PM Modi ought to declare health as fundamental right on 75th Independence Day

Quality healthcare is a dream for average Indian. Inability to pay for it forces people to take loans they can ill afford or even sell their assets, often leaving them in penury for a lifetime

Representative Image (Photo Courtesy: Social Media)
Representative Image (Photo Courtesy: Social Media)

Dr Arun Mitra

Since independence, our country has progressed in many fields. The British colonial rulers squeezed our economy and left the nation with poor education and health status. According to Sanjay P Zodpey and Preeti H Negandhi as per the 1951 Census, India’s population was 36.1 crores. Only 18.33% of the total population was literate then, of which female literacy was 8.86%; only one out of every 11 women were able to read and write. The overall life expectancy was 32 years.

The infant mortality rate (IMR) was 145.6/1000 live births. Maternal mortality ratio (MMR) in the 1940s was 2000/100,000 live births, which apparently came down to 1000 in the 1950s. There were only 50,000 doctors across the country. The number of primary health-care centers in the country was only 725.

In the pre-independence period, Indian society was largely dependent on the traditional medicines, faith healing and belief system. Modern health planning in India started after the Joseph Bhore committee recommended in 1946 that ‘the health programme should be developed on a foundation of preventive health work’ and that ‘if the nation’s health has to be built, such activities should proceed side by side those concerned with treatment of patients’.

No individual should be denied the means to secure adequate medical care because of inability to pay; medical services should be free to all without any distinction and doctor should be a social physician, it emphasized.

The committee also observed that health and development are inter-dependent and improvement in other sectors like water supply, sanitation, nutrition, employment lead to improvement in health status.

In the first few decades of post-independence period, the direction of the healthcare was influenced by these principles. During that period much of the health care was developed in State sector with an emphasis that modern scientific healthcare should reach the remotest rural areas.

Sensing the need for cost effective drugs, Prime Minister Jawahar Lal Nehru went forward to establish drugs manufacturing in the public sector.

“The drug industry must be in the public sector….. I think an industry of the nature of the drug industry should not be in the private sector anyhow. There are far too much exploitation of the public in this industry,” he had said.

Indian Drugs and Pharmaceutical Ltd. (IDPL), which was established in 1961, played a major role in the strategic National Health Programmes. Recognising its role, the World Health Organisation commended that “IDPL had achieved in 10 years what others have in 50. IDPL products have been examined for quality very carefully by the developed countries and many of them want to buy from here”.

But after the shift in economic policies and ushering in of the neoliberal model of development, the whole scenario changed. From the holistic perspective, there occurred a policy shift towards health, which treats it as ‘techno-dependent and amenable to commodification’. The shift was seen in the approach of WHO also.

Thus, in our country we find that the public sector is now largely restricted to preventive services while the private sector is profiteering from advanced tertiary care.

The effect on medical education is also all too evident. At the time of independence, there were 20 colleges out of which only one was in the private sector. Presently, there are 612 medical colleges with 92652 seats. Out of these, 313 are government colleges while the rest 299 are run by trusts or the private sector.

Tuition fee in the latter group is exorbitantly high, to the extent of over Rs 1 crore for 4.5 years of an MBBS course in some of them. Thus, there is complete denial of admission in these colleges to the students from lower and middle income group.

We have seen a huge growth of corporate hospitals in the health sector, where advanced healthcare has become out of reach of low and even middle income group. Health is being projected only as a curative thing, with little talk to improve health determinants like improved sanitation, clean drinking water supply, housing, job security and increase in capacity to spend on nutrition.

No wonder the government recognises the fact that every year, 6.3 crore people are pushed below poverty line because of out of pocket expenditure on health.

But the remedy being offered is further pushing the people into debt. The whole healthcare concept is insurance based which fails to provide comprehensive healthcare. Senior citizens are the worst affected.

Even the Ayushman Bharat covers only 50 crore people, while the rest 90 crore are left out. It is applicable for indoor care only, whereas 70% of the out of pocket expenditure on health is on OPD care.

Moreover, there are several conditions attached to get registered for this scheme, which makes it hard even for eligible people to go avail its benefits.

Other State-run insurance schemes offer a limited benefit. For a person to get insured with a private or public sector company, she/he has to shell out a huge amount of money.

The government launched various schemes like ESI in 1952, CGHS in 1954 and ECHS in 2003 to provide comprehensive healthcare to employees to an extent. But now, an attempt is being made to dilute the ESI, with the government planning to handover district hospitals to the private sector to open medical colleges. In these hospitals, 50% patients will get free treatment, while the rest will have to pay. Even the free patients will have to get authorization from a designated authority, thus creating several hurdles for them.

The concept of universal comprehensive health care was first realized by the erstwhile USSR which in its constitution promulgated in 1936 guaranteed that its citizens have the right to health protection.

The NHS was launched in the UK on July 5, 1948 by the then Health Secretary Aneurin Bevan. This guaranteed free healthcare to the nation’s population.

India spends around Rs.1753 on health per capita in the public sector. It is one of 15 countries with the ignominious distinction of public spending of less than or about 1% of the GDP on health; other similarly placed countries spend twice the amount while developed ones spend 10 times more, says K Sujatha Rao in her book ‘Do We Care’. The small nation of Cuba spends up to 15%.

It is no surprise therefore, that the then secretary general of the United Nations, Ban Ki-moon, during a visit to Cuba, hailed its healthcare service as “a model for many countries”.

Our major health indicators are still not up to the mark. Our MMR is 103 (2019) for every 100,000 live births and IMR 30 per 1000 live births. We ranked dismally low in the Hunger Index, at 101 out of 116 countries.

Quality healthcare is a dream for an average Indian. The inability to pay is pushing our population to take loans for health or sell their assets. To make things worse, obscurantist ideas like astrology, gau mutra and tantriks are being highlighted under the present regime.

There is an urgent need for reversal of these policies to make healthcare a social responsibility, with the State making an effective intervention at all levels to ensure healthcare for each and every citizen of the country. It is the duty of the public health and social activists to educate people on the issues of their rights to health in proper perspective. Health should be declared as a fundamental right.

“The focus on our health policies should be grounded in the ideology of human welfare and to achieve the three basic goals of health systems – equity, efficiency and quality,” K Sujatha Rao wrote.

In September 2019, a High-Level Group on the health sector constituted under the 15th Finance Commission had recommended that the right to health be declared a fundamental right. If implemented, this will strengthen people’s access to healthcare.

On the 75th year of independence, let the country take effective measures for health. The government must promote, finance and provide comprehensive Primary Health Care. Public spending on health must be enhanced from 1% to 5 % of GDP immediately. An end to privatisation of public health services must be made and the private medical sector effectively regulated.

(IPA Service)

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