LSTV Insights – Health begins with policy
Draft National health Policy is out for public comments and opinion. It, among other things, aims at recognizing ‘right to health’ as fundamental right. If this is done, any denial to heath care by any doctor will be an offence. It will ensure that, no person will die because of unaffordability of health care services. Currently, National Health Policy 2002 is in place.
But on the other hand, government has plans to cut health expenditure in current year by 7000 crores, because of tight fiscal situation. This if true, contradicts the commitment shown by the government in health policy. It is clear that adequate financing to public health care is most crucial factor on which success of all other policies dependent. Current spending is as low as 1.04% of GDP. New policy aims at 2.5% of GDP, but time and again, this target has remained only in books. It is irony that health despite of being most important social sector, is least vocal and is often compromised for other supposedly more important sectors.
Interpreting article 21 of the constitution, Supreme Court has brought ‘Right to food’ and ‘right to primary education’ (21A) under fundamental rights. So there’s no reason to believe that health care is lesser important that these things. There should be minimum standard preventive, curative, diagnostic and emergency care for everyone.
India’s health sector is most privatized in the world. Consequently, ‘out of pocket’ expenditure is about 3 times the public spending. This private expenditure pulls huge number of people back to poverty. In order to make ‘right to Health’ deliver, govt. will have to expand its presence in rural health sector, delivering adequate quality of services. For this to happen, center will have to work more closely with state as health is a state subject. Some state government need to be strictly monitored because of rampant corruption and negligence. In these states, most of the Government doctors illegally practice privately and this renders public dependent upon government helpless.
Delivering on ‘swacchh bharat mission’ is critical for preventive health care in India. If it is done, there will be atleast 20% less infections, diseases and expenditure.
Issue of Medical education is to be addressed. In past decade private medical institutions are seen flouting the norms. Also, fee of these institutions is very high and medical graduates are often not able to find proper remunerative occupation. This makes them vulnerable to fall in the trap of corruption. Further, Doctors are expected to charge reasonable to the patients, as medical profession is based on trust. Recognizing that doctors too have personal ambitions government should compensate them. In case of government doctors, there merit should be recognized in form of higher remuneration.
Recent Chhattisgarh tragedy was due to unrealistic targets given by health departments to Doctors. Doctors should refuse to accept those targets and report any such pressure to authorities.
Recent, Draft policy also allows AYUSH doctors to practice allopathy after 1 year training under Allopathic doctor. Similarly, Ayurveda doctors are being allowed to do some selective works like abortion. Indian Medical Association opposed this step on the grounds that this will lead to more accident and traumas to patients.
Other things that policy includes are, Upgradation of 58 medical colleges, 15 new All India Medical Science (AIIMS) institutes and 2.5% of GDP on health care. It expresses that majority of finance will come from Cess on unhealthy things such as cigarettes; junk food etc and Corporate Social Responsibility also will be used. In first phase focus should be entirely on rural areas.
It is very crucial to build institutional capacities in poor states starting right from manpower, considering arrangements for communicable, non-communicable, preventive/curative/diagnostic services in holistic manner. Such institution should be lasting and evolutionary, so that they are able to deliver what is expected of them.
Further, there must be community participation in policy making, especially of Women and Child experts. Also there should be grievance redressal mechanisms, provision for social audits etc. in place.