 per cent of GDP to start with and a UHC modelled on the National Health Service (NHS) of the United Kingdom.
NDA-2 has apparently attempted to break away from some of the socialistic scaffold of the UPA. Thus the draft NHP-2015 was rightly not keen on rights-based health care, deferring it till individual states were willing to take greater responsibility. The draft NHP2015 offered the following:
This is a good and pragmatic document, talking of affordable care instead of free care. However MCI reforms, expansion of health human resources to include paramedics and AYUSH and clear choice of UHC model should be part of this.
The NHAM, although preceding the NHP-2015, was a NHP-congruent action plan for strengthening universal primary care and protection from catastrophic health expenses by improving public hospitals and contracting public-private-partnerships (PPPs), if necessary, for tertiary care. Together this makes a good policy and action plan.
The modern liberal position abhors a welfare regime; yet it retains a variable role for the state in social sectors. Here are some defining lines for a liberal position on health sector reforms.
Equity, access, quality, affordable cost, participation, informed choice of both healing system and provider are the important keywords for a liberal UHC. The NDA-2 government can rework the NHP-2015 (and NHAM) along these lines and start a new chapter of an India-relevant UHC.
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