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Health gets greater attention in the 2014 Indian elections by Dinsa Sachan

A very thought provoking article, although the words “greater attention” in the title may be debatable.

Health has been a seriously neglected issue in past Indian general elections.  While infrastructure, jobs, poverty and development have always been important campaign issues in past elections, health issues rarely made the cut.But this year, they have received slightly more recognition according to a compelling article written by  Dinsa Sachan in the Lancet. (I use the words slightly more because again, it is no way near the amount of recognition it needs.)

According to some activists, 2014 elections seem to have signalled a change  and Dinsa Sachan’s article highlights the views of several activists working in health in India including Joe Varghese with the People’s Health Movement who believes that the situation has improved since 2004. “They’re at least beginning to talk about health in their manifestos now”, he says.

Even though the parties may be talking- ever so slightly -about health (in comparison to other areas) in their manifestos, it has yet to become a major campaigning issue. And while everyone is eagerly awaiting the results, many health activists are also questioning if the new government will lead to improved health care in the country? Many are predicting that the BJP- NDA alliance will come into power and we will have to wait to see what the new government will do .

Also, very interesting are the several concerns highlighted by experts in this article on BJP vs Congress – who will have a better (if at all) impact on health in India. Some of the concerns include:

  • There has been an increasing demand among civil society to monitor the largely unregulated private sector, which provides 80% of outpatient and 60% of inpatient care in the country. The out-of-pocket spending is so high that it pushes an estimated 2·2% of population into poverty every year. Many experts say a BJP government could increase privatisation in health care.

  • Rakhal Gaitonde, a community medicine expert with People’s Health Movement is also critical of the BJP approach. “While they are in power in Chhattisgarh, there have been several attempts at privatisation, which can only mean a weakening of the public health system and increasing inequity”, he says.

  • The BJP manifesto states that the NRHM has failed to meet its objectives and will be “radically reformed”.Gaitonde is concerned by this statement. “What are they going to undo?”, he says. “I fear that the focus on public health sector strengthening in the NRHM is going to be dangerously diluted.”

  • Gaitonde adds the BJP manifesto is a “typical right-wing” document, but welcomes their intention to recast the health ministry to include nutrition and pharmaceuticals under its remit.

  • Experts would like the next government to increase health spending from 1·4% to 3—5% of GDP.The Congress party has promised to increase health expenditure to 3% of GDP in its manifesto, while the BJP has not pledged any increase.

  • Even though polls suggest a Congress win is unlikely, experts commend the party for its flagship scheme, NRHM.Shailaja Chandra, former secretary in the health ministry, calls the NRHM “the biggest achievement of the health sector” in the past two decades.“In terms of maternal health, institutional deliveries have shot up to 90% in some states, and even [poor] states like Uttar Pradesh and Bihar have registered gains. It has made a huge difference to the maternal and child mortality rates in the country”, she says. “It will be a pity if the next government abandons the maternal health programmes of the NRHM.”

  • T Sundararaman, former executive director of National Health Systems Resource Center agrees with Chandra, but quickly adds that the programme has become more bureaucratic and centralised in recent years.

  • Amar Jesani, editor of the Indian Journal of Medical Ethics thinks a Congress government will not be much better. “Their focus on providing universal access to health care has also focused on insurance. Insurance schemes only transfer money to private sector. They should rather focus on providing free access to health care by improving public hospitals.”It is may be worthwhile to note that Congress has introduced insurance based UHC schemes such as the Rashtriya Swasthya Bima Yojana (RSBY) and the Rajeev Gandhi Jeevandayi Arogya Yojana (RGJAY) in the past .According to sources, the RSBY scheme had failed to make a mark in many of the Congress-ruled states. States like Delhi,  Andhra Pradesh, Maharashtra and Rajasthan have either not implemented it or abandoned it mid-way. Only Assam has worked the scheme well.

If we are to go by some of the views expressed by experts in this article, the future of health in India isn’t looking promising with the BJP- NDA party in power. We, at HII are own conducting our own mini survey on this topic. Look out for our next article in this week on “BJP/NDA and what it means for health in India ?” To participate in our survey, click here.

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