Sunday, 19 March 2023 16:15

Talking Point 8 - On Health

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Health is our Right. But in India it is not recognized as a fundamental right in the Indian Constitution. Most provisions related to health are in Part-IV –i.e., in the Directive Principles of State Policies that is not obligatory on the part of state to implement. In 1990s India had “liberalized” its economy which meant opening it to international markets, leading to mass-scale privatization of public services and goods. Moreover, it advocated state withdrawal from sphere of public services like health. Accordingly they had directed the third world governments to reorient public health spending for selective health programme for targeted populations against the aims of universal health care for its all citizen. Thus bulk of health care were left the mercy of market- private

  • That is why India continues to have one of the highest out of pocket expenditure on health. Although it fell from 64 per cent in 2013-14, it stands at 48.2 percent in 2018-19. There is also a lot of inter-state disparity. In Uttar Pradesh the share of out-of-pocket expenditure stands at 71 percent. High out of pocket expenditure on health has direct links with deepening poverty as well as impoverishing large sections. This is due to the neoliberal policy of the state abdicating its responsibility to provide health for all
  • Continuously sliding budgetary allocation for Health. Last year’s health budget saw a decline by 7 percent in real terms, while this year the real decline was of 2 percent as compared to the budget estimates of last year. Share of health in total budget this year has declined from 2.26 percent to 2.06 percent as compared to last year.
  • The Revised Estimates of Budgetary allocations for 2022-23, show that health spending stand at a pitiable 0.3 percent of the GDP. This kind of budgetary cuts in the aftermath of a devastatingCovid-19 pandemic amounts to a criminal act against the working people of the country.
  • There have been deliberate attempts to weaken the public health system by reducing the budgetary allocations and thereby pushing people towards private healthcare. For instance, the National Health Mission (NHM), which is the largest public-health programme and includes the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM), with a focus to support poor and marginalized sections, has been flushed out of funds. In real terms the budget for the programme has been reduced by Rs 1438 crores between 2022-23 and this year. The Ayushman Bharat – Health and Wellness Centres which had been announced with much fanfare last year, found no mention in this year’s budget.
  • The thrust of this government has been on health insurance, such as the Pradhan Mantri Jan Arogya Yojana (PMJAY), which in reality is diverting public funds to the private sector. 75 percent of the insurance claims went to the private sector under the scheme. The scheme failed miserably to provide any relief and support to the most vulnerable and poor sections during the Covid-19 pandemic. But still the government has increased allocations towards the scheme in this year’s budget, despite a significant underspending of almost half of allocations in the last year. Reports have shown that the more complicated diseases are not treated by the private sector and are sent back to the public health system. The scheme has failed to serve the poorer and marginalized sections that it was intended towards.
  • There has been a constant demand from public health activists to absorb all publicly funded health insurance schemes into an expanded public health system publicly financed through general taxation. This program should include a comprehensive system for healthcare protection of unorganized and organized sector workers, linked to the rejuvenation of the Employees State Insurance Scheme (ESIS).
  • In the current neo-liberal eco-system, private health insurance companies are getting entrenched. They have deep rooted in the healthcare sector. They have been advocating to get rid of government guaranteed health schemes. Accordingly, the corporate servile Modi regime has been doing everything to dismantle ESI so as to fill the coffers of the private health insurance merchants at the cost of workers’ lives.
  • When shamefully India ranks 107th in the Global Hunger Index, among 121 countries of the world, with 19.5 percent and 35.5 percent of its children below 5 years wasted and stunted respectively, the central budgetary allocations under SAKSHAM and POSHAN 2.0 schemes have seen a decline by 4.3 percent in real terms. These two schemes cover the essential child-nutrition- ICDS and Anganwadi programmes. No scope for increasing the pay of essential ASHA and Anganwadi workers, who are the backbone of child and maternal healthcare and nutrition programmes, have been kept in the budget.
  • Similarly, the Pradhan Mantri Matri Vandana Yojana which provides maternal nutrition supplements, has seen budgetary slash. Overall, the spending on health and nutrition focused welfare schemes have in recent years seen spending less than 2014-15 levels.
  • The government’s tall claims of becoming Atmanirbhar or self-reliant in healthcare falls apart against the actual spending on making healthcare a universal right. The Covid-19 experience had shown the iniquitous nature of India’s public health infrastructure and services, and continues to be so.

The COVID-19 pandemic exposed a severe lack of healthcare infrastructure across the world. India has also fared poorly on health infrastructure indices for many years-the Human Development Report 2020 shows a national ratio of only five beds per 10,000 people. This inadequacy was further exacerbated during the COVID-19 pandemic resulting in medical infrastructure being placed under extreme stress. 

Another pressing problems in India remains a severe shortage of trained manpower in the medical stream, this includes doctors, nurses, paramedics and primary healthcare workers. The situation remains worrisome in rural areas, where almost 66 per cent of India’s population resides.

The doctor-to-patient ratio remains abysmally low, which is merely 0.7 doctors per 1,000 people. This is compared to the World Health Organisation (WHO) average of 2.5 doctors per 1,000 people. Improving this situation needs a protracted struggle join struggle of all working people.

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Read 2237 times Last modified on Tuesday, 21 March 2023 04:59