[Overall, in the first year of the Modi Government, India might have taken a few steps back in public health after having previously made a commitment to public sector-led universal health care.]
http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)60977-1.pdf India's BJP Government and health: 1 year on 1 year after the Bharatiya Janata Party Government was elected, public health experts say that it is not advancing health in India. Dinesh C Sharma reports from New Delhi. For the report by the Parliamentary Standing Committee on Health see http://164.100.47.5/ newcommittee/reports/ EnglishCommittees/ Committee%20on%20 Health%20and%20Family%20 Welfare/83.pdf In May, 2014, the right wing Bharatiya Janata Party (BJP) led by Narendra Modi won a decisive mandate to rule India for 5 years. The party promised to propel India on a trajectory of development and economic growth for all, placing high priority on reforms in diff erent sectors, including health. The overarching goal of health care, as stated in the party's election manifesto, is to provide "health assurance to all Indians and to reduce the out-of-pocket spending on health care" with the help of state governments. In addition, the party promised to focus on key determinants of health--sanitation and drinking water--to reduce water-borne diseases. The first initiative to translate these promises into reality came in October, 2014, in the form of a national campaign to end open defecation by 2019. The second initiative was the New Health Policy (NHP) unveiled in January, 2015. It does not commit to any increase in public spending on health--currently hovering around 1·2% of gross domestic product (GDP)-- but emphasises sourcing of care from the private sector. The annual budget for 2015-16 presented in parliament earlier this year, reinforced the government's new thinking by slashing central government's health spending by 15% compared with last year. The pretext was greater devolution of tax revenues to states as recommended by the Fourteenth Finance Commission, and hope that states will spend more on health. Public spending on health in India is shared by the central government and 29 states. The primary and secondary health system is funded and operated by the states, and central government funds population control, nutrition, medical education, and programmes on communicable and non-communicable diseases. The policies of the Modi Government mark a clear shift from those pur sued by the United Progressive Alliance (UPA), which was in power for two terms from May, 2004, to May, 2014. With a goal of providing "accessible, equitable and affordable healthcare", the UPA provided more funds to states to improve health indicators such as child and maternal mortality and to boost capacity of the government health system under the National Rural Health Mission (NRHM). UPA had also committed itself to universal health coverage (UHC). Subsequently, NRHM was subsumed in an umbrella initiative called National Health Mission (NHM). *"The annual budget for 2015-16 presented in parliament earlier this year, reinforced the government's new thinking by slashing central government's health spending by 15% compared with last year."* Underfunding concerns The lack of support displayed by the Modi Government for a publicly funded health sector has raised fears that health programmes will be severely underfunded. NHM, under which central government provides funds to states for reproductive, maternal, newborn, child, and adolescent health programmes, has received almost a quarter less money for 2015-16 than last year. It supports a network of about 1 million community health workers known as accredited social health activists. Reduced funding for health in the annual budget comes on top of reductions in allocations to the health ministry in November, 2014, as a part of overall fiscal management. "This [cut in health spending] is appalling and unjustifiable since it will be associated with continued stagnation and even deterioration of health indicators in a country where inadequate public health is already a huge problem, and out-of-pocket spending even by the poor is one of the highest in the world, contributing signifi cantly to poverty risks", remarked Jayati Ghosh, professor of economics at the Jawaharlal Nehru University in New Delhi. "Both--the direction of NHP and the budget cuts--run contrary to basic tenets of public health. The NHP does not provide a clear road map for strengthening of public health services or public funding for creation of health human resources, while the budget has slashed fi nancing for public health and incentivised private health insurance", pointed out Amit Sengupta, associate coordinator of the People's Health Movement in New Delhi. Experts don't share the govern ment's optimism that more funds will be at the disposal of states under a new tax sharing formula or that states will spend more on health. "The most generous estimate gives states an additional 0·7% of GDP in terms of tax receipts, while some states will actually lose out. Other estimates suggest the net 'benefi t' may be even more marginal and close to zero", explained Ghosh. Even if more funds become available to states, it is doubtful if health will get due priority. "While giving a greater share of taxes