Even after more than 67 years of independence the successive governments have failed to provide universal healthcare to the people. India is a signatory to the Alma Ata declaration whereby the government was committed to provide healthcare to all by the end of 2000. But with the international economic relations scenario changing in the early 1990s the concept healthcare as a social responsibility was deliberately changed with more emphasis being laid on the individual responsibility.
Even after more than 67 years of independence the successive governments have failed to provide universal healthcare to the people. India is a signatory to the Alma Ata declaration whereby the government was committed to provide healthcare to all by the end of 2000. But with the international economic relations scenario changing in the early 1990s the concept healthcare as a social responsibility was deliberately changed with more emphasis being laid on the individual responsibility. Thus the Alma Ata declaration was virtually thrown into dustbin. A new idea of millennium development goals for health was set. These targets were to be achieved by the year 2015. But our country has not been able to achieve the target set by the Millennium Development Goal (MDG). Our health indicators are far below Sri Lanka which is economically not more developed than our country. Bangladesh with a population density of 1174 as compare to 382 of India and with much poor economy does not fall much below India’s health indicators. This is an indication as to the faulty health policies of our country. The present government has come out with draft national policy and invited public comments on this. The Indian Doctors for Peace and Development (IDPD) discussed it in the central council meeting held at Agra on 1st February 2015. Following this a draft of comments was prepared which was again circulated among the members for further comments. The draft has not drawn on the shortcomings and limitations of not achieving health related goals of MDG which is coming to an end in 2015. There is lack of specific commitment towards increasing public health expenditure. Even the suggestion in the draft of increasing public health expenditure from present 1.04 percent to 2.5 percent of GDP is devoid of any road-map. The public health expenditure should be increased to 6 percent of GPD to meet the healthcare needs of the citizens. In this policy draft there is strong tendency to privatize the public health delivery system especially at the secondary and tertiary level care. It is care at this level where out of pocket expenditure is highest and leads to impoverishment of the people particularly the poor. In order to attract private players in health sector the policy puts emphasis on medical tourism and insurance. It negates the basic concept of India being a welfare state and makes health a business. The entry of corporate sector in the tertiary healthcare has added to the cost of healthcare exorbitantly and also the unethical practices. Although the draft talks of comprehensive health care but makes no reference to High Level Expert Group on Universal Health Coverage or 12th Plan document. There is no road map for it neither is there any defined goal against which the progress could be assessed. The draft does not state how public health delivery system or facilities will be strengthened at primary, secondary and tertiary level. Here is an urgent need to form a Centre for Policy Research under the ministry of health. Recently there has been push by the WHO and UNICEF to include vaccines like Hepatitis B, HIB (Influenza Vaccine) through Pentavalent vaccines in Universal Immunisation Programme (UIP). There is also a move to include vaccine against Rota virus in UIP. The efficacy of these vaccines and the cost benefit is still being debated. Needless to say it is being pushed by international vaccine manufacturers. Centre for Policy Research should review all these issues before it is finally included in the national health programmes. There is weakening of present status of fixing social accountability in the draft policy. Under National Rural Health Mission (NRHM) various provisions are for fixing the accountability like public hearings of health delivery system, Community Based Planning and monitoring, formation of multi-stakeholder committees at different levels. The draft is silent on these issues. No user fee should be charged at any public health facility. The National Pharmaceutical Pricing Authority (NPPA) has withdrawn its order to fix prices of drugs, which are not under the list of essential medicines, a move that has been welcomed by the pharmaceutical industry. The NPPA had on 22nd September 2014 issued a statement, saying it has withdrawn guidelines for price control issued under Para 19 of the Drug Prices Control Order (DPCO), 2013. The Paragraph 19 of the DPCO, 2013, authorises the NPPA to control the prices drugs that are not under the NLEM (National List of Essential Medicines) under extraordinary circumstances in public interest. The NPPA had invoked Para 19 of the DPCO to cap prices of 108 medicines, including cardiac, diabetes and HIV/AIDS drugs. As a result since the present government took over the prices of the newer Anti HIV and Anti Cancer drugs have increased rocket high. The NPPA should put an effective control on the drug prices. The draft should guarantee universal free access to medicines and diagnostics, somewhere between 500 to 700 drugs as is being done in Tamilnadu and Kerala. IDPD welcomes the decision of the government of opening Jan Aushadhi, where it will sell around 500 drugs under generic names at low cost. There is no mention of the drug pricing policy. The drugs should be brought under the ministry of health and family welfare and instead of the ministry of Petroleum & Chemicals. The drug prices should be fixed on the basis of the cost involved in their production. The MRP of the drugs being sold under the generic category should be rationalized to give benefits to the patients as it has been found that in many such cases the difference between the MRP and the purchase price by the retailers is exorbitant. The policy should opt for universal coverage under Rashtriya Swasthya Bima Yojna (RSBY) scheme including out-patient care like consultation, diagnostics, treatment at all level of facilities. And it should be brought under Health Ministry instead of Labour Ministry. National Population Policy should be freshly developed. The previous policy prescription although talks of target free approach but uses terms like expected level of achievement. It has led to many tragedies as in Bilaspur, Kapafora, etc as the service providers keep on organizing sterilization camps with little regards for safety and more importantly the dignity of women. Thermostatic models of providing micronutrients for example IFA, Vitamin A, Iodine have not been sufficient in improving the nutritional status of adolescent girls, women in reproductive age and children. There is a clear need to link malnutrition to food security. The draft should include the social determinants of health like ending poverty, income generation apart from clean water and environment, housing and sanitation. There should be clear road map for it. The intent of having Right to Health Act in the draft policy is a welcome move. Surprisingly it is silent on Health Bill which was put in public domain in 2009. A yearly assessment should be made and data published on the number of patients treated free of cost by the corporate hospitals who have been leased out land virtually free of cost. Special clauses should be introduced in the health policy 2015 to ensure ethical practice by the medical professionals, institutions and organizations.