Relevance: GS-2: Issues relating to development and management of Social Sector/Services relating to Health, Education, and Human Resources.
Key Phrases: National Health Policy 2002, Right to Health Bill, Major Problems of Health Services in India, Politicization, Prioritizing health sector
Context:
- Though there is consensus among policymakers about prioritizing the health sector in India, yet, there seems to be a sense of reluctance in making healthcare a political priority.
- Healthcare came to be seen as a politically viable and electorally rewarding issue in some states.
- Let’s delve deeper into the issue of the health sector in India.
Major Problems of Health Services in India
- Neglect of Rural Population:
- A serious drawback of India’s health service is the neglect of rural masses. It is largely a service based on urban hospitals.
- According to health information, 31.5% of hospitals and 16% hospital beds are situated in rural areas where 75% of total population resides.
- Moreover the doctors are unwilling to serve in rural areas.
- Emphasis on Culture Method:
- The health system of India depends almost on imported western models. It has no roots in the culture and tradition of the people.
- At the cost of providing comprehensive primary health care to all, it has completely neglected preventive, pro-motive, rehabilitative and public health measures.
- Inadequate Outlay for Health:
- According to the National Health Policy 2002, the Govt. contribution to the health sector constitutes only 0.9 percent of the GDP. This is quite insufficient.
- In India, public expenditure on health is 17.3% of the total health expenditure while in China, the same is 24.9% and in Sri Lanka and USA, the same is 45.4 and 44.1 respectively. This is the main cause of low health standards in the country.
- Social Inequality:
- The growth of health facilities has been highly imbalanced in India. Rural, hilly and remote areas of the country are underserved while in urban areas and cities, health facilities are well developed.
- The SC/ST and the poor people are far away from modern health services.
- Shortage of Medical Personnel:
- In India shortage of medical personnel like doctors, nurses etc. is a basic problem in the health sector.
- In 1999-2000, while there were only 5.5 doctors per 10,000 population in India, the same is 25 in the USA and 20 in China.
- Similarly the number of hospitals and dispensaries is insufficient in comparison to our vast population.
- Medical Research:
- Medical research in the country needs to be focused on drugs and vaccines for tropical diseases which are normally neglected by international pharmaceutical companies on account of their limited profitability potential.
- The National Health Policy 2002 suggests allocating more funds to boost medical research in this direction.
- Expensive Health Service:
- In India, health services, especially allopathic, are quite expensive. It hits the common man the hardest.
- Prices of various essential drugs have gone up.
Politicization of the issue
- Early 2022, Tamil Nadu and Rajasthan indicated they would legislate a Right to Health for their citizens.
- These bills signify a culture where politicians feel incentivized to deliver better healthcare as their competitors try to one up them.
Tamil Nadu’s case
- The Right to Health Bill’s antecedents include -
- A maternity benefits scheme for women’s nutritional security (1987)
- Procurement and distribution of free medicines (1994)
- Health insurance (2009).
- Over decades, policymakers pursue initiatives that have embedded an expectation of health among voters.
- Present-day politicians, who seek to sustain their legacies, thus have an incentive to continue reforms.
Competitive political issue: Rajasthan’s case
- In Rajasthan, health has become a thriving, competitive political issue in the past decade.
- In 2011, the then Chief Minister introduced the free medicines and diagnostics schemes, which went on to become so popular even his successor had to continue it, despite murmurs about watering it down.
- Later in 2013, the then Chief Minister introduced a health insurance scheme, and set up ‘Model PHCs’.
- Again in 2018, the then Chief Minister first expanded the coverage and eligibility under the insurance scheme and has now introduced the Right to Health Bill.
Other States
- There have been a few more instances where Chief Ministers decided to bet big on health, in turn affecting voter expectations of other politicians in the State.
- For instance in Andhra Pradesh, the Rajiv Aarogyasri Scheme, the first State-wide health insurance scheme for families below the poverty line in India, in 2007, sought to create a pro-welfare, rural-centric image of the government.
- The insurance scheme’s ensuing popularity ensured that even when the opposition came to office, they could not roll it back, due to pressure from both citizens as well as hospital associations who benefited from the scheme.
Shifting priorities
- A virtuous loop of political action and voter demand can be observed from above examples as most apparently has happened in Rajasthan.
- What started off as free medicines and diagnostics scheme has today snowballed into a political plank for both major parties in Rajasthan.
- Good service delivery arguably leads to loss aversion among the voters, which builds pressure on competitor politicians to continue the scheme and build on it.
- Even smaller reforms, such as guaranteeing delivery of medicines, may begin to change the political culture, and eventually lay the path for the State to pursue systemic reform.
Way Forward
- Healthcare is by no means an easy issue to fix. Even after 75 years, our health system pushes more than 50 million people into poverty each year, with out-of-pocket-expenditure as high as 70 per cent in some States.
- The Covid-19 pandemic further uncovered the deficiencies of the Indian public health system.
- There is a marked absence of mainstream political discourse around health financing, outcomes, human resources in health, etc.
- This must change, and maybe our politicians, inspired by the examples above, will be incentivized to surprise the voters with a new political agenda involving healthcare.
- More emphasis should be given to the alternative systems of medicine. Ayurveda, Unani and Homeopathy systems are less costly and will serve the common man in a better way.
- The health system has many problems which can be overcome by effective planning and allocating more funds.
Source: The Hindu BL
Mains Question:
Q. The health system in India has many problems which can be overcome by effective planning and allocating more funds. Comment. [150 Words].
