Lok Sabha Election 2019: Manifestos yet to raise toast to health

Less than a week away from the first phase of the Lok Sabha polls, the general public is still in a fix which political party to trust when it comes to good healthcare. Despite the health challenges the country face, healthcare has been fairly neglected as India is one of the countries with the lowest GDP share to healthcare.

While Congress president Rahul Gandhi has announced 'Right to Healthcare' if his party comes to power, the BJP's flagship scheme – Ayushman Bharat – made to the news for benefitting over 18 lakh people in the country since February 2018.

While Congress has announced raising the GDP share to healthcare to 3%, the healthcare professionals say it will still not be enough.

PRIORITISE IT: IMA

To highlight the need for better healthcare, many public healthcare professionals have been releasing their own health manifestos and asking the political parties to focus on the issues highlighted.

For instance, Indian Medical Association (IMA), an organisation of over 3 lakh doctors in the country, released its health manifesto on March 17 and handed it over to the parties asking them to prioritise healthcare and give suggestions on areas that require urgent government attention. It also offered its services as a think tank group to the government at both national and state level.

The association has demanded an increase in the GDP share in healthcare from 1.2 to 5%; prioritising primary and preventive health, social determinants of health, medical education and research for fund distribution. "After exhaustive deliberations with multiple stakeholders, IMA has prepared a document of health issues which need urgent attention of the government and political parties, including universal health coverage through government funding and increased public expenditure in healthcare," stated the manifesto.

"The issue of shortage of MBBS doctors in rural, tribal, and hilly areas can be addressed through incentive-based approach with improved administration and infrastructure. Also, one drug, one price policy should be followed; i.e. the government should regulate the price and quality of drugs, implants, equipment, and consumables," it said.

Similarly, Jan Swasthya Abhiyan, the Indian regional circle of the global people's health movement formed by health professionals, released its manifesto in February focusing on the government's Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (PMJAY).

The manifesto demands increase in public expenditure on health to 3.5% of the GDP in the short-term and absorbing the Ayushman Bharat health insurance scheme — based on the discredited 'insurance model' — under a strengthened, well-funded public health system and a right to health Act which includes a patients' charter.

The insurance programme was announced by the current BJP government in the 2018 budget and received a big chunk of allocation (Rs 6,400 crore) in this year's budget. Also referred to as Modicare, PMJAY offers 500 million Indians a health insurance cover of Rs five lakh completely free of cost.

ISSUES PEOPLE FACE

India, at 1.3% of GDP, is among the countries with the lowest health expenditure in the world, despite facing severe health challenges. India maintains a 174 maternal mortality ratio per one lakh births and accounts for only 17% of global maternal deaths with a 4.7% of the annual rate of reduction between 2005 and 2015. 21% of deaths among children below five and 29% of newborn deaths. More than a third of India's children are stunted. The number of children who suffer wasting, an indication of acute starvation, has risen in recent years to near 21%.

India is also seeing a high surge in the number of cases in non-communicable diseases, with 63% of NCDs amounting to deaths in the country. Of these, 27% are cardiovascular deaths, 9% due to cancer, and 11% due to chronic respiratory cases. There is a 16% suicide mortality rate in the country, thus facing a mental health crisis.

AYUSHMAN BHARAT

Ayushman Bharat Yojana or the Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018 with an aim to help the poorest 40% of the population afford quality secondary and tertiary care. In one year, and under 150 days of inception, the scheme managed to cross 18 lakh hospital admissions (by April 6, 2019).

Under, what was called an ambitious scheme, an annual health cover of Rs 5 lakh, a straight increase from the earlier Rs 30,000, to a vulnerable family for secondary and tertiary care, hospitalisation is being provided along with cashless access to services at the point of service. Every year, six crore people are pushed below the poverty line due to catastrophic expenditure for hospitalisations. The scheme intends to help mitigate this financial risk.

The scheme has, till April 6, provided treatment worth Rs 1,865.0 crore to more than 18 lakh beneficiaries across the country, reveals official data. Claims worth Rs 1,865 crore have been submitted till Saturday, and of these Rs 1,354 crore has been approved. Another Rs 2,529 crore has been authorised for hospital admissions.

But doctors of Patna Medical College & Hospital, the largest state-run hospital in Bihar say state needs to cover a lot of ground in healthcare infra for the scheme to be a success. "Most of the cases which are presently coming under PMJAY pertain to delivery and that is because the public hospitals impanelled in the districts hardly have any infrastructure for advanced services," said a senior doctor.

"Govt needs to work on 4-As of universal health coverage -- making healthcare Available, Accessible, Affordable and Acceptable. We have less than one-bed per 1000 against the requirement of 3.5. The govt can give visible incentives to the private sector to open new hospitals in tier-3 cities. PMJAY, if implemented properly, will make healthcare affordable. The govt has to incentivise quality and patient safety to make healthcare acceptable," said Dr Girdhar Gyani, Director General, Association of Healthcare Providers.