Budget Track

You would have heard the simple yet sound adage that “Health is Wealth” and also agreed wholeheartedly. It seems, however, that the Indian government continues to ignore the intrinsic merit behind this statement as is revealed by the continued indifference towards provisioning adequately for the health sector. Recently, the Prime Minister in his IndependenceDay speech said that the 12th Plan would be a health plan just as the 11th Plan was an education plan. If the way the Union government has side-stepped provisioning of ‘universal’,’quality’ and ‘free’ education to all is any indication to go by, it is with some scepticism that one would consider this proposal of the 12th Plan being a plan focused on health! There has been a proliferation of private players in the education sector and the 11th Plan has clearly veered towards a more active role for the private sector in its multiple avatars. In India, private out-ofpocket spending in healthcare is already sky-rocketing. Given this situation, a clearly-defined legislation that outlines provision of universal quality and free healthcare to all is the need of the hour.

In this regard, Jan Swasthya Abhiyan (JSA) - the Indian chapter of the global People’s Health Movement - has been leading this demand. In 2004, in collaboration with National Human Rights Commission (NHRC), JSA had organised several public hearings across the country on right to healthcare, the findings of which culminated in a set of detailed recommendations by NHRC to the Union government. One of these recommendations was to enact a national law for recognising and operationalizing the right to healthcare in India. In January 2008, the Ministry of Health and Family Welfare initiated drafting a National Health Bill that has been in the public domain as the Draft National Health Bill 2009. However, critical gaps remain in the draft legislation. This issue of Budget Track focuses on some of the key concerns with regard to the draft legislation and other critical issues pertaining to people’s right to health.

To begin with, Imrana Qadeer outlines the social context of the National Health Bill 2009 by bringing into focus the onset of privatisation and destruction of public institutions by the adoption of a ‘bio-medical’ approach. Ravi Duggal then takes us through the political economy of healthcare financing in the country by tracing the move from Jajmani system to commodification of healthcare. He also charts the five steps to re-structuring the existing system to align healthcare in a rights-based approach. Abhijit Das and Moumita Ghosh follow this with examining how far the country is from achieving universal health coverage. In this regard, they present an overview of the Thailand model of universal health coverage or the commonlyknown ‘30 baht’ scheme. Indranil picks up this thread of universal health coverage and deconstructs the focus on coverage rather than provisioning. In this regard, he reviews insurance mechanisms versus tax-financed options to public provisioning for healthcare and also examines the Thailand experiment in considerable detail.

Another key ingredient to ensuring universal healthcare is access to essential medicines.  Narendra Gupta highlights how this seems a far-fetched thought when 65 percent of the Indians do not have access to essential medicines. He also provides a ballpark estimate of how much the government needs to spend to make access to essential medicines a reality. Moving on, Jashodhara Dasgupta shifts the focus on a vital aspect that needs sustained attention of policymakers, i.e. public provisioning for maternal health. She reviews the present government provisioning for maternal health and comments on Janani SurakshaYojana as the sole vehicle to reduce maternal mortality and also flags some concerns relating to quality of expenditure. Biraj Swain then directs our attention to the foot soldiers delivering healthcare to all – the doctors –and the need to regulate their service conditions to ensure that the legislation (when it is enacted) is adequately bolstered with clear guidelines on the dos and don’ts for private practitioners.

The usual Budget and Policy Tracking piece presents an overview of the Union Budget 2011-12 and summarises the discussion in Parliament during Budget session before highlighting some of the key policy debates.

We do hope you enjoy reading this issue as much as we did in putting it together!