Pharma companies influence policy, says former health secy

Tell us about your book?

My first book is essentially about how we neglect health in India. Development is not just a question of GDP and coal, but also of enhanced human capacity and capability building, which can only come through focus on health, education, and nutrition. Sanitation was never in the picture until our Prime Minister began talking about Swachh Bharat Abhiyan. I have tried to analyse and document India’s experiences in the health sector. We are one of the 15 countries that spends less than 1 per cent of its GDP on health. Our development dialogue has not been very encouraging. Our governance and financing of health has been so poor. And in spite of our neglectful attitude we have had big success stories.

What do you think about India’s current health model?

We have no model at the moment. There is no vision, we don’t know where we want to go. India is confused whether it should follow in the foot steps of the US with privatisation or socialised healthcare where the government bears all costs. Each model had its own benefits and drawbacks. We need a health system specially fashioned to India’s socio-cultural conditions. Given the disparities in our country, the state cannot remit its responsibilities. We need more funding and attention.

What do you feel about centralisation of health schemes?

The problem with the health sector is that the Centre started getting into nitty gritties like how much to pay an ASHA (Accredited Social Health Activist), something that should be left to the states to decide based on the prevalent socio-economic conditions in each. We don’t pay attention to outcomes. The project was centralised, and the states were not allowed enough room to make their own policies based on their disease profile. What we need is a national vision that states need to be bound to ensure that no citizen is denied basics like water, sanitation etc.

What do you think is the based way to approach healthcare in India?

We need a top-down approach. You have to engage with communities, and we need social audits. The NACO (National AIDS Control Organisation) is a good example that shows how a programme can become strong. We need to talk to the patient. Lack of conversation is why we are not able to tackle many diseases despite resources.

How much do pharma companies and private players influence public policy?

Quite a bit. It’s a political economy. For example, vaccinations; more often than not it is the vaccine manufacturing company that would influence the doctrine on this policy. In the US, bringing a vaccine into the public health programme could take three to four years, with a huge amount of public interaction. Pharma companies influence many of these decisions. The process of policy making needs to be more rigorous and transparent.

How much of a say do bureaucrats have?

Despite all the constraints there is a lot of room for the bureaucrats to manoeuvre at all levels. We can make a difference in policy making by being just more open. In the health sector, we are not as open as we must be.