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Is Globalisation A Bane Or A Boon To India’s Healthcare Sector?

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The success of a socio-economic transformation in any country should be evaluated in terms of benefits and opportunities made available to an ordinary individual. For an individual, a healthy and secured life – free from illness and ailments and a reasonable lifespan — remains a vital consideration. Good health benefits an individual by providing an opportunity to develop abilities required to achieve personal goals. Gains increase if the individual is vulnerable and living in poverty, as a healthy body is the primary productive asset (WHO, 1999), which can be deployed for facilitating earnings and minimising the risk of falling deep in poverty.

Healthcare has also been declared as a human right under Article 25 of the Universal Declaration of Human Rights. Good health reflected in the declining incidence of morbidity, mortality and disability helps society by contributing to its economic growth through higher work productivity, and releasing resources that otherwise would have to be spent on public healthcare. The health promotion, therefore, assumes the role of a vital public good and a basic human right of people.

In the area of health, a multiplicity of changes are taking place at both micro and macro levels, ranging from healthcare requirements to health-seeking behaviour to actual health outcomes. Issues such as inequitable access to basic services, inefficiencies resulting into waste, suboptimal utilisation of existing resources, declining ethical norms, and patient rights and citizens’ entitlement to basic health services (preventive, promotive and curative) have assumed greater importance. At the same time, the world economy is changing rapidly with globalisation policies getting deep-rooted and widespread all over, challenging the established development paradigms.

This is true for India too. In the late 1980s, India fell deep into an economic crisis with its internal and external economic imbalances reaching unprecedented heights and international creditworthiness questioned. This backdrop created the compelling grounds for the country to adopt the World Bank-designed development paradigm by adopting a new market-oriented macro economic policy framework.

This process, popularly captioned as liberalisation, privatisation and globalisation (LPG), has not only increased interdependence on and interconnection with the international markets, but it has also brought far reaching implications for the administrative and socio-economic and political structures of the country (Arora 2002).

Globalisation and Healthcare

With the opening of the economy and an increased participation from the private sector, both domestic as well international, the health sector has been explicitly recognised as an industry as well as a service sector. Gains are considered to be substantial with the rapidly rising health sector (as pointed out by the study conducted by Confederation of Indian Industry (CII) – Mckinsey Study 2002) and also from promoting India as a global health destination (Union Budget, 2003-04).

Liberalisation of the economy has increased the responsibility of the government to provide an efficient health system covering health education, preventive programmes and curative services. The market-oriented development process has caused changes in lifestyles, increased urbanisation and connectivity, and enhanced access to information and services not available earlier. These and other factors, in one way or another, have profoundly impacted the epidemiological and health-seeking behaviour patterns of the people along with exposing inadequacies of the present health system — both in public and private domains.

Globalisation policies are being aggressively pursued when structural changes are taking place in the health sector. During the 1990s, while mortality rates reached a plateau, there emerged a challenging dual disease burden. Communicable diseases have become more difficult to encounter because of the development of insecticide-resistant strains of vectors, antibiotics resistant strains of bacteria; and the emergence of HIV infection for which there is no therapy. With India’s health achievements not at pace with requirements, in spite of the fact that health development has remained one of the major thrust areas for social development, the subject of health has only grown complex.

The process of globalisation brings dual effects. Some of its effect are beneficial, whereas some are not:

    • The effect of globalisation on health systems and individuals is complex. At first glance, many people would say that globalisation has had an overall positive impact on people’s health. In many ways, that is true. For instance, global transportation and the communications revolution enable rapid response to epidemics and catastrophes, saving thousands of lives.
    • Access to the latest technology through globalisation may help, but potential risks associated with increased prices and availability of essential drugs are also equally serious. Medical technology in India has generally focused on pharmaceutical drugs, diagnostics for sex determination of the foetus and corruption in public procurement. Policies for practicing and monitoring potential impacts of medical innovations on health expenditures have remained ignored. Technological changes in many advanced countries have led to a substantial increase in health spending, mainly due to expanded utilisation of medical devices and higher prices. Therefore, increased utilisation of medical technology is required and should be encouraged
    • The flip side of the above example is that due to rapid mobility of people across borders, the spread of infectious diseases is a threat to everyone, particularly the poor.
    • Health gains are likely to be positive only if globalisation-led economic growth creates economic inequalities that are moderate, domestic markets are competitive and non-exclusionary, access to healthcare infrastructure is evenly spread out, regulatory instruments are effective and strong, social safety nets are well-placed, and rules to access to global markets are non exclusionary.
    • The increased importance of for-profit health sectors and restructuring of public institutions on market principles has made healthcare difficult for the poor. The proportion of those who were unable to access care because of financial reasons has gone up significantly in both rural and urban areas, as has the proportion who says that there is bio-medical facility available. The declining share of public hospitals and dispensaries in public health expenditure has coincided with growing state support for privatisation of the healthcare sector and specific involvement of private providers in the public health system.

Globalisation is one of the key challenges facing health policy-makers and public health practitioners. Although there is a growing literature on the importance of globalisation for health, there is no consensus either on the pathways and mechanisms through which globalisation affects the health of populations or on the appropriate policy response. There is, however, an increasing tension between the new rules, actors and markets that characterise the modern phase of globalisation, and the ability of countries to protect and promote health.

It would be overly simplistic and inaccurate to describe globalisation as either “good” or “bad” for health. For example, spatial changes are leading to an increased migration of people throughout the world. For high-income countries, the debate surrounding globalisation and health tends to focus on the perceived threat, from low- and middle-income countries, of acquiring certain acute and epidemic infections, such as HIV/AIDS, tuberculosis, plague and, more recently, severe acute respiratory syndrome (SARS).​

Richer countries also fear the potential financial burden of unhealthy populations migrating from the developing world. What are less appreciated are the risks that high-income countries may export to other parts of the world through products such as tobacco and fast food and, more indirectly, macroeconomic policies affecting foreign direct investment and debt burdens.

There is also a tendency to overlook the benefits to high-income countries from population mobility — migration of health professionals from poorer countries​ ​offers benefits to the understaffed health systems in high-income countries (but at the expense of capacity in the developing world). In other words, the increased movement of people and other items creates a complex equation of pluses and minuses for each society.

Similarly, temporal change affects the spread of disease. The speed of modern transportation systems means that infections can potentially move around the world within a few hours (as illustrated by the SARS outbreak in 2002–03). On the other hand, modern technology potentially enables the health community to respond more quickly to such emergencies. For example, an international network of institutions coordinated by the World Health.

Recent Examples

We all know how the Covid-19 pandemic has adversely affected populations across the world. The virus was first identified in September 2019 in China, with no surge in cases in China till March 2020, when nearly 80,000 people got infected from the virus. From then on, the virus got transferred all over the world. While China recovered from the pandemic early on, it started manufacturing and exporting masks and sanitisers to other countries due to globalisation. China even over-exported these masks and sanitisers all over the world due to over-production.

India exporting a medicine names ​hydroxychloroquine to the US can also be recognised as a great example of globalisation in the current scenario.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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