Explained: Why Healthcare Reforms Should Be an Election Issue in 2019

Experts want the public health system to be “democratised" and policy making to be scientific and pro-people.

New Delhi: As political parties prepare their manifestos, a string of public health professionals have been preparing “health manifestoes” with the demand to make healthcare a priority.

Four such documents have been released by civil society in the past few months. Seen together, they provide a thorough look at the number of issues plaguing Indian health care and how political parties can address them.

Today, the Jan Swasthya Abhiyan released their “People’s Health Manifesto.”

In December, the Alliance of Doctors for Ethical Healthcare (ADEH), released an eight point document for political parties.

In February, a range of civil society leaders released a document called ‘Reclaiming the Republic.’ This also has a chapter on health reforms.

This month, the Vikalp Sangam has also released a ‘People’s Manifesto For a Just, Equitable, and Sustainable India’ with a chapter on health and hygiene.

“Abandon Ayushmaan Bharat”

Monday’s release by the Jan Swasthya Abhiyan has especially focused on the government’s much touted national health insurance scheme, Ayushmaan Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY).

The manifesto boldly calls for the entire programme to be abandoned. This insurance programme was announced by the current BJP government in the 2018 budget and received a big boost in this year’s budget, going from Rs 2,000 crore to Rs 6,400 crore.

Various estimates have said the scheme could actually cost the government anything between Rs 12,000 crores to Rs 50,000 crores and the manifesto says this would be “much better utilized by investment in expansion of public facilities and creation of permanent public assets.”

Also Read: Budget 2019: Ayushman Bharat Gets Rs 6,400 Crore, But to Benefit Private Sector

The health professionals also say the government should abandon public-private partnerships and stop working with multi-lateral organisations or corporate consultancies. Ayushmaan Bharat is however looking to operate largely on a public-private model, with the government offering to fund and subsidise the private sector, as The Wire has reported.

Health as a well-funded right

This manifesto also repeats a long-standing demand that the right to healthcare is made a justiciable right. India currently has a right to education and a right to food for example, but no specific right to health. However the right to health is largely protected under the larger right to life and by a number of court orders.

The manifesto says that the public health system should be “democratized and expanded exponentially” and that policy making should be scientific and also pro-people.

It also asks for an increase in public health financing through taxation, to at last 3.5% of India’s GDP. This money should go towards decreasing out of pocket spending and increasing human resources. ASHA workers, anganwadi workers and others in the public health system should be well paid and protected from unfair treatment.

Essential drugs and diagnostics should be entirely free, with lessons learnt from schemes already running in Tamil Nadu, Delhi and Rajasthan. Vaccines should also be made more easily available and drug discovery and production needs government help, says the manifesto. Generic medicines should be promoted.

Corruption in healthcare needs to be tackled. The document says attention needs to be paid to medical education, to appointments and funding in the public health system and to the business models of private hospitals.

The manifesto also says that political parties should pay special attention to the health of women, Dalits, Adivasis, particularly vulnerable tribals, refugees, migrants, queer and transgender people, people in conflict zones, people with hazardous occupations (such as manual scavengers), differently abled people, children and the elderly.

A range of health manifestos

While JSA’s manifesto and its 29 points is broad in its sweep, the eight-point manifesto released by ADEH in December placed specific focus on pricing and corruption in the medical field.

They asked political parties to find ways to control the prices of drugs and devices, such as through trade margin caps. They also urged governments to not leap into private health insurance tie ups. Medical education should be cleaned up, with tuition fees regulated, said this document.

In February, ‘Reclaiming the Republic’ released six key points in their manifesto, for political parties to look into. Their primary thrust area was also an increase in health care spending, to at least 3%.

Also Read: Healthcare Spending Is Losing out to Health Insurance, Say Activists

Further, they asked the government to promote cheaper generic drugs and through a pooled procurement of drugs, which will bring down prices even further. They also focused on issues with human resources in health care, suggesting that there be a public health cadre for primary care and workers should not be temporary or contracted but should be permanent staff.

Vikalp Sangam’s ‘People’s Manifesto for a Just, Equitable and Sustainable India’ released this month focusses on health and hygiene. This manifesto says that ill health needs to be improved by focusing on its many basic components, many of which are social determinants for health such as nutrition, water, sanitation and the environment.

It also says that medical systems should be pluralistic and integrate modern medicine with traditional, indigenous medicine, nature cures, Ayurveda, Unani and so on. This idea has been echoed in all manifestos except ADEH’s.