Dr Arun Mitra
The elections are over and it is just a matter of procedures that the new government will take over. The people have given unprecedented mandate. Even though the basic issues were missing in the election campaign, but at the end of the day people would expect steps to be taken by the new government to improve their lot in terms of employment opportunities, job security, proper remuneration, quality healthcare and education etc. Even though unfortunately none of these were in the frontline of the agenda of the elections, however they remain core issues of life.
It is admitted by repeated documents of the government including the national health policy 2017 document that as a result of out of pocket expenditure on health 6.3 crore people of or country are pushed below poverty line. This is a serious issue. There is immediate need to improve this situation. There is need for several steps to be taken to ameliorate the situation.
Health is a basic requirement of all individuals irrespective of caste, creed, gender, religious groups or economic status. It is therefore imperative that health is recognized as a fundamental right. There is need to enact National Health Bill as Right to Health care Act that can guarantee that every citizen shall have right to comprehensive and quality healthcare at state’s expense, in a government health facility, and in case of its non-availability in a private health facility. Health should be included in the concurrent list of the Constitution and adoption of a National Health Policy legally binding on the executive.
To meet the above it is urgently required that public spending on health should be increased. The share of Out Of Pocket Expenditure on health care as a proportion of total household monthly per capita expenditure was 6.9% in rural area and 5.5% in urban area. This poses heavy burden on the households. More than 40 per cent of the population has to borrow or sell assets for treatment, according to the 2004 National Sample Survey Organisation. The estimated costs of Universal Health coverage range between 4 and 6 per cent of GDP. Though considerable, this financial commitment is achievable. As an immediate step the public health spending should be increased from 1% to 2.5% and then to 5% in the coming four years. Direct spending by the government has shown better results compared to the insurance based healthcare delivery system worldwide.
National Health Profile 2015; Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare, Govt. of India estimates that expenditure on medicines constitutes nearly two-thirds (60%) of out of pocket expenditure, forcing them to get buried in quagmire of poverty. There is need to implement a Rational Drug Policy that allows drugs to be sold only under their generic names. Exempt production of generics from patent rules. Ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system; through quality conscious pooled procurement systems and promotion of manufacture of essential medicines. There is need to adhere to policy of cost of production for ceiling of drug price.
In the last few decades there has been shift from opening the medical colleges in the state sector to the private sector. This process has been further speeded up in the last four years. In the year 2017 there were 214 government medical college and 253 private medical colleges. In the period between 2014-2017 the number of new medical colleges opened was 36 in government sector and 58 in the private sector. The colleges in the private sector charge exorbitant fee to the tune of rupees one crore for the MBBS course. Most of these colleges lack proper infrastructure and violate the norms and forms of medical ethics. There is commercialization of medical education. Policy should be change to open more medical colleges in the state sector.
Set up Primary Health Centre at every 30000 population, with 24-hour service, a Health Sub-Centre at every 5000 population and a fully staffed Community Health Centre with all facilities at every 100000 population. Establish round-the-clock ambulance service at every 30000 population. Post women medical and paramedical personnel in all health centres and hospitals in adequate numbers. All Government health facilities should adhere to Indian Public Health Standard (IPHS) norms.
Social determinants of health like safe drinking water, sewage facilities, clean environment, proper housing, sufficient remuneration, employment opportunities and job security must be given priority. Rules should be framed accordingly. Arrange assured safe drinking water supply through piped water in all habitations, total sanitation in all households and localities, and enforce complete safeguards against air, water and soil pollution by industries, mines and other developmental projects.
Eliminate Malnutrition by implementing National Food Security Act 2013 which aims to provide subsidised food grains to approximately two thirds of India’s people and ensures Maternity entitlements to all pregnant women. Set up Nutrition Rehabilitation Centre at each block to address the issue of severely malnourished children.
Whereas our spending on health is very low, we are spending huge amount on arms race including the nuclear weapon system. Presently India is the second biggest buyer of arms in the world and also aspires to become an arms exporting country. We have to play a leading role in initiating mutual dialogue with neighbours to strengthen peace and divert money towards health, education and develo-pment. (IPA)
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