Lok Sabha Elections 2004
Under BJP Rule:
Health Is Not For All
Ailing India: Record of the NDA Government
When people in the country starve, the impact on the health of its people would be obvious. The NDA government, to compound matters, has presided over the virtual dismantling of India’s health care infrastructure. Expenditure patterns on health care have always been grossly skewed in favour of urban areas. Savage expenditure cuts in the health sector have further distorted this picture with the axe on investment falling first on rural health services. The government admits today that health expenditure in India has declined in the past decade from 1.3% of GDP in 1991-92 to 0.9% of GDP in 2002. India has one of the most privatised health care systems in the world, with 84% of health care costs being paid for privately. This may be contrasted with 80-90% of health care costs being paid for by the government in most developed countries. Even in the US, 45% of health care costs are paid for by the government. In this context, a World Bank-funded report says that India spends less than 1% of its gross domestic product (GDP) on health, comparable to war-ravaged Congo that does not even have a government in place!
Balance Sheet of “Achievements”
What does the balance sheet of achievements of the NDA have to show in the Health Sector? It is a sad story of a rolling back of the limited gains that we had made in the earlier decades. Let us look at some of its “achievements” :
· Between 1997 and 2000, routine immunization coverage fell from 60 to 40 per cent.
· The reduction in Infant Mortality Rates has been virtually halted, with it remaining stagnant at around 70 deaths per 1000 live births.
· The national family and health survey revealed that the maternal mortality ratio in India has increased from 424 to 540 between 1992-93 and 1998-99.
· Between 1991 and 2001, the sex ratio of the child population (those aged between 0 and six years of age) fell sharply from 945 females per 1,000 males to 927 per 1,000.
· India bears 83% of the world’s polio burden, despite an annual expenditure of Rs. 500 crore on immunisation programmes; 60% of the amount constitutes a loan from the World Bank. It comes as no surprise then that international donor agencies are expressing grave concern at India’s failure to wipe out polio, that cripples children below the age of five for a lifetime.
· Half a million people die of Tuberculosis in the country every year – much higher than in any other country in the world.
· India is experiencing a resurgence of various communicable diseases including Malaria, Encephalitis, Kala azar, Dengue and Leptospirosis. The number of cases of Malaria has remained at a high level of around 2 million cases annually since the mid eighties and these figures are a gross underestimation. The Malaria Research Centre says that the actual figures are more than six times the official figures. By the year 2001, nearly half of the cases are of Falciparum malaria, which can cause the deadly cerebral malaria. Environmental and social dislocations combined with weakening public health systems have contributed to this resurgence.
· Around 6 lakh children die each year from an ordinary illness like diarrhoea. Most of these deaths can be prevented by universal provision of safe drinking water and basic sanitation facilities.
These figures hide even larger disparities:
· While 31% of government expenditure on health benefits the richest 20% of the Indian population, only 10% goes to the poorest 20%.
· Child mortality (1-5yrs age) among children from the 'Low standard of living index' group is 3.9 times that for those from the 'High standard of living index' group according to recent NFHS data. Every year, 2 million children under the age of five years die in India, of largely preventable causes and mostly among the poor. If the entire country were to achieve a better level of child health, for example the child mortality levels of Kerala, then 16 lakh deaths of under-five children would be avoided every year. This amounts to 4380 avoidable deaths every day, which translates into three avoidable child deaths every minute.
· Tribals, who account for only 8% of India's population, bear the burden of 60% of malarial deaths in the country.
· The ratio of hospital beds to population in rural areas is fifteen times lower than that for urban areas.
· The ratio of doctors to population in rural areas is almost six times lower than the availability of doctors for the urban population.
· Per person, Government spending on public health is seven times lower in rural areas, compared to Government health spending for urban areas.
The response to this situation by the NDA government has been characteristic. While the rural health infrastructure is in shambles the government talks about setting up “AIIMS kind of” hospitals in large metropolitan centres. It talks of promoting “health tourism” in the country to benefit foreign patients. It promotes the levying of user fees in government health facilities. It talks about its grandiose plans to help the private sector – a sector that is known to be callous, indifferent and insensitive to the real needs of the Indian people. It further decontrols prices of medicines, and now proposes that only 20-25 medicines will be kept under price control – down from 74 in 1994.
All the recent initiatives of the BJP-led NDA Govt. have been designed to favour the rich and heap further miseries on the poor. Corporate hospitals like Apollo, Escorts, etc. are being provided land, tax breaks and easy loans while Government run Primary Health Centres are allowed to decay. The pitiable state of PHCs can be seen from the following statistics:
- Only 38% of all PHCs have the necessary staff
- Only 31% have some supplies (60% and more of all necessary supplies), with only 3% of PHCs having 80% of all necessary inputs.
- In spite of the high maternal mortality ratio, 8 out of every 10 PHCs have no Essential Obstetric Care drug kit.
- Only 34% PHCs offer delivery services, while only 3% offer Medical Termination of Pregnancy.
- A person accessing a community health centre would find no obstetrician (to conduct deliveries) in 7 out of 10 centres, and no paediatrician (child specialist) in 8 out of 10.
On top of this pitiable state of basic health services, the Govt. is encouraging the levying of user fees in public health facilities. This is being done in a situation where public funding of health care expenditure has fallen from 22% in the early nineties to 16% in 2000. India has one of the most privatised health systems in the world. To harp on user fees while not providing for a quantum jump in health care expenditure by the government is a ploy by this government to abandon its responsibility of providing health care to the people of this country. We see below the impact that rising health care costs have on the people of this country:
· Forty percent of hospitalised people are forced to borrow money or sell assets to cover expenses incurred on health care.
· Over 2 crores of Indians are pushed below the poverty line every year because of the catastrophic effect of out of pocket spending on health care.
In callous disregard of people’s needs, this Govt. now wants to promote “health tourism”, i.e. promote the use of India’s health infrastructure to treat foreign visitors. While people are being forced into destitution to meet their health care needs and die on the streets, in villages, in their homes, denied of even basic facilities, our doctors and our facilities will treat foreign tourists! And this is being touted as the new vision for health care in India!
Drug prices have been spiralling upwards and the NDA Govt. has now proposed that the prices of all drugs will be decontrolled. We have a situation where only one in five persons can afford all essential drugs. Yet the New Drug Policy has called for further decontrol of drug prices, reducing the number of drugs in the controlled category to 20-25 from 74. Even the drugs available in the market are of dubious quality – estimates say that 40% of drugs in the market are either substandard, or spurious.
The NDA Govt. now wants to shift the blame for its non-performance in the Health Sector by passing the blame on to the states based on the play that Health care is a state subject. What it does not say is that its economic liberalisation programme has squeezed the finances of the states to such an extent that they are unable to find money for very basic services like health and education. What they also say is that the whole policy of privatisation, of charging user fees, of dismantling the public health infrastructure, is being done in many states under instructions from this BJP led Govt.
Yet the “India Shining” booklet prepared by the NDA Government talks about its commitment to “Health For All”. Can we think of a crueller joke at the expense of the sick and ailing in this country?