Right To Health
By Dr. Oishee Mukherjee
Health care comes into sharp focus this General election. While the BJP already has its ambitious Ayushman Bharat scheme in place, the Congress has sought to counter it by promising ‘Right to health care’ in its 2019 manifesto. This is in continuation of the rights- based laws enacted under the Manmohan Singh government, such as Right to Education and Right to Information, which were milestones in the history of public welfare in India.
‘Three things we are considering for our manifesto’, had said Party Rahul Gandhi while interacting with health care professionals in Chhattisgarh, before the polls were announced. ‘Right to health care’ which will guarantee a certain minimum health care to all Indians, increasing the expenditure on health to 3 per cent of the GDP and training doctors and health care professionals”, he added was the party’s “top priority”.
Recall, Modi government had launched the Pradhan Mantri Jan Aarogya Yojana, last September. However, health experts including those in public hospitals pointed out that this does not cover the cost of outpatient services (OPD), diagnostics and medicines — the biggest source of patient expenditures. And so, the Congress seeks to improve on it and commits that health care professionals would work out an effective model for the right to health care.
Its justification being in its belief that be it any government, it has to do three things — “one, fix the problem, two, provide low cost, high quality education and three, ensure that people are protected as far as health care is concerned”.
And while time will tell whether Congress will get an opportunity to fulfil its commitment, the Centre and some States are trying to improve the present health facilities. A decision has been taken to allow dentists to practice general medicine, in view of the acute shortage of doctors in the country. It is said that the first two years of MBBS and BDS courses are more or less the same, and the decision may to some extent help tackle doctors’ shortage, in rural and semi-urban areas.
Then there is Maharashtra government which has recently drafted a bill to create special reservation quota up to 10 per cent in undergraduate (MBBS) and 20 per cent in post graduate (MD) medical seats for those who give a commitment to work in tribal and rural areas. Candidates must serve for a period of 7 years immediately after completion of MBBS and for 5 years after completion of MD.
The health care situation in rural Maharashtra is dire need of over haul. Though there is a huge network of 1816 primary health centres, 400 rural hospitals, 70 sub-divisional hospitals and 26 civic hospitals, these are largely rendered useless because of lack of manpower. A similar situation prevails in some North Indian States.
In Odisha, the situation in the tribal belt is worse. A new scheme of incentive policy has been introduced since mid-April in the 1750 government hospitals, wherein doctors posted in vulnerable and backward areas are being given maximum incentives.
In Jharkhand, where 65 per cent of women are anaemic and cases of vector borne diseases like malaria, kala azar and Japanese encephalitis are above the national average, the shortage of doctors in rural areas remains. Though three new medical colleges have come up during 2017-end at Palamau, Dumka and Hazaribagh, of the sanctioned strength of nearly 11,000 doctors in State health service, 6000 are said to be vacant. Obviously, this is because doctors do not want to work in CHCs and even in district hospitals. Similarly, in Uttarkhand, medical students do not honour terms of the bond signed to work in rural areas. Recently, the State’s medical education department issued legal notices for recovery of money to 383 doctors for not keeping their commitment.
It is a well-known fact that resources allotted to health are quite meagre. While 10.6 per cent of the total amount in the Interim Budget is allocated to defence, only 2.2 per cent was given to healthcare. Funding need not be redirected from current allocations to preventive care, but surely India can make health spending a priority, much like defence? Despite several innovations in the healthcare sector in recent times, the Government remains woefully short of its ambition to increase public health spending to 2.5 per cent of GDP. At present, health spending is even below 1.5 per cent of GDP.
Last year, it was announced that nearly 1.5 lakh health and wellness centres would be set up under Ayushman Bharat, with the mandate of preventive health and community-based management of basic health problems. But this should have included health education and holistic wellness integrating modern medicine with traditional Indian medicine, which is not the case. Both communicable disease containment as well as non-communicable disease programmes should be included. An estimated ¹ 250 crore has been allocated for setting up health and wellness centres under the National Urban Health Mission while the National Rural Health Mission received ¹ 1,350 crore. The amount is undoubtedly meagre considering the increase in both population and diseases in recent years.
Malnutrition and under nutrition has added to the problem as directly or indirectly these relate to health problems. On the other hand, in urban India the over dependence on fast food has aggravated diseases like obesity, diabetes and even cancer. In 2017, dietary risks were the second biggest factor behind deaths and disabilities in 2017 in the country, close on the heels of malnutrition. Dietary risks also increased by 35 per cent in a decade since 2007 when it ranked fourth after malnutrition, air pollution and the risk of water, sanitation and hygiene (WASH).
In spite of all this, the allocation for the non-communicable diseases programme of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke has been allocated just ¹ 175 crore, which is much less, or as estimated by experts, to be even 50 per cent of the actual need. While the rich and the middle income sections have the financial means for treatment, the poor and even the low income sections cannot carry on with such treatment after a period of time, or some can’t even start it.
It is distressing indeed, to note that the policy makers of the country have yet to understand the importance of health in social and economic development of the country. The big question to ask them is whether they are even aware of the living conditions of the poor, the backward sections and do they have genuine concern for their welfare? Whichever government comes to power, must make a note that as the nation celebrates the 150th birth anniversary of Mahatma Gandhi, it is critical to make health a fundamental right and thus ensure that in the next two years each sub-division should have a well-equipped hospital. It must realise that only a healthy people can ensure a healthy nation. —INFA