bio: Shrinivas Dharmadhikari is a management consultant by profession with keen interest in global businesses, geo-politics, social equity and secularism.
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Odisha TV journalist Ajit Singh has tormented sensitive India’s conscience by the Kodak moment of Dana Manjhi, an Orissa tribal carrying the dead body of his wife on his shoulder with his 12-year-old sobbing daughter in toe. “All the money I had was spent on medicines, and the hospital declined to help," said Dana Manjhi. A picture is worth a thousand words, so said a wise man. But in this case, it speaks volumes of our insensitive ruling class and its continued neglect of the public health sector.
The endemic indifference of various governments since independence towards our public health sectors is the well-known fact in intellectual circles. According to sociologist and demographer, Monica Das Gupta of the University of Maryland, the reasons for the neglect are more political. Achievements in preventive public health are uneventful and hence electorally less rewarding. No wonder, the expenditure on public health has always been equal to or below 1 per cent of GDP as against the United Nation’s millennium development goal of 2.5 per cent which all nations including India have signed.
During the last two and half decades, the neo-liberal economic policy regime, packaged as the compulsions of globalization provided a new vigour and vocabulary to the systematic throttling of funding to important social sectors like public health and primary education. Balancing budgets by cutting social sector expenditure, pricing social goods for full cost recovery and fiscal discipline became the new buzz words consigning the erstwhile concepts of public welfare and distributive justice to the dustbin. During the first reform year in 1992-93, the Congress-led UPA government slashed the health sector expenditure by around 40 per cent. As a result, today, a child born in Nepal or Bangladesh has a better chance at survival than India. In case of the major human development indicators, we fall behind many least developed countries (LDCs). The sustained and targeted starving of funds has dilapidated the already crumbling public health infrastructure. Whatever little left is being vandalized or traded for personal gains by operating level bureaucracy. In 2004-05, scholars estimated that the per capita public spending on health was Rs 242, while private spending was almost four times at Rs 959. Another study indicates that only about 20 per cent of outpatients and less than 40 per cent of in-patients are treated by public facilities. The rest are at the mercy of often unscrupulous and expensive private providers
The present BJP-led government came to power with among other things on a promise of “health assurance to all Indians and reducing the out-of-pocket spending on health care” (directly quoted from the BJP election manifesto). However, in the first full year budget, the government slashed expenditure on health sector by 15 per cent, filled only 19 per cent of specialist vacancies at the rural specialist centres and constructed only half the number of PHCs and CHCs as compared to the previous fiscal year. Dr Jayanti Ghosh, the renowned professor of economics at the Jawaharlal Nehru University in New Delhi, has the following to say: "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 significantly to poverty risks.”
Having committed the nation to the neo-liberal policy compact, both Congress and BJP are now orchestrating a grand scale deception on the average Indian. Because, "If you invite a bear to dance, it's not you who decides when the dance is over. It's the bear.” So is the case of globalization and neo-liberal policies our governments are wedded to since 1991. As a consequence, the only way to retain hold over power is by pulling wool over people's eyes. The cardinal principle of democracy that “it requires accountability and consent of the governed, which is only possible if citizens know what is being done in their name” is long lost. Instead, what takes precedence is the nationalistic jingoism of superpower status and a seat in UN Security council.
In this background, the visceral disdain of established political class, cohort of crony capitalists and urban elites towards Aam Aadmi Party becomes clear as daylight. AAP is the only political party which treats itself accountable for its manifesto and puts it into workable plans. The Delhi government has allocated nearly ten times more budget for public health than what the BJP government at the Centre has done.
AAP’s well-designed public health programme involves a three-tier caregiver system which begins with a modern, adequately staffed and stocked clinical set up conceived and constructed within a reasonable budget. These mohalla clinics together with 100 well-located polyclinics will attend to the most frequent preventive medical needs and thereby decongest the hospitals making it efficient caregiving centres for advanced medical needs. Unlike present state government dispensaries, these mohalla clinics are an open system capable of using local community resources available on voluntary basis. This will add element of extra expertise and sense of dedication in the service delivery.
The mohalla clinic is a project in making. It may go through iterations and innovations before a viable format is evolved and stabilized. What is more heartening is that perhaps for the first time something is being done in right earnest keeping the common man as the focus. I urge other regional parties with moral compass intact to take a leaf out of AAP's book and come up with models appropriate for their socio-economic conditions in states where they are in power. Let us nurture a culture where the welfare of that “last man in the queue” is all that matters for electoral success and not the size of expenditure at hustings.
“Into that heaven of freedom, my father, let my country awake.”
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