By
Dr Arun Mitra
Despite advances in health care there
persist gross inequalities as far as access to it is concerned. Even today the
low socio economic groups have difficulty in getting modern healthcare. Inequalities also persist in terms of
geography, caste, religion and gender. High out-of- pocket expenditures, with
the rising financial burden of health care adds to these inequalities.
Out-of-pocket expenditure by the patient constitutes 63 per cent of Total Health Expenditure. As a result every
year 6.3 Crore people are pushed below the poverty line in India due to health
care costs.
The share of Out of Pocket Expenditure
on health care as a proportion of total household monthly per capita
expenditure is 6.9 per cent in rural
area and 5.5 per cent in urban area.
This led to an increasing number of households facing catastrophic expenditure
due to health costs. A large proportion of the population still lacks access to
food, education, safe drinking water, sanitation, shelter, land and its
resources, employment and health care services. It affects both the occurrence
of disease and access to health care.
The recently launched National Health
Protection Scheme (NHPS) reduces universal health care to health insurance
coverage, and that too for only 50 Crore population while the rest 80 Crores
are left out. Moreover it covers only inpatient care even though more than 60
per cent of healthcare cost incurred by
the patient is on outpatient treatment. The private health insurance companies
and health care providers are already expecting huge windfalls from NHPS. With
significant involvement of the private sector, the scheme is clearly indication
of a shift from public provisioning of health towards privatization. These
would have far reaching implications especially in the area of healthcare.
Health is a social, economic and
political issue and above all a fundamental human right. Inequality, poverty,
exploitation, violence and injustice are at the root of ill‐health and the deaths of
poor and marginalised people. Health for all means that powerful interests have
to be challenged. That globalisation has to be opposed, and that political and
economic priorities have to be drastically changed. It is in this context that
the political parties should come forward with promises on healthcare in the
coming elections to the Lok Sabha.
Political parties have to agree to
that the attainment of the highest possible level of health and well‐being is a fundamental
human right, regardless of a person’s socio-economic and ethnic background,
religion, gender, age, abilities, sexual orientation, class or caste. The
principles of universal, comprehensive Primary Health Care, envisioned in the
1978 Alma Ata Declaration, should be the basis for formulating policies related
to health.
Therefore the parties should promise
to enact National Health Bill as Right to Health care Act that can guarantee
that every citizen shall have right to comprehensive and quality healthcare at
state’s expense, in a government health facility, and in case of its
non-availability in some cases in a private health facility and include health
in the concurrent list of the Constitution. Further a National Health Policy
legally binding on the executive will be adopted.
Other programmes must comprise promise
to take positive steps so that governments promote, finance and provide
comprehensive Primary Health Care as the most effective way of addressing
health problems and organising public health services so as to ensure free and
universal access, enhance public spending on health to 4 per cent of GDP and
setting up a standing National Commission of Health with judicial powers to
which the bureaucracy would be answerable followed by such commissions at state
level.
The political parties programme should
put an end to privatisation of public health services and ensure effective
regulation of the private medical sector, including charitable and NGO medical
services and set up Primary Health Centre at every 30000 population, with
24-hour service, a Health Sub-Centre at every 5000 population and a fully
staffed Community Health Centre equipped with all modern facilities at every
100000 population, establish round-the-clock ambulance service at every 30000
population, and post women medical and paramedical personnel in all health
centres and hospitals in adequate numbers. All Government health facilities
should adhere to Indian Public Health Standard (IPHS) norms.
The programme has to arrange assured
safe drinking water supply through piped water in all habitations, total
sanitation in all households and localities, and enforce complete safeguards
against air, water and soil pollution by industries, mines and other
developmental projects. Also malnutrition has to be estimated by implementing National
Food Security Act 2013 which aims to provide subsidised food grains to
approximately two thirds of India’s people and Nutrition Rehabilitation Centre
has to be set up at each block to address the issue of severely malnourished
children. Further people’s spending power has to be promoted by ensuring
sufficient wages so as to meet their nutritional needs.
Expenditure on medicines constitutes
nearly two-thirds (60 per cent ) of out of pocket expenditure. There is need to
implement a Rational Drug Policy that allows drugs to be sold only under their
generic names. Exempt production of generics from patent rules and ensure
improved availability, accessibility and affordability of drugs including
vaccines and sera in the public health system; through quality conscious pooled
procurement systems and promotion of manufacture of essential medicines.
Public Sector Units have to be
strengthened to make cheap bulk drugs and adhere to policy of cost of
production for ceiling of drug price with no more than 30 per cent trade margin.
A regularly updated Indian National
Formulary on the lines of British National Formulary has to be established to
provide unbiased prescribing information and rational guidelines for use of
drugs.
The estimated costs of Universal Health
coverage ranges between 4 and 6 per cent of GDP. This financial commitment is
achievable. What is required is political will for this if we want to build
healthy India. (IPA Service)
The post Universal Health Care Has To Be The National Mission appeared first on Newspack by India Press Agency.
