In his recent opinion editorial column in The Indian Express, Kaushik Basu puts forth an interesting point. He writes: “It is human creativity that enabled us to think of viable universal healthcare and social welfare. Politics and policy can be as creative as science and literature. That is our collective responsibility.”
The rapid economic growth that India is witnessing should foster freedom of speech, and encourage informed decision-making among citizens, journalists and policy makers. This freedom of speech and the collective responsibility that Basu talks about should provide us with rational choices for our welfare and development.
There is a deeper relevance of Basu’s column. I read his article right after going through what the National Health Policy, 2017, has to offer. In brief, the policy is based on “professionalism, integrity and ethics, equity, affordability, universality, patient centred and quality of care, and accountability and pluralism.”
It talks about the co-existence and partnerships between the public and private sectors to promote better healthcare in a very sick India. It also seeks to reduce the ‘out-of-pocket’ expenditure that patients have to bear and increase the budget for public healthcare by 2025.
Furthermore, the policy wants to reinforce trust in public healthcare systems and also encourage yoga in schools for a healthier lifestyle. According to India’s health minister, JP Nadda, apparently, there is no dearth of money and therefore the government doesn’t need to tax citizens to raise money for this policy.
One of the most important points that was neglected in this discussion is the proposal to make healthcare a fundamental right. Why, you may ask. It is because India lacks infrastructure, and the state may not always be in a position to provide healthcare. Nadda does not mince words.
After all these explanations, two questions came to my mind:
1. If there is no dearth of money, why has India’s healthcare infrastructure only deteriorated in recent times?
2. How does a state that obsessively talks about development and welfare justify the exclusion of healthcare from fundamental rights?
Now, I know that India did not declare itself a ‘welfare state’, but its rhetoric post-independence has mainly been focussed on development and social welfare. The Planning Commission was established to streamline policies and schemes with strategic goals of welfare and development, and then linked to politics.
To this day, political parties feed off policy crises to play power games. Policy planning was one of the backbones of resuscitating the Indian state after independence. The Planning Commission played an integral part in this. However, with the increasing number of policy failures, the planning process, that was initially restricted within the walls of government departments, came to the public’s notice. Responsible journalism and general public disappointment were pivotal to this revelation.
From the 1970s and 80s to 2017, India has seen paradigm shifts in its economy and politics. People’s approaches to developmental issues have also changed. In the age of click-bait articles and fake news, it is indeed refreshing to see millennials speak up and question a normative understanding of welfare.
My favourite go-to man for understanding the duties of the state is Amartya Sen. He had said that the two strongest pillars of any state are its education and healthcare systems. If these two systems are not robust, the citizens as well as the government’s performance will suffer.
He also talked at length about people’s capabilities to use opportunities and their agency to generate outcomes. This was his alternative to welfare economics, which wasn’t suitable in the Indian context. Again, it is no rocket science to understand the conundrum in the spheres of health, education, agriculture, economics, welfare and politics. These form a rather complex system on which policies are based and are not mutually exclusive. Therefore, implementation of policies becomes a problem if these intersectionalities are not considered.
I remember writing a piece about the Right to Education (RTE) Act, when it was introduced. That time, a young professional, who had been working with a grassroots organisation, had obtained a first-hand experience on what exactly happened during admissions under the RTE Act in Rajasthan. The RTE Act was a good effort, but its implementation has gone awry.
Now, with the new National Health Policy, it is indeed disheartening to find that healthcare is not yet considered to be a fundamental right – only because the government is unsure about its own reach among citizens. By the time I reached the end of the policy paper published online, I felt the same way as I do generally after watching a Rohit Shetty movie – anticlimactic.
The paper talks about a lot of initiatives that the government wishes to undertake. However, it lacks explanation on how it plans to undertake these initiatives. It is to be remembered that ‘health’ is a subject under the State list. This implies that individual states may or may not subscribe to what the policy says.
The tone of the policy shifts from curative to preventive. Nadda talks about eradication of leprosy and measles within a stipulated time-frame. But he conveniently ignores the latent issues of environmental degradation that cause acute respiratory problems, one of the leading causes of deaths in India. According to World Health Organisation, cancers, cardiovascular diseases, chronic respiratory diseases and diabetes are the four most widespread non-communicable disorders that cause deaths in India. However, we are unsure regarding how the government aims to tackle these problems.
Then, there are health issues that Indian children face. Children, who are considered to be one of India’s biggest strengths, are often malnourished and have stunted growth.
The other menace is the lack of proper sanitation in urban slums and rural areas. Manual scavenging is still hugely prevalent. Workers are dying of silicosis and asbestosis in India’s mineral-rich states. Does the government plan to address all of these issues just by writing fancy words on a policy paper?
The health minister wants to reinforce people’s trust in India’s public healthcare systems. However, just a day after introducing the new policy (on March 16, 2017), nurses from the All India Institute of Medical Sciences (AIIMS), New Delhi, called for a mass ‘casual leave’ to protest against the Seventh Pay Commission. According to them, they are not paid fairly and the administration has been ignoring their demands for over a year now. This mass leave led to a shutdown of the emergency services and disruption in operation theatres. This adversely affected the many patients in the institute.
For me, what was most irksome was the fact that the policy intends to encourage the growth of the private healthcare industry. This reeks of neo-liberalism in a country where some communities do not have access even to public healthcare centres. The use of ‘industry’ implies that healthcare has become a commercial entity whose primary aim is to make profits. Well, maybe this is all the ‘creativity’ that the country’s politics and policies have to offer.
Above all this, Nadda says that healthcare cannot be a fundamental right because the state might not be able to provide it at all times! Are you kidding me right now?