For an All-Party Manifesto on Health

Each year, more than 40 million people, mostly in rural areas, are impoverished and run into massive debts to access healthcare. The devastating contribution of out-of-pocket medical expenses to poverty is often not fully appreciated by the media and policy-makers

BY VINOD PAUL  &
      K SRINATH REDDY

As the countdown to the next general election begins, political parties are making multiple promises to pull in votes. All the party leaders are committing to transforming the lives of people. But health, ironically, does not feature high on their priority list, even though it is the central pillar of a nation’s development and productivity and the key to happiness for individuals, families and societies. Perhaps it is time to remind all parties that are seeking to govern the country that India’s health challenges are perhaps the greatest for any single nation in the world.
We continue to face the unrelenting burden of the old and new threats of communicable diseases. The discussion on maternal and child health care, and nutrition, is far from being complete. We have also emerged as the world’s epicentre of chronic diseases such as diabetes, hypertension, heart ailments and mental disorders. Nothing short of a massive transformation of the health system can address these challenges and meet the needs of citizens. People expect much more than a handful of select services under the limited ambit of the existing national programmes.

The Good and Bad News
The fundamentals have been laid down in the last few years as part of the National Rural Health Mission. More than 8,00,000 Accredited Social Health Activists workers, 33,000 nurses, 14,000 paramedics, 8,000 doctors and 3,000 specialists have been inducted; over 20,000 facilities have been constructed; and over 20,000 ambulances have been deployed. Medical graduate seats have increased by 55 per cent and postgraduate seats by 75 per cent. The Janani Suraksha Yojana has ensured that an additional 12 to 13 crore women are now delivering in government facilities and more than 6 lakh newborn babies are receiving care in neonatal care nurseries in district hospitals each year. Polio has been eliminated from the face of the country. The infant mortality rate (IMR) too has declined from 68 to 42 per 1000 live births between 2000 and 2012. This is exciting, but not enough. In Brazil, the IMR is 13 and in China it is 12.
Each year, more than 40 million people, mostly in rural areas, are impoverished and run into massive debts to access healthcare. The devastating contribution of out-of-pocket medical expenses to poverty is often not fully appreciated by the media and policy-makers.
Long-term goals in healthcare transformation require a timeline that surely goes beyond the life of one Lok Sabha. The Centre and States also have to work in unison, regardless of which parties are in power. An all-party commitment to broad tenets is therefore absolutely essential to ensure focus, consistency, speed and accountability. We, therefore, call for a national manifesto on health affirmed by all parties.

On Universal Health Coverage
The Twelfth Plan strategy envisages Universal Health Coverage (UHC) as the long-term goal “that will unfold over two or three Plan periods.” The doctrine of UHC guarantees cashless access to a defined package of quality health services to all citizens. Such a system that has been in existence for long in developed countries such as Germany, the U.K., Canada, Japan, Australia, New Zealand and in Scandinavian countries, has now been embraced by middle-income countries such as Thailand, Mexico and Brazil.
Given that India has a mixed health system, both public and private sectors have to work in tandem to provide appropriate, equitable and affordable care at all levels. The High-Level Expert Group (HLEG) on UHC, constituted by the Planning Commission, envisioned a National Health System wherein a strong public sector leads the design and delivery of UHC, drawing on support from the private sector in a well-regulated framework. In this system, all citizens are entitled to a comprehensive package of primary, secondary and tertiary care services, and have access to government and accredited private facilities for obtaining services such as diagnostics, vaccines, drugs or surgeries as an entitlement, without having to pay at the point of care. It is estimated that UHC would require public spending on healthcare to the tune of 3.0 per cent of the GDP or more.
A debate on the details of how the Centre and the States will deliver UHC can be settled through democratic processes in due course. It is however time that the entire spectrum of political leadership expresses unequivocal allegiance to the high principles that embody commitment to health equity and pledge to transform the health system in a decade. And let these common principles be enshrined in the manifestoes of all the national parties.

The Main Priority
To begin with, parties must make healthcare a core priority for the next decade, to enable transformation of the healthcare system, while promoting pro-health policies in other sectors. We believe that the following five principles form the core national agenda on health and should be embraced by all the parties.
First, we call upon all the political parties to commit to the goal of achieving UHC in the country by the year 2025, and develop a clear roadmap thereof by mid-2015.
Second, public spending on health should be raised from a meagre 1.04 per cent of the GDP in the Eleventh Plan Plan to 3 per cent by 2020, and 4 per cent by 2025.
Third, all essential drugs, including anti-cancer agents, should be made available free to all citizens in 3-4 years.
Fourth, standards of care including clinical guidelines, applicable to both the public and the private sectors, should be developed and enforced in the next five years.
Fifth, equity must be ensured in the provision of health services across districts, communities and gender.
The next government, irrespective of its party composition, should within the first 100 days of coming to power create an enabling mechanism to plan, mentor and implement the above promises. A National Health Regulatory and Development Authority would help to effectively advance this agenda.
This election should set a benchmark and transform the landscape of healthcare in India, no matter who comes to power.

-Vinod Paul is Head, Department of Pediatrics and WHO Collaborating Centre for Training and Research in Newborn Care, AIIMS, and K. Srinath Reddy is President, Public Health Foundation of India
-courtesy: The Hindu