On National Health Policies 1983 to 2002 and the Impact of Globalisation
Health of the people is the wealth of the nation. Pro-people scientific health and other necessary policies are the basic criteria to protect and enhance this wealth. This alone will not suffice. The feelings of those in power and their commitment to the people will determine the actual implementation. Let us examine our real situation. The attitude of the successive governments following independence to so vital a question as health clearly revealed itself in the fact that it took nearly 35 years just to propose the first draft policy in this regard in 1983. Let us now see what the policies say. The National Health Policy 1983 (N H P 1983) held the age-old imperialist policy responsible for the precarious situation of our national health as it had “ provided benefit to the upper crusts of the society”. Candid confessions and admission of failures of N H P 1983 have been made in N H P 2002 as if these and these alone absolve them of all responsibility. In the glaring absence of redeeming actions these are just some attempts to hide the reality. Is it not an attempt to induce a general acceptance that the road to privatisation is the only solution?
According to the 1983 policy, “irrespective of the changes, no matter how fundamental, that may be brought about in the overall approach to health care and the restructuring of health service, not much headway is likely to be achieved in improving the health status of the people unless success is achieved in securing the small family norm, through voluntary efforts and moving towards the goal of population stabilisation”. The National Health Policy (N H P) 2002 sings the same song: “Efforts made over years for improving health standards have been partially neutralised by the major growth of population” (2.28.1)
Not only in health, but also in case of all welfare responsibilities, governments both at the centre and states blame ‘population’ as the major cause of all their failures. But the prerequisites for building up the health standards of the people, which are historically the role of democratically elected governments, are yet to be fulfilled. There is ample scope of applying modern science to produce huge amounts of bulk drugs necessary for the treatment of the vast population. There are thousands of doctors and other health workers unemployed and unutilised while diseased millions are dying for lack of proper treatment. Can the growth of population be held responsible for all these ills, or does the cause lie elsewhere? Long ago the socialist countries buried the ‘Population Theory’ and showed that it was the systems of production and distribution that mattered most in this respect. They have proved that manpower is the most important resource of human civilization, for, without human labour, both physical and spiritual, the peak that civilisation has now ascended would have been impossible. And India must be proud of her vast human wealth and other natural resources, and a planned and proper combination of manpower and natural resources can make the country far more developed and powerful. Pro-people policies practiced in other highly populated countries under socialist systems as previously in China had brought remarkable social development.
The first policy ridicules the “poor eating habits of people” and blames it for malnutrition and ill health notwithstanding the fact that the vast section of people living below poverty line cannot even manage a square meal every day.
The Policy lays the blame on the “cure oriented approach” of the health care delivery system and condemns it in words. But its prescribed actions and fund allocations towards prevention result in naught. What is required is a proper blending of preventative and curative methods of treatment. The targets set for the attainment of “Health for All by 2000 AD” fell short of the actual requirements. Even these targets seemed to be merely an eyewash and too weak to pass even for a lie, since all intermediate targets can still be had by most of the population only in dreams. The government’s promises to provide immunisation to all children is still a far cry. Even such baseline promises to provide safe drinking water and sanitation to all citizens by the year 1990 under the International Drinking Water Supply and Sanitation Decade 1981-90 still remain a far cry, and are shamelessly re-promised each time a new set of promises are made. It is an irony that millions of victims of arsenicosis and fluorosis are shown in government records to have access to potable water. Infrastructure to ensure treatment for all in planning and implementation is lacking seriously. Whatever inadequate number of hospitals and health centres are there, these are again under-equipped, under-staffed. Never has there been a truthful introspection and self-criticism to reveal the real cause of failure of targets set and promises made with all fanfare.
It is the need of the hour that the N H P should aim at nationalisation of health and thus should include the whole nation in its network of health care delivery system. But the government, shedding tears always on the poor health condition of the people, instead of discharging its duty, shirks its responsibility and hands it out to the private sector for the latter to amass profit. The government has all through taken pro-people poses with high-sounding talks, but has done just the opposite by encouraging voluntary organisations and private houses for catering health service.
Article 8.7 of N H P 1983 declared, “ With a view to reducing Governmental expenditure and fully utilising untapped resources, planned programmes may be devised, related to the local requirements and potentials to encourage the establishment of practice by private medical professionals, increased investment by non-governmental agencies establishing curative centre and by offering organised, logistical, financial and technical support to voluntary agencies active in health field”.
The Consumer Protection Act 1986 created a false hope of justice among the people against malpractices, which a section of the practitioners do indulge in. The government at one stroke absolved itself and employers from the responsibility and interpreted professional service as a commodity. It opened up a huge market for the legal and insurance sectors.
The central and respective state governments gave a red carpet welcome to the policy of Globalisation, Liberalisation and Privatisation in the 90s, promising to bring down the heaven to earth. But after nearly a decade and a half, the results are there for every one of us to see particularly in the health sector. Healthcare, which is the responsibility of a democratic welfare state that India professes to be, is converted into a saleable commodity. The social securities including health offered to the common man by the government are being rapidly withdrawn as per the policies of World Trade Organisation (WTO), leaving him at the mercy of commercialised health services. The state of the government hospitals which had been rendering whatever meagre services possible with minimum facilities has changed radically as they have gone beyond the reach of common people due to the exorbitant charges introduced for each small service rendered. At many places the hitherto existing facilities are being withdrawn, let alone upgradation of the hospitals in keeping with the technological developments of today. Thus was engineered the breakdown of public health care system – curtailment of life saving drugs, continuous increase of hospital charges, stoppage of permanent recruitment of personnel even in the essential services in favour of contractual jobs and these going on together with large-scale retrenchment, lay-off and freezing of posts, rampant corruption and nepotism, and, over and above, the direct entry of business houses in government hospitals. The blueprint of Public Private Partnerships in Health Sector is being promoted to privatise public property accumulated over decades and to exploit the people’s sufferings and miseries by the powers that be for reaping profits. As their interest is focused on the profitable diagnostic and curative aspects, the preventive side is being utterly neglected, which leads to repeated preventable man-made epidemics, disasters and innumerable deaths.
The governments at the centre and states are openly pursuing this policy to serve the big corporate houses. These have been brought into the health care delivery system as the dominant and determining force. They are given free access to reap super-profits at the cost of the sick people who approach their hospitals having no other alternative. The Union Government promotes the private sector healthcare as ‘Infrastructure Industry’ and the National Health Policy 2002 promotes India as a global health care destination for health tourism, even creating a website solely for this purpose: to enable the private sector to carve a bigger pie out of the 3.5 trillion dollar worth world market of healthcare.