The Weekly Dose: Vote for Healthcare
I went through the manifestos of some major national and regional parties to ascertain where healthcare figures in their plans for the next five years.
Starting today, the world’s largest democracy votes in the world’s largest-ever election. In the last few days, Indian political parties have been playing a game of endurance: who can release their manifesto at the last possible minute and give voters the least possible time to make an informed choice? Some parties are yet to announce their poll promises; some have unveiled their manifestos in bombastic public functions but found it unnecessary to make them available online. I went through the manifestos of some major national and regional parties to ascertain where healthcare figures in their plans for the next five years.
Expenditure on Healthcare
Every party is having a fun time lobbing numbers into the air. If elected, the Congress intends to double spending on health to 3% of India’s GDP in the next three years. Tamil Nadu’s DMK echoed its election partner by saying it will ‘urge’ the Centre to allocate the same amount. West Bengal’s Trinamool Congress (TMC) has demanded this shoot up to 4.5% of the GDP, while its old foe the CPI(M) went further by demanding this be raised to 3.5% in the short-term, and 5% in the long-term, with the caveat that this ‘would include a significantly enhanced allocation from the Centre.’
The BJP has safely recused itself from putting its money where its mouth is and has merely ‘committed to leverage all resources to ensure that the out-of-pocket expenditure on health is reduced’.
The BJP’s flagship Ayushman Bharat program already provides a hospitalisation cover of up to five lakh rupees to each poor and vulnerable family, reducing out-of-pocket expenditure on healthcare - one of the leading causes of indebtedness. Turning the five lakh figure on its head, the TMC says that any family whose annual income is less than that should be entitled to an unspecified amount of insurance coverage.
The Congress is ‘of the firm belief that the insurance-based model cannot be the preferred model to provide universal healthcare in our country’, and would rather spend its money on free public hospital care instead. The CPI(M) wants to scrap the Ayushman Bharat scheme immediately and entirely, which it claims will reverse ‘the trend of privatisation of health care services and outsourcing of services’.
Reducing Health Expenses
Following its crackdown on spiralling prices of essential drugs, the BJP will create an ‘essential (medical) devices’ list, and a separate pricing policy for them, which will promote their affordability to the masses. If the Congress wins, all assistive and adaptive aids, appliances, and devices will be zero-rated under the GST regime.
The CPI(M)’s manifesto committee has clearly dedicated some time to this section; it promises to remove all taxes on 30 essential medicines and reduce excise duty on drugs by basing it on production cost instead of MRP. It also harps on its paranoia of privatisation by intending to ‘break the monopoly of drug multinationals in critical areas (commendable), reviving public sector pharmaceutical units to harness them for production of essential drugs and vaccines (good), and removing the US government’s drug law enforcing agency USFDA’s offices and officials from India (eh?).
Without exception, all parties believe they possess magical medical wands which they can wave and presto! – the vast gaps in India’s public health personnel will be filled. With supreme confidence, the Congress has declared it will ‘ensure that all vacancies at all levels in PHCs and in public hospitals are filled within a period of one year’. The BJP vows to increase the doctor-patient ratio to 1:1400, but makes no distinction between government and private doctors. The Biju Janata Dal – in power for 19 years and facing simultaneous centre/state elections – will somehow make Odisha a doctor-surplus state.
It also intends to set up nursing and paramedical training schools in all 314 blocks of the state, and – commendably – promises to appoint new personnel on permanent, and not contract basis. All parties have recognised the need to increase the number of trained nurses, pharmacists, and health attendants.
The BJP claims it has ensured there is one medical college for every three parliamentary constituencies, and intends to ramp this ratio up to one for every district (including – unfortunately – private medical colleges). The CPI(M) wants public funding for such colleges in poorer, and north-eastern states.
The BJP should be lauded for its commitment to detecting disabilities among children earlier, at the aanganwadi and pre-school level. So should the Congress, for intending to establish a National Centre of Research and Excellence for Special Education to ensure that quality education is imparted to children with special needs.
The BJP will work towards tripling the number of child-care facilities and reduce malnutrition levels by at least 10%, while the Congress will spend more on the Mid-Day Meal program and include milk, eggs, and fresh produce instead of packaged foods. The Congress will also support municipalities and panchayats in installing sanitary napkin vending machines, and promises to implement the landmark Mental Healthcare Act, somehow producing and appointing qualified mental health professionals in every district hospital.
If you detected notes of cynicism in my analysis, you were right. Because, despite making all the right noises, I’m not sure any party will actually accord healthcare the pressing importance it deserves. Here’s why:
In the 55-page Congress document, healthcare shows up only on page 46. ‘Fisheries and Fisherfolk’ (with due respect to them), and ‘Perspective Planning and the New Planning Commission’ are deemed more important, and feature earlier. The BJP’s manifesto – so help me God – begins with the brand-new concept of ‘zero-tolerance approach to terrorism’, making one wonder if previous governments (including its own) have been cosseting terrorists with yoga retreats and surgical strike insurance. The Shiv Sena, its ally in a state with the second-highest number of medical colleges, is yet to publish its own manifesto and has contented itself with giving ‘200 out of 100’ marks to the BJP’s manifesto.
My favourite, though, is the Samajwadi Party. Seeking to come back to power in Uttar Pradesh – a state with some of the worst health indices in the country – it has allotted a grand total of no words to healthcare in its 16-page ‘vision document’. However, the sick, the aged and the marginalised need not fear for their lives; it has promised to build a playground in every village cluster and a stadium in every district, so everything will be fine.