Health for all: an elusive goal

Being a signatory to the Alma Ata Declaration in 1978 that promised ‘Health for All by 2000,’ it looks like India has miles to go to achieve the goal that it never took seriously. Inequality of access and entitlement makes quality medical treatment a pipedream because of the rising disparities of wherewithal to avail of the benefits of the medical advances.

Our public hospitals are in an awful shape and India is the most privatised health market in the world. Public support for healthcare averages less than one per cent of the GDP, and public health investment and expenditure registers a precipitately declining trend. In 2002, the private sector accounted for 78.7 per cent of total health expenditure, while public expenditure made up just 21.3 per cent.

The recently-drafted National Health Bill  comes close to recognising right to health and hopes to stride towards the mammoth goal of health for all. But the fine print of the bill needs a closer scrutiny because how far it is going to address the increased private control and rapacious marketisation of healthcare is not clear.

The government’s focus now is on a selective and targeted programme based healthcare policy with the public domain being confined to family planning, immunisation, selected disease surveillance and medical education and research.

Public spending

It is a departure from the definition of the Bhore Committee  of the health policy in India which stressed on a comprehensive universal healthcare system. Prime Minister Manmohan Singh said that his government is determined to increase public spending on healthcare from 0.9 to 2 per cent of GDP.

Health being defined as the state of complete physical, mental and social well-being and not merely the absence of disease and infirmity, there’s no fair count of how many Indians would qualify as being healthy. More than 27 per cent of the undernourished population globally live in India which is home to more than 230 million undernourished people, more than any other country. Aid agencies say if India wanted to reduce poverty by 2015, the year marked by the United Nations as the deadline to attain the eight Millennium Development Goals (MDGs) to development, it needs to spend at least three per cent of GDP on health.

India’s maternal mortality rate (MMR) stands at 450 per 1,00,000 live births which is way behind a mandated reduction to 109 by 2015. The UN Human Development Report 2005 baulked at such contrast that while some of India’s cities were in the midst of a technology boom, one in every 11 Indian children dies in the first five years of life for want of low-technology, low-cost interventions.

In yet another estimate, annually 22 lakh infants and children die from preventable illnesses; over a lakh mothers die during child birth, five lakh people die of tuberculosis in India. Diarrhoea and malaria continue to be killers while five million people are suffering from HIV/AIDS.

Medical care is the foremost common cause of rural family debt. It is noted that mounting health expenses prompt many poor households denial of treatment, incomplete treatment, or worse, under desperate circumstances, treatment at the cost of financial and social wellbeing. Households curtail spending on food, sell assets or take loans, children are dropped out of school and/or forced to work, adults are pushed into labour, people are made to work longer and harder than usual — factors which can give rise to further indisposition.

Talks of expansion of public-private partnerships in health, and public health insurance fall aground because we do not have a basic health delivery system in place. We should broaden the area of mandatory public health insurance for people that acts more expediently and less bureaucratically, with special emphasis on children and with a growing life expectancy, on the elderly. Such schemes must be made mandatory while coverage has to be more inclusive and comprehensive.

If India does not urgently spend more on healthcare and save its poor population from poverty and hunger, it is condemned to face the risk of slower economic growth.

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