to states may seem like strengthening state autonomy, we have seen that historically states with the poorest health indicators invest the least in health. This trend will not reverse without any explicit directions or guidance from the central government", said Abhijit Das, director of the Centre for Health and Social Justice in New Delhi. The performance of states in care delivery and their capacity to absorb additional funds varies, as refl ected in wide disparities in outcomes. In several states, front-line health workers have not been paid salaries for months and vacancies for doctors have not been filled. "Devolving a greater share of revenues to states does not necessarily translate into better health care in states. Public provision of health care by several states suffers from abysmal levels of quality. Access to quality primary health care is lacking in several villages. In such a situation, the central government should boost health funding and work to achieve UHC", suggests Rijo M John, assistant professor at the Indian Institute of Technology in Jodhpur. Eff ect on key programmes As many as 15 of the health ministry's national programmes, including tobacco control, mental health, prevention of blindness, trauma care, elderly care, and human resource development have not been allocated a single rupee, and have been merged with NHM, which has also had its funding curtailed. "Starving these schemes of budgetary support may have catastrophic implications for expansion of tertiary care facilities and equitable distribution of tertiary care", cautioned a report of the Parliamentary Standing Committee on Health presented on April 24. Tobacco control initiatives suffered a setback with the removal of Harsh Vardhan, a physician and health activist, as health minister in November, 2015. Pro-tobacco lobbies succeeded in postponing implementation of larger health warnings on tobacco packaging from April 1, 2015 *"As many as 15 of the health ministry's national programmes, including tobacco control, mental health, prevention of blindness, trauma care, elderly care, and human resource development have not been allocated a single rupee..."* Health-related schemes operated by other ministries are also facing the axe. The Integrated Child Development Scheme (ICDS) run by the Ministry of Women and Child Development has got just half of the funding allocation it had last year. "Such hefty decrease in budget means initiatives like a new nutrition mission, strengthening of ICDS, and expansion of benefits for lactating mothers may have to be shelved or postponed", said J P Dadhich, national coordinator of the Breastfeeding Promotion Network of India. "It appears India needs to wait for some more years before witnessing a signifi cant decline in child undernutrition." The National AIDS Control Programme (NACP), which succeeded in helping to keep overall prevalence of HIV below 1% with prevention strategies, also faces a shortage of funds. "It may have an adverse impact on key priorities of NACP and hinder scale-up of interventions in hitherto untouched areas", the Parliamentary Standing Committee on Health noted, while pointing out that some low prevalence states like Assam, Chandigarh, Delhi, and Jharkhand have had increases in the number of new infections. Focus on sanitation In his public speeches, Prime Minister Modi has focused on the importance of sanitation as a precursor to good health. "You construct one hospital and brag about it. I can guarantee health by constructing a toilet. Hospitals can wait. We will construct hospitals too, more than what previous governments did. But try to understand why I am focusing on sanitation", Modi remarked while speaking to his party's MPs on April 19, apparently referring to criticism of his government's policies. Elsewhere, he has advocated yoga and Indian systems of traditional medicine such as Ayurveda for holistic wellbeing. Experts, however, doubt if the construction of toilets alone is suffi cient to ensure better health. "In order to achieve health gains from sanitation, it is essential to put resources into eff ective behaviour change strategies, so that latrines are used correctly and consistently by all", said Thomas Clasen, professor of environmental health at Emory University, GA, USA, who led a study on effectiveness of rural sanitation in addressing diarrhoea and child malnutrition in India. "Our research has shown that many households with latrines are not using them. This is particularly true for men and children and for the disposal of child faeces. Poor use leads to continued exposure to faecal pathogens that will prevent health gains associated with eff ective sanitation." ***Overall, in the fi rst year of the Modi Government, India might have taken a few steps back in public health after having previously made a commitment to public sector-led universal health care.*** [Emphasis added.] -- Peace Is Doable -- You received this message because you are subscribed to the Google Groups "Green Youth Movement" group. To unsubscribe from this group and stop receiving emails from it, send an email to [email protected]. To post to this group, send an email to [email protected]. Visit this group at http://groups.google.com/group/greenyouth. For more options, visit https://groups.google.com/d/optout.
