The health agenda
Political parties must do more than just pay lip service to universal healthcare in their election manifestos.
V R Murlidharan
The governance of the public health sector has become more complex than we imagine. To improve overall health, the sector will have to coordinate and collaborate with other sectors, nationally and regionally, and with several stakeholders. There is no sector that does not have an impact (positive or negative) on public health.
What is to be done? Traditionally, policymakers assumed that the achievements of the public health sector should be measured in terms of increase in life expectancy. But the sector per se can, at best, contribute only to a limited extent in improving life expectancy. Much depends on policies and programmatic interventions in other sectors of the economy, including nutrition, water, housing, transportation, energy, employment, pollution (in both industry and agriculture), transportation, etc. We have made considerable progress towards health-related Millennium Development Goals over the past decade, but are woefully behind (in terms of health indicators and public spending on healthcare) compared to some neighbouring countries and those at a similar stage of economic development.
Such a perspective is important while designing effective policies and programmatic interventions in public health. Election manifestos mean nothing unless there is an underlying perspective of health. “What must governments do?” in programmatic terms should (and will) flow only from such broad underlying perspectives. So, what must political parties commit themselves to?
One, they must address sub-regional inequity in health status and access to healthcare. Irrespective of the state from where an MP is elected, she must dedicate limited resources to reduce intra-state and -district inequities in access to public healthcare facilities. There is evidence to show that inequity exerts perhaps the most detrimental influence on the overall health of a population. Even economically advanced states and districts exhibit an unacceptable level of variation in health and the presence of public healthcare facilities.
Two, they must spend scarce resources more “effectively”. This means, as in many countries, substantial resources (at least 35 per cent of the state budget for health and family welfare) should be allocated for primary healthcare services, beefing up primary health centres (PHCs) and health sub-centres (HSCs) and taluk-level facilities. While there is a definite case to double or triple budget allocations, we need to begin with only a modest increase. The government must ensure this is done. Politically, every government says so, but it must be shown in practice. A cursory glance at the budgets of various states and the Centre will show how slow their response has been in the past.
Three, double the continued…