National Health Policy of 2017: Old wine in a new bottle

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The Union Cabinet in its latest National Health Policy 2017 has set aside only 2.5% of the India’s Gross Domestic Product (GDP) on public healthcare expenditure. A general overview of the policy, which was approved on March 15th, highlights the Indian government’s intention to provide affordable healthcare services to all. A closer look at it reveals ambiguity in the policy that the government fails to address effectively.

Could it be any lesser?

While the latest percentage is an increase from the current levels of spending, which stands at 1.4% of the GDP, it is half of what the government had pledged at the time of independence. The government, committed to spend 5% of its GDP towards healthcare in its first five-year plans never spent more than 1.8% in all these years and this is linked to over 60% of the population’s healthcare costs being individually borne. According to The World Bank, India lags behind China, Brazil and Nicaragua who spent 3.1%, 3.8% and 5.1%, respectively in 2014 on healthcare. Among the developed industrial nations, Sweden and the United States spends 10% and 8.3%, respectively.

Although the policy makes great claims, the roadmap seems abstruse, for example this holistic policy does not state how it will deliver the services in remote villages were even availability of ambulance is akin to none.

Racing against time

The Cabinet seems to have refurbished the previous healthcare policy, last drafted in 2002, by setting new deadlines to the old targets that were not achieved. A closer look at it would show less of a difference from the targets previously set by the Cabinet in 2002. Since it had failed to meet that deadline of reducing infant mortality rate (IMR) to 30 per 1000 children by 2010, the new goal is now to reduce IMR to 28 per 1000 children by 2019. Similarly, the government had committed to eradicate Leprosy, Kala Azar and Elephantiasis during 2005-2015 and now the new goal is set for the 2017-2018 period.

India accounts for one-fourth of all the maternal deaths worldwide, a disturbing statistics. Still, the latest policy’s approach toward this issue remains stagnated at reducing the maternal mortality rate to 100 per 100,000 deaths since 2010. The situation is worse for women living in villages, who do not have access to maternity clinics and rely on midwives.

Affordable healthcare for all? But how?

The policy aims at ensuring availability of 2 beds per 1,000 of the population; provide primary health care through the Health and Wellness Centers. It also proposes to provide free drugs, diagnostics, and free emergency and essential healthcare services in all public hospitals. While all this looks good on paper, turning it into a success remains a distant dream as most of the healthcare centres functions largely on paper. Adding to this is the paucity of an adequate number of doctors and nurses. According to Deloitte’s Healthcare Outlook Report 2015, India has a ratio of 0.7 doctors and 1.5 nurses per 1,000 people compared with the WHO average of 2.5 doctors and nurses per 1,000 people. Our neighbours China and Sri Lanka fare better than India in terms of health infrastructures. Shortfalls in the primary healthcare centres and sub-centres have increased over the past five years due to a rise in population. No new facilities were constructed in Jharkhand, Maharashtra, Uttar Pradesh and West Bengal during the full year 2013-2014, despite significant shortfalls at all levels.

Although the policy makes great claims, the roadmap seems abstruse, for example this holistic policy does not state how it will deliver the services in remote villages were even availability of ambulance is akin to none. While it focuses on Primary health care and AYUSH, there has been no mention of improvising of Family planning schemes.

Beyond the numbers

Looking closely at these numbers raises troubling questions about the government’s role in promoting an inclusive healthcare through promoting certain models. With the paltry sum set aside for healthcare spending and collapsing public services even in urban areas, the poor population of our country remains the most hard-hit from this situation. This is because the burgeoning private sector becomes more expensive and less accountable. And an increasing dependence on this sector entails bankruptcy for poor people, hastened by the lack of basic healthcare facilities in the rural areas and villages.