The great Indian democracy is currently holding her largest elections ever. Leading political leaders have criss-crossed the country in a variety of vehicles from imitation mediaeval chariots (rath) to high tech private jets. Some have proclaimed that the country is shining and equally, all promise the earth if elected. In this period various interest groups are engaged in hectic political lobbying.
The Jan Swasthya Abhiyan (Peoples Health Campaign), a national coalition of health groups, organized a meeting with various political parties in the month of March on a minimum standard of health for all Indians. The larger political parties however had clearly different priorities and the two major political formulations the National Democratic Alliance and the Congress did not consider it worth their while to send any representative to this meeting.
As a matter of protocol, political parties inform the electorate about their political priorities and future course of action if elected, through election manifestos. On that note, it is interesting to study the promises made by the NDA and the Congress on the eve of the 14th general elections.
The NDA has devoted a whole section of its manifesto to Social Development and Health for All is the title of the subsection devoted to health. This phrase, the electorate is promised, is not merely a slogan but an avowed objective and cherished goal, and a commitment to the people. These are words which are enough to warm the cockles the heart of all peoples health advocates. However a careful reading of the details that follow reveal the hollowness of this promise.
The list of proposed activities starts with a gross inaccuracy. It is mentioned that the total public spending on health care is 2% of the GDP and that it will be doubled in five years. The National Health Policy released in 2002 had mentioned that the maximum public expenditure ever had been 1.3% of the GDP and has declined to 0.9% at present. The very government which made the health policy has made such an error. Perhaps the authors misunderstood the National Health Policy objective of raising health investment to 2% by 2010 as being the current reality! Experts however recommend that a minimum of 5% of the GDP of a country public investment should be in the health sector.
Nineteen more points follow the first and there are details provided how the government will set up new AIIMS like hospitals, create an insurance based health security scheme, move to a polio free state, cover the entire country with the TB programme, eradicate filariasis, reduce maternal and infant mortality by half and similar very commendable promises. Many public health experts however point out how the obsession with the pulse polio program has caused a significant decline in the coverage of immunization of other infectious diseases. Health personnel in many parts of the country are now only concerned with the polio campaign and the sterilization program leaving little time for other health priorities.
For reducing maternal and infant mortality the NDA promises to lay emphasis on the Vande Mataram scheme which was launched with much fanfare on the 9th of March this year. This scheme which envisages the participation of private gynaecologists in providing care for pregnant women is not only incompletely conceived but assumes that the significant proportion of maternal and infant deaths occur in places where qualified private sector gynaecologists have their practice. Anyone familiar with rural India where most of Indias poor live, even in these India Shining times, knows very well that qualified private sector gynecologists are rare in villages. Similarly any midwife and nurse worth her salt knows that care for the pregnant mother is better provided by them than the specialist gynaecologist.
And this hastily drawn up scheme has forgotten all about safety during delivery, the most crucial time when lives are lost. Pushing poor women in the direction of privately practicing gynaecologists may well amount to providing the private practitioners with more patients to admit in their private nursing homes, more caesarian operations, more health care induced poverty and indebtedness. The authors of the manifesto may have considered these costs acceptable for the negligible reduction in maternal and infant mortality that the scheme may succeed in achieving.
The most clearly defined among the twenty points is the one devoted to making India a preferred global destination for healthcare. Expanding on a small mention in the National Health Policy 2002 the NDA manifesto aims to draw up an action plan before the end of the year and encourage the private sector to look after foreign patients. It is difficult to see what use the proposed increase in public spending on health will be required for when the private sector will not only be busy providing services to 1 billion Indians for a fee, and also earning millions in foreign exchange by catering to foreigners as well.
In a separate subsection on Population Control the NDA proposes to introduce disincentives for instituting a two child norm and at the same time promote the girl child. The NDA would also like this to be a pre-requisite for contesting all elections. Disincentives are necessarily coercive and there is enough evidence to show that imposing a two child norm is against the interests of the girl child not only in India but in China and other countries of Asia as well. The two child condition for contesting elections will also remove many more women from the political arena as has happened in the states where such a norm exists.
[See : Two children, countless wrongs, Abhijit Das]
The Congress party does not deem health of the people important enough to merit a separate subsection. It is clubbed together with education, and in this subsection of six paragraphs only a miserly two are devoted to health. Having a total of only hundred odd words to devote to health the authors have not been able to delineate any plans. The party promises to raise public spending on health, look after the welfare of the disabled, introduce insurance and a new health worker scheme. The only specific population subgroup or health issue that the Congress party mentions is the disabled, obviously the health issues of all other sub-groups and all other health conditions either dont merit their attention or have already been resolved.
One of these two political parties and alliances will come to power once the results are announced and the exercise of putting together a majority in the Lok Sabha is over. The health of over 600 million poor is in their hands.
