The Union Ministry of Health and Family Welfare has placed a draft National Health Policy (NHP), 2015 in public domain for comments, suggestions and feedback. This new policy is going to replace the NHP of 2002 followed by the first policy of 1983. Health being one of the most important matters of public concern, it needs to be addressed with top priority as health of the people is wealth of the nation. The proposed policy will further position the role of the Government in setting the priorities of health sector to ensure universal access to affordable healthcare services following the principles of equity and universality as told in the policy.
Though India is emerging as one most vibrant economy in the world but the question of equity and universality remains a matter of concern because of its diversity and disparity in socio–economic status and scope of accessing opportunities by different social groups. There are backward States and within the State backward regions which have been bearing the burden of underdevelopment even after planed development of last sixty years.
The national resources have not been democratically allocated to all its citizens for ensuring basic human rights such as right to health. There are millions as left out, unreached and excluded due to lack of opportunities and discriminatory treatment of the State in allocating resources and creating opportunities through policy decisions. India ranks at 135 among 187 countries in the Human Development Index for 2014 by the UNDP. It is even below Srilanka and just equal with other south Asian countries. The quality of life in terms of average life expectancy, reproductive health and access to health services, health infrastructure remain far behind countries such as Norway, Netherlands, Sweden and Canada with very high human development.
India remains poor in terms of health sector spending among BRICS countries as quoted in the draft policy. The States such as Kerala, Tamil Nadu, Maharashtra, and Andhra Pradesh have made good performances in health sector where as States like Bihar, Rajasthan, Madhya Pradesh and UP are struggling with a number of challenges. Coming to Odisha, in spite of MDG target for maternal and child survival, it is still the poorest of the poor and ranks below the national average in all aspects of human development.
Especially in health sector, Odisha has high MMR and IMR. There are remote and inaccessible areas with primitive tribal communities, poor people in rural hamlets and urban slums who are still unaware of modern health system. Public healthcare services are out of reach of these people due to their socio-economic backwardness. The State interventions in health sector have benefited an insignificant few whereas a vast majority of public is living without hope. How this new national health policy is going to address the health sector- related concerns of backward States and marginalized communities is very important to States like Odisha and the people of marginalized communities.
It is good that the policy has accepted the principles of equity and universality in public healthcare expenditure and affirms to take care of excluded groups by increasing investment from of 2.5 per cent of the GDP which is just 0.5 per cent more than the target fixed in the earlier National Health Policy of 2002 though ideally it should be 5 per cent of the GDP. In searching finance for health sector, the policy proposes special tax on extractive industries such as mining and development projects which caused displacement and loss of natural resources and habitations, to invest more on affected communities’ healthcare development along with policy of CSR.
The policy says the Indian private healthcare industry is the second largest destination for global capital investment in health. As the private healthcare industry in India has been growing very fast in comparison to other sector, it is projected that by 2020 it will be at value of 280 billion dollar which includes insurance and equipment, pharmaceuticals, diagnostics and hospitals and clinical care. The Government has been promoting private investment, with provision of 100 per cent FDI in healthcare, by reducing tax in many ways such as income tax exemption over health insurance, subsidized allocation of land, subsidized education for professionals and lots of other attractive subsides. The policy says as 50 per cent of the heath expenditure goes to human resources for heath it will increase employment in fighting jobless growth in the country.
It is evident that the private sector healthcare industry is inaccessible for poor and largely concentrated in metropolis without rural presence and the healthcare charges have been increasing day by day. While the Government has been providing support to private health industry there should be regulations to ensure services of these industries to the poor and people in rural and inaccessible areas. But it is observed that the policy has not sufficiently dealt with the controlling mechanism over the private sector in ensuring transparency and accountability and specially protecting the interest of the poor and marginalized. The NHP 2015 says over 63 million persons are suffering with poverty every year due to healthcare cost alone.
It is also observed that the public sector health insurance has not reached to all and due to lack of awareness, the people have not yet been assertive over getting their due entitlement in health sector. The Central Government under the Ministry of labour and Employment, running the Rastriya Swasthya Bima Yojana since 2008, has covered only one-fourth of the population and many of the RSBY card holders are not aware about the use of the card. The national programmes like NRHM and NUHM have been meeting the health services of millions of people. But they are still facing the problem of inefficiency in fund utilization, poor governance and linkages in public expenditure which has been a matter of concern.
The Government hospitals in Odisha are running with poor quality of health service and lack of health infrastructure. Usually they are charging user’s fee especially for diagnostics and outside prescription for drugs. The medical college and hospitals are overcrowded with patients and there is insufficient minimum infrastructure and trained staff even to meet the emergency need of serious cases. Someone who has visited the casualty room in SCB Medical College can better understand the state of affairs of health system in most popular and oldest premier hospital in the State. The people in interior parts still do not have the minimum opportunity to get health service from the public health sector. While the Government has been deliberately encouraging private sector in health but there has been no attempt to improve the quality of service delivery at par with private hospitals. This has been creating a negative understanding about public health system among public and in spite of increasing in number of private hospitals still a vast majority of poor are depending on public health system which needs to be strengthened.
The policy identifies coordinated action in seven priority areas relating to health as a social movement for health involving community and media in the name of Swasthya Nagarika Abhiyan which includes Swachha Bharat Abhiyan relating to sanitation and drinking water, balanced and health diet to reduce malnutrition and food security, Nasa Mukti Abhiyan against tobacco and alcohol, Yatri Suraksha to control rail and road traffic accident, Nirvaya Nari, against gender violence including sex determination, workers safety at workplace and controlling pollution and related illness.
Health being a State subject under the constitutional provision, Odisha has to take more initiatives rather than depend on the Center for support.
(The writer is a rights activist who can be contacted at ojaabbsr@gmail.com)