In the 21st century, there has risen the ultimate quest- a race of sorts- for States to taste the manna of “superpower”. Drunk with the idea of the ultimate superiority- a child nursed by post Second World War politics- government apparatuses all over the world have allowed the true motive and goal of a “welfare state” to slide and take an absolute backseat. And the greatest reflection of this unfortunate fact is very evident in the lack of an efficient health policy in some of the most developed nations of the world. India too, rather regretfully, is party to this list. The real question remains to be- what parameters are being set by the international community in general, and India in particular, for a country to be in the running for utmost glory and superiority, because human upliftment certainly doesn’t seem to have made it to that list.
While most of us do not realise the huge and significant role health care must play in the development scheme of a nation, it becomes the prerogative of the State system and the various Government machineries, in power, to pointedly make it one of the biggest priorities of nation-building. This however has been found absolutely and entirely lacking in the Indian planning and policies in the sixty-eight odd years of independence. This however does not take away from the various successive governments what they do best- the tall promises that have been made in terms of health care ever since the very high aiming United Nations’Â “Health for All” Declaration in Alma Ata in 1978. Following this the High-Level Expert Group (HLEG) was created in 2010 by the Planning Commission of India which, after a very long hiatus, sought to advice and change the face of Indian medicine and health care.
The committee describes Universal Health Care in the lines of- “Ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income level, social status, gender, caste, or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative, and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services”. To be able to implement a goal and an ambition as farfetched as this one is rather impossible, for India, in the times of disparity for health care in the nation (the irony lying in the fact that, as a developing and prospective world power, one of our greatest concerns should be enforcement and not mere legislation in the field of health care. All having been said, this committee (like committees are generally inclined and meant to do) did recommend some effective reformations in the Indian Health Care scenario. The most striking of this was the identification of a larger scale of public expenditure in the sector, including a more intensive execution of implementation that trickles and seeps right down to the grass roots. An inspiration to the Planning Commission’s 12th Five year plan of 2013, the recommendations have not been rendered redundant after all.
Having said that, it is however imperative to point out that the Plan did not consider a higher investment of public spending in the area, entirely ignoring the higher expenditure involved in privatising this sector, making some of the most essential aspects of health-care unreachable and unaffordable for more than half the population in India. This does not begin to cover the inefficiencies in the Rashtriya Swasthiya Bhima Yojna or the National Health Insurance Policy, whose clauses hardly cover some of the most basic amenities. There is no ignoring the fact that the Indian Health Care Policy has hardly gone through any positive and constructive change since 2002, and while I say this I have to emphasise on the failing of the latest health plan in meeting any proper goal as a much required initiative, that was meant to step up to a certain standard when it comes so many years later.
Even though we gloat about the “eradication” of polio or malaria, is the Indian conscience truly convinced of the legitimacy of these statistics? Is that, again, the beginning and end of the State machinery’s responsibility in the area of health-care? And how much truly has the Government had to do with these initiatives in the first place, when they are generally engineered and pioneered by International or Non-Profit Organisations? Pressing as they may be, these questions are hardly, if ever, addressed. It is a matter of much regret that in an age when the face of medicine changes and improves each day, we in India do fall rather far behind. Plans are made, legislations passed and yet there seems to be no perforation of its implementation. The scheme selectively and conspicuously neglects major health concerns in India, mentioning the high out-of-pocket (OOP) expenditure in the passing, but not allowing or allotting it the much needed attention.
While we’re on it, there are some serious matters that are entirely overlooked by policy makers of our nation while dealing with health care. The fact that child malnourishment has gone down by one percent, even though the economy has grown by 50% according to a statistic taken for the time between 2001 and 2006, leaves India strikingly lagging behind the nations with a similar growth rate and speaks volumes about the neglect in places that need it the most and for the people who can least afford it. We live in a nation that, as it struggles up the climb of development, ignores some of the most imperative givens which aid the making of greatness and prosperity. When the citizens aren’t ensured protection against lack of sanitation, unaware and a fundamental negligence towards the availability of clean and safe necessities, what could one possibly make of its highly developed status in official records stacked away in obscure departments of public offices?
Till the time an effective and strongly enforced set of measures are not wilfully implanted in areas such as female health (including the rampant incidence of Breast Cancer and PCOD) and the very alarming state of rural health; not much can be expected in terms of striking change in the field of health care. There is a screeching need, but the real and glaring question is — who is willing to step up?