People's Democracy(Weekly Organ of the Communist Party of India (Marxist)
June 17, 2007
A Critical Look At Health Policy & Health Ministry Related Issues- III
MASSIVE INCREASE IN FUNDING REQUIRED
What is required today is a massive infusion of funds from the central government to re-energise the public health system and create both physical and social infrastructure. It is here that the neo-liberal philosophy becomes an impediment. In 1991 when the neo-liberal policies were initiated in India, the public health expenditure to GDP was a paltry 1.3 per cent. This had come down to 0.9 per cent in 2001-2002 and has increased only marginally since. This puts us among the lowest in the world in terms of public health expenditure to GDP — we spend more than only five countries — Burundi, Myanmar, Pakistan, Sudan and Cambodia. While the Finance minister may be proud that India has supposedly joined the trillion-dollar economy club, the monthly per capita expenditure on health is at a dismally low level of less than 17 rupees. Prior to economic reforms in the mid-80s, public health expenditures accounted for 3.95 per cent of the budget. By 2001, this had dropped to 2.7 per cent and further down to 2.4 per cent in 2005. Even a restoration of budgetary support to levels achieved in the 1980s would mean a doubling of allocation. We can look at these figures in another way. By 2008-09, assuming the current growth rate, we should be spending nearly five times more than what the state and central governments, put together, presently spend on health.
Another serious concern is the shortfall in the actual expenditure as compared to the outlay approved in the budget. The actual expenditure always falls short of the approved outlays. The table below shows that from 2002-03 to 2005-06, the actual expenditure of the ministry of Health and Family Welfare has always fallen short of the budgetary outlays by significant margins- between 9 to 18.5 per cent
Therefore, there is a vicious circle. We need more resources, but we cannot fully utilise the resources we have. One of the reasons relates to the moribund status of the health infrastructure as we have discussed earlier. Infusion of sub critical resources does not help, because the infrastructure and the delivery system in its present state is incapable of delivering. The answer is to greatly enhance infusion of resources together with an overhaul of the existing infrastructure. Without such an approach, the grand policy declarations of the union Health ministry will only be a reminder of the promises unfulfilled.
DRUG CONTROLLER-GENERAL OF INDIA (DGCI)
The Health ministry has other important institutions working under it like the DGCI. This authority has many important roles such as licensing for new drugs, assessing medicines in market and weeding out or banning those where subsequent research has been found to be harmful, checking spurious drugs, giving permission for clinical trials etc. Thus its regulatory and monitoring role is extremely important for a proper drug policy yet shockingly it has only 29 officers working under it. Obviously with such a small staff strength even if comprising of the best officers the DGCI cannot fulfill its important responsibilities. In Delhi alone there is a huge centre in the middle of the city where thousands of spurious drugs are traded but no action has been taken. Again as far as the issue of weeding out drugs from the market, including where later research has shown the drug to be harmful as for example Aralgan which was banned, most cases have arisen out of PILs against the specific drug and not through any proactive steps on behalf of the DGCI. Even today India has the most lax policy as far as permitting the sale of such drugs is concerned. But even as it cannot fulfill present responsibilities, the ministry wants to encroach into state jurisdiction and take over licenses for drug manufacture also which will cause further problems and should be opposed. The DGCI’s reputation was deeply affected when two of its most important functionaries in the past were hauled up for corruption and one even had to spend time in jail. Instead of learning from this experience, the Health ministry has not put in place any checks and balances or any mechanisms to make the working more transparent. It is important to ensure that the health of citizens does not get compromised under corrupt officials succumbing to powerful pharma lobbies.
The only area where the DGCI is active in granting permission to pharma companies to conduct clinical trials in India. We had earlier protested against the changes made in the relevant Schedule Y of the Drugs and Cosmetics Act, which has removed the earlier protection provided against exploitative clinical trials. Today, India has emerged as the favoured destination for MNCs based in advanced countries, who want to use Indian people as guinea pigs in tests which cost them 60 per cent less than in their own countries mainly because of more stringent client protection laws there. In India there are no provisions for compulsory insurance or compulsory compensation. Most hospitals, which allow clinical trials, do not even have functioning ethics committees. Shamefully in the budget 2007, the Finance minister actually cut all taxes on clinical trials thus further helping pharma companies. It would be more appropriate and in the interests of our people if the government ensured a set of stringent regulations to govern clinical trials.
In view of the increasing demand for ayurvedic drugs, not only in India but across the world, it is also essential to put in place a clear protocol which includes listing of all ingredients in indigenous medicines so that consumers are aware of what they are consuming. The Health ministry also needs to play a bigger role in ensuring safety standards in food and beverages. Recently the ministry gave a clean chit to Coke and Pepsi regarding their pesticide content. But in spite of an assurance given in parliament by the minister of Health, standards for the permissible levels of pesticides or other such harmful products in colas and carbonated drinks are yet to be set. These standards must be established without delay and action taken against all those who violate those norms. In view of the increased presence and operations of the domestic and foreign companies in food and pharmaceuticals, the government should gear up to frame and implement effective regulations.
In its influential 1987 document Financing Health Services in Developing Countries: An Agenda for Reform, the World Bank stated, “The approach to health care in developing countries has been to treat it as a right of citizenry and to attempt to provide free services for everyone. This approach does not work”. The reforms in the health sector in India since 1991 have been guided by this philosophy. The result has been a decay of the public health institutions and mushrooming of the private healthcare industry, which has excluded large sections of the population from affordable and quality healthcare. It has to be realised that for the healthcare system to work it must be a universal right accessible to all. And unless the state plays the central role in the health sector, both in terms of fund allocation as well as creating and maintaining infrastructure, the objective of health for all shall remain a mirage.