General Elections 2024: Political parties need to prioritise healthcare in poll manifesto – ET HealthWorld



New Delhi: As the world’s largest democracy gears up for the 18th Lok Sabha election, the political parties mulling over the election manifesto are drawing up strategies to address healthcare issues. As per the National Health Profile (NHP) 2021, government hospitals have only 21 per cent and 35 per cent of the required beds in rural and urban areas, respectively. With gaping gaps in public health infrastructure, it is clear that healthcare needs to be taken as a priority issue, which is always taking a backseat. Against a requirement of more than one lakh public health centres (PHCs) in urban areas, it is just 9245 in urban areas, which has a 91 per cent shortage. After 76 years of independence, Indian citizens still succumb to preventable diseases, delay their health needs due to a lack of funds, or are driven into deeper pauperisation, exposing the seriousness of why healthcare needs to be prioritised by political parties. All political parties, be it the ruling party or the opposition, that are contesting the elections are trying to garner votes by painting a rosy picture or mocking the policy measures undertaken by political rival governments. The factual status of health showcases the stark truth that nothing much has changed when it comes to the health status of the country. A fact sheet released by the Jan Swasthya Abhiyan (JSA), NGO stated that more than a fifth of under-five deaths per year take place in India, the highest anywhere in the world, and the majority of deaths are preventable. As per NFHS 5, only around 58 per cent of pregnant women receive at least four ANC visits (NFHS 5). One-fourth of the children aged 12-23 months do not receive full vaccination.As per the World Health Statistics (WHS), every year around 145 mothers die while giving birth per lakh population, whereas in Sri Lanka 36, in China 29, and in Thailand only 37 mothers die. According to the World Health Organisation (WHO), an average person born in India is likely to live four years less than their Bangladeshi counterpart, seven years less compared to a Thai, five years less compared to a Sri Lankan, and seven years less compared to a Chinese person. As for tuberculosis (TB), the number of notified TB cases is increasing in India. In the year 2021, there were 2402291 notified cases, which is 23 per cent of the total global burden of TB
Our country also fares badly in terms of out-of-pocket expenditure. More than half the money spent on health comes from patients and their families. In this context, JSA’s manifesto makes concrete policy proposals that will improve access to free and quality healthcare for all. JSA has proposed an 18-point people’s health manifesto in the run-up to General Elections 2024, urging all the political parties and independents in the election fray to commit to incorporating them in their election manifesto. This comprehensive document by the NGO urges that over 80 crore people of this country, who today depend on free rations, also require protection for their health-related vulnerabilities. Despite the COVID experience, people’s health remains a very low priority for the Union government.

“Increasing commercialisation and a decrease in the government’s role have placed quality healthcare out of reach of the majority of Indians. Although the pandemic underlined the outstanding need for stronger public health systems, the Union government’s spending on health remains dismal. It continues to restrict funds, along with neglecting the National Health Mission (NHM), while eroding federalism and imposing hyper-centralised decision-making. Refusal to regulate profiteering by the commercialised private healthcare sector, accelerated privatisation of health services, and failures of the much-hyped PMJAY health insurance scheme have further worsened the situation, leaving the vast majority of the population, especially marginalised communities at risk,” the NGO stated.

The NGO has proposed a few key policies concerning the right to health and healthcare, viz, legislation called Our Health, Our Right to be passed, which will ensure guaranteed availability of free quality treatment for all conditions, close to the place of residence. Denial, delay, and incomplete treatment are to be strictly prevented. Increase budgetary allocation for health to 3.5 per cent of GDP, with one per cent of GDP coming from the centre. States to get special financial envelopes for raised health expenditures.

The proposal also touched upon the out-of-pocket (OOP) spending on health to be reduced by 25 per cent of total health expenditure. As for health workers, the NGO urged that no public health establishment should engage contractual staff, pitched to regularise all scheme-based and contractual health workers. Ensure adequate wages and protection under labour laws. Devolve administrative and financial powers to local bodies and state governments to enable them to conceptualise and manage health systems in their jurisdictions, with support from national and regional bodies.

Expand and strengthen the public healthcare system to ensure the free availability of quality healthcare at all levels, including the entire range of medicines, diagnostics and vaccines. Ensure availability of affordable and quality essential drugs and diagnostics – Implement effective and rational price control; return to cost-based pricing. Ensure the availability of medicines as per the NLEM 2022, and eliminate all irrational medicines and fixed-dose combinations (FDCs).

Informing that healthcare is primarily the government’s responsibility, the NGO proposal pointed to phasing out government-funded health insurance schemes such as PMJAY and public-private partnerships (PPPs). Regulate the private healthcare sector by ensuring the effective implementation of an improved Clinical Establishment Act. It was added that all states must ensure effective regulation of private healthcare while implementing the Patients Rights Charter, along with transparency and regulation of rates and grievance redressal systems for patients.

Seeking major reforms in medical education and the National Medical Council (NMC), the NGO pointed out that there is an urgent need to control commercialised private medical colleges while not sanctioning further such private colleges and mandating their fees to be no higher than those of government medical colleges. It also suggested that there is a need for an independent, multi-stakeholder review and reform of the structure and functioning of the NMC. Suggesting that there is a need to review and restructure the National Eligibility cum Entrance Test (NEET), which tends to place candidates from rural areas, those from non-English-medium schools, and less privileged backgrounds at a disadvantage.

“A pro-people pharmaceutical policy must be implemented, which would bring all essential medicines and devices under effective and rational price control. The comprehensive price control regime should restore cost-based pricing for all medicines, along with banning irrational drugs and combinations, regulating pharma marketing practices, and promoting generic medicine outlets. It is important to implement a comprehensive generic medicine policy that covers labelling as well as prescribing of all medicines,” the proposed manifesto stated.

The JSA people’s manifesto also touched upon free trade agreements, intellectual property rights (IPR) issues, monitoring of the online medicine trade, and effectively promoting fair-priced drug outlets. Urging to strengthen public pharmaceutical industries and public sector vaccine production units, while rolling back their privatisation. Reinstate funding for Open-Source Drug Discovery (OSDD) initiatives, promoting collaborative research for affordable and accessible medications. It is recommended to abolish the GST imposed on the sale of medicines, as part of the wider spectrum of measures required to ensure the affordability of medicines, which are essential life-saving drugs.

The manifesto also mentioned regulating the private healthcare sector and safeguarding patients’ rights. Effectively regulate the private healthcare sector by amending the Clinical Establishment Act 2010 to ensure patient rights, quality of care, transparency, and standardisation of rates. All states must ensure effective regulation of private healthcare while implementing the Patients Rights Charter, along with transparency and regulation of rates and grievance redressal systems for patients. A public-centred system for universal healthcare, ensuring a common system to provide healthcare for all residents of India, must be developed in the foreseeable future.

  • Published On Apr 2, 2024 at 11:42 AM IST

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