People's Democracy

             Ill Health Of The Health Sector Under The NDA Rule

Indranil Mukherjee

THE NDA rule has been marked by sharp cutbacks in capital expenditure on social sectors, the health sector being particularly affected. Despite the fact that India is among those countries, which hopelessly lag behind most others with regard to human development, the government claims that it has made considerable progress in health care. The health ministry has claimed that prices of essential drugs have come down and have announced its intention of creating more centres of excellence in the line of AIIMS in several states. However, hidden behind these claims and declarations of intent, are the grave realities of Indian health care system, where millions have little or no access to basic health care facilities.

INDIA’S LOW HDI RANK

While the NDA government has been suffering from a hallucination of late that India is poised to become a developed country within the next two decades, its health indicators compared to other developing countries bring out the true picture. The Human Development Report 2003 ranked India 127 out of a total of 175 countries. India’s Human Development Index (HDI) rank was 124 in 2002 and 115 in 2001. Thus the celebration of a ‘Shining India’ is taking place at a time when we have been gradually sliding behind other countries in terms of basic indicators of development. If we compare India’s performance with some selected developing countries in terms of some basic social sector indicators, our backwardness appear starkly.

TABLE 1

HD Indicators Some Selected Developing Countries

                        Source: Human Development Report 2003

The pathetic state of affairs as far as life expectancy, infant or maternal mortality and people’s accessibility to drugs are concerned, as brought out by the above Table 1 is easily explained by the Figure 1 which shows that India lags behind all the other countries mentioned above in terms of both public health expenditure as a proportion of GDP as well as per capita health expenditure. 

                                                  Figure 1

HD Indicators Some Selectors Developing Countries

Source: Human Development Report 2003

The proportion of public expenditure on health to GDP in India is only 0.9 per cent of GDP while the average public spending of Less Developed Countries is 2.8 per cent of GDP. Only 17 per cent of all health expenditure in India is borne by the government, the rest being borne privately by the people, making it one of the most highly privatised healthcare system of the world.

DWINDLING PUBLIC EXPENDITURE

Many people die of communicable diseases in India and the resurgence of some like Malaria and Tuberculosis have also been observed in the recent past. However, the allocations in the Health Budget for combating major communicable diseases have gone down during the NDA rule (AIDS being the only exception). Among the major communicable diseases, allocation for the control of Malaria as a proportion of total expenditure on combating communicable diseases has gone down from 16.34 per cent in 1998-99 to 7.22 per cent in 2003-04; in case of TB it has fallen from 7 per cent to 4.37 per cent in the same period.

                                              Figure 2

            Expenditure Budget: 1998-2003

While the government is keen on advertising its pious intentions of creating AIIMS like centres of excellence across the country, expenditure budgets show that capital expenditure in the health budgets of the Central government actually declined from Rs 45.09 crore in 1996-97 to only Rs 7.3 crore in 2001-02.

GROWING INEQUALITIES 

Infant mortality rate (IMR) remains at 70 per 1000 births in India. In the poorest 20 per cent of the population the IMR is 2.5 times higher than that in the richest 20 per cent of the population. The figures are even higher at 83 for SCs and 84.22 for STs. The ratio of hospital beds to population in rural area is 15 times lower than that of the urban areas and spending on public health is 7 times lower in rural areas. The ratio of doctors to population in rural areas is 16 times lower than availability of doctors in urban areas.

The worsening of the child sex ratio in the country from 945 in 1991 to 927 as revealed by the Census 2001, points to the growing incidence of female foeticide and infanticide in the country. It is ironical that some of the more prosperous states of India like Punjab, Haryana, Gujarat and Delhi have registered the sharpest fall in the child sex ratio between 1991 and 2001.

TABLE 2

Sex Ratio In Some Selected States

                            Source: Census 2001 and UNFPA

NATIONAL HEALTH POLICY 2002

The National Health Policy (NHP), which was announced by the NDA government in 2002, had abandoned the concept of “comprehensive and universal health care”, which India was committed to as a signatory to the Alma-Ata Declaration on Primary Health Care of 1978. While remaining silent on the need to review the ill-conceived population control programme, which has proved to be a massive failure causing a huge drain on primary health care, the NHP 2002 instead argues for the virtual dismantling of the latter. The NHP also remains silent on drug prices and manufacturing with the ministry of industries taking over the decisions about Drug Policy. Glossing over the burning issues concerning basic healthcare, the NHP instead argues for greater privatisation — privatisation of existing public hospitals, creating new private hospitals and subcontracting public health to NGOs, besides emphasising on the creation of health facilities to attract foreign exchange and promoting health tourism. The National Health Policy document actually exposes the insensitivity of the NDA government towards the dire need to strengthen and expand the public health system in India and its lop sided priorities in promoting health tourism while millions of Indians die of preventable communicable diseases.

DRUG PRICES

The NDA government’s claim of bringing down drug prices is indeed a shameless one. The fact of the matter is that the pharmaceutical industry has been deregulated to a great extent, the number of drugs under price control coming down steadily over the years and stood at 73 in 2003. The Drug Policy announced by the NDA government in 2002 recommends that the number of drugs under price control be further reduced to 25.

TABLE 3

Number of Drugs under Price Control

As a result of the policies of decontrol, prices of drugs have increased several times, many drugs being sold at 200 to 500 per cent profit margins, with only 20 per cent of the population having an access to all essential drugs they require (Policy Brief, National Coordination Committee for Jana Swasthya Sabha, 2004). Prices of many commonly used antibiotics, anti-diabetics and analgesics have increased substantially. A study by Wishvas Rane (‘Have Drug Prices Fallen?’, published in EPW, 1-7 November 2003) show that out of the 253 formulations (sold by the 73 top selling brands in 2000), 169 (67 per cent) show a price rise, while only 49 (19 per cent) show a price declines. In case of   35 (14 per cent) there has been on a changed in prices.

CONCLUSION

The National Health Policy coupled with the Drug Policy announced in 2002 by the NDA government aims at greater privatisation and market domination in the health sector. These policies also aim at dismantling the existent public facilities even when the experiences worldwide show that development in healthcare can only come about through enhanced public investment. The NDA rule has not only failed to improve the health situation in India, it has actually adopted a course which is leading to a reversal of the gains that were registered in the post independence era.