India, though still a developing nation, has achieved a lot in improving its healthcare sector since Independence. The impact of the efforts in the sector have had both a positive as well as negative impact. Several government policies and regulations have been both praised and criticised for their pros and cons.
The stride of globalisation, which started in India in the early 1980s and intensified in the 90s, severely influenced the policies affecting India’s healthcare sector. With structural adjustment programmes, the Indian government at that time started withdrawing public expenditure on core sectors including healthcare, education and food, which were seen as ‘non-productive’.
The argument given was that privatisation would lead to competitiveness and better utilisation of services. It was also argued to help enable more people to benefit from modern healthcare services. All policy and executive changes led to a severe impact on people, especially from rural India. According to the World Bank, in 2007, rural areas, which reside 70% of our population, have only 20% of India’s total hospital beds.
Some of the major impacts that the healthcare sector has had on India’s poor are:
The World Bank asked countries to promote health insurance, thus making health more of a personal responsibility. Insurance companies started their business and their high premium packages were really difficult for the poor to pay for. In recent times, some affordable insurance schemes have come up, including Rashtriya Swasthya Bima Yojna (RSBY) by the government, and Yeshasvini and VimoSEWA by co-operative societies, but they lack grassroots penetration.
Many poor people have been deceived by various fake insurance agents and have lost trust in them. All this makes it even more difficult for affordable insurance coverage for all, which could have been an alternative to direct public spending.
The process of globalisation has devastated the poor. The feminisation of poverty is what can explain the situation better. The poor, without any resources, have been further denied access to healthcare services. The introduction of user fees has not affected government expenditure, but has killed all prospects to access healthcare services for many.
These policy changes were accompanied by changes in patenting laws that benefited MNCs by providing significant concessions to corporates — this meant that the companies should have at least provided cheaper medicine at least to the deprived sections of the society. But without proper regulatory mechanisms from the government, prices of medicines have skyrocketed. Hospitals were provided with heavily subsidised land and in turn, expected to provide free services to the poor.
However, findings reveal that 10 out of 37 hospitals that had benefited from subsidised land by the government provided absolutely no services to the poor. The Supreme Court in 2011 ruled that at least 25% of out-patient department capacity and 10% of beds should be reserved for the poor. But in 2014, the Delhi High Court quashed a policy enforced by the Union Government that had made it mandatory to reserve facilities for the poor (even if the land agreement didn’t contain any such clause). Conditions more or less remain the same with no concrete step in this direction till now.
Issues related to food security also sprang up during the time:
With all the negative aspects, globalisation also brought some positive aspects to healthcare in India. It created an opportunity in terms of medical tourism, which is growing with time. Medical tourism can contribute as much as 25% of the GDP. A specific disease approach such as with polio, HIV/AIDS, cancer, etc. helped India fight these diseases more efficiently. It opened doors to foreign funding agencies.
But in conclusion, the effects have led to more neglect of the poor. Pressure from international organisations and funding agencies has led to a shift in focus and priority areas, leaving India’s poor entirely at the mercy of politicians, bureaucrats and market forces. The focus has shifted from basic needs and services to what international policy prioritises. This ultimately leads to policies inconsistent with the needs of India’s poor.
To serve all segments of Indian society, we need differential investment at different levels, with an emphasis on planning led by stakeholders. Even considering the current coronavirus outbreak, it is recommended that there should be larger investments in public health infrastructure in rural areas, mobile units should be made operational and the current system be improved with the help of relevant training programmes for health workers.