People's Democracy

Dr. Singh: The Nation�s Health is Failing!

G Mamatha

�WE recognise health as an inalienable human right that every individual can justly claim. So long as wide health inequalities exist in our country and access to essential health care is not universally assured, we would fall short in both economic planning and in our moral obligation to all citizens�. This is not a part of the speech given by a leader belonging to either the CPI(M) or to any other Left party demanding the Right to Health. This is quoted from the speech given by Prime Minister Manmohan Singh in 2005, delivering the convocation address at the All India Institute for Medical Sciences in New Delhi.  Manmohan Singh further said that he believed the bulk of the provision of basic health services and medical care, especially for the poor, would continue to remain in the public domain in the near future. �Private care�, he added, �cannot be the immediate answer to the needs of those who do not have basic purchasing power�. Even recently addressing the nation from the ramparts of the Red Fort on the 63^rd Independence Day, the prime minister said, �Good health is one of our basic needs�. So much so for the words! Alas, one can be liberal with words as the one who utters them feels that they will not be audited. Comparing statistics with the words uttered reveals the gap between the actions that the mouth and the hand do.

Let us look at the present ground reality. India has one of the most privatised healthcare systems in the world. The World Health Organisation (WHO) has shockingly revealed recently that in 2007-08, India ranked 171 in a list of 175 countries in the world in terms of public health spending. If you take public expenditure on health as a percentage of GDP, in India it is a mere 0.9 per cent, among the lowest in the world and ahead of only five countries --- Burundi, Myanmar, Pakistan, Guinea and Laos. If you take the share of the government in total health expenditure, again India figures at the bottom of the pile with government spending accounting for just 25 per cent of the total health expenditure in the country.

Compare this with the share of government in health spending which is 76 per cent in Europe and 34 per cent in South-East Asia. India�s spending falls below the lowest even in this range. If you were to consider the share of health expenditure in total government expenditure, India again has among the lowest proportions in the world � a mere 3.4 per cent. Only Pakistan (1.3 per cent) and Burundi (2.3 per cent) allocate a lower portion of total expenditure on health.

In India, private spending on health is 4.2 per cent of GDP. More than 70 per cent of all health expenditure in India is paid for by people from their own pockets and this expenditure has been rising, especially for the poorest with increasing privatisation of healthcare.

According to a Planning Commission paper of May 2009, several studies conducted in villages showed that healthcare expense was responsible for over half of all the cases of decline into poverty. It is estimated that in 2004-05 (for which latest data is availabe), an additional 39 million people were pushed into poverty due to out-of-pocket payments for the costly health care.

NSSO data for 2004-05 shows that of the total medical expenditure per capita, medicines alone accounted for 74 per cent of the expenses in rural areas and 67 per cent in urban areas. If we were to consider only non-institutional medical care, which constitutes the bulk of health expenses, drugs constitute over 80 per cent of people�s expenditure. Think of it, the government intends to further deregularise the prices of drugs and allow the pharma companies to increase the prices stating that our country is home to 'cheap drugs' compared to other parts of the world. 'Cheap' they are indeed! Routinely, 900 people die every day due to Tuberculosis (TB). Over 1000 children die every day in India, due to malnutrition or diseases that can be completely preventable.

The majority of the people are forced to turn to private health systems that are often beyond their reach. For the poor, the choice is sometimes between treatment or death. That is a choice no citizen should be forced to make. India is home to more than 230 million undernourished people, more than any other country. The ever rising food prices are already adding millions more to this list. The government has completely failed to control the food prices and ensure that basic food items providing essential nutrients are made available to the people - to live if not a healthy life, at least a life! The absence of essential nutrients in diet is further decreasing the inbuilt resistance power of the majority of the people and is making them more disease prone. To improve on the dismal record, Indian government needs to increase its social and public expenditure and ensure better healthcare facilities and make its regulatory functions effective.

In 2004, when the UPA-1 government was formed, under Left's pressure, the Common Minimum Programme promised to raise the levels of public health spending from 0.9 to at least 3 per cent of the GDP. Six years later, this continues to remain at the same miserable level of 0.9 per cent. If the Congress party led UPA- 2 government is really serious in providing universal health care as promised in its election manifesto and reiterated on many instances by the prime minister, it needs to get its act together. Its lofty words should reflect in the allocations for health, atleast in the coming budget. It should remember that it cannot escape people�s audit the next time around if it continues with the same policies. Alas, you cannot fool all the people all the time!