Subir Roy: Say goodbye to national health policy

The draft national health policy, issued by the Union ministry of health and family welfare late last year, does not just stress implementation. It adds that there should be a framework that will "specify approved financial allocations and linked to this measurable numerical output targets and time schedules".

It is just as well that this is a draft policy, as the Union Budget for the coming year (2015-16) has allocated just under Rs 30,000 crore, which is virtually the same as the revised estimate for the current year (2014-15). But this is after the estimates were slashed by 20 per cent late last year - in the mindless manner in which allocations are cut as the end of the financial year approaches, in order to achieve the semblance of a more balanced Budget.

So over a two-year period (2014-16) the Union government expenditure on health is set to go up by just nine per cent, that is, at a pathetic 4.5 per cent compound annual rate of nominal expenditure. If you adjust for inflation, there is actually a fall. This, when public expenditure on health in India is already at a global low of 1.2 per cent of gross domestic product (GDP).

All hope must now rest on a National Health Assurance Mission, which the prime minister is supposed to launch in April. When that comes, hopefully it will be accompanied by several realisations. One is that health is a national issue and since the country is in such poor health (look at infant mortality and female nutrition, with the accompanying disease burden), a coordinated national action plan is needed. It will not do to say, as is implicit in the Union Budget allocation, that after the substantial devolution of resources courtesy the 14th Finance Commission, it is the states that will have to carry the can.

The second realisation, though urgently needed, will take some time to come. Right now, India's rulers are fairly enamoured of private health insurance and expect it to deliver a large chunk of in-patient care with public funding of premiums. But private health insurance in India today is riddled with inefficiency and corruption. The world is yet to find a better model than the European one where the predominant role is played by an efficient and well-funded public health service that offers universal coverage - and only a supportive secondary role played by private health insurance. The opposite, American model is inferior and should be shunned.

The third and perhaps the most important is a realisation that the Union health ministry is in a mess and has been so for years. Unless something is done to change this, the country can say goodbye to any national health policy worth the name. What is more, without efficient regulation at work, approval of new drugs, conduct of clinical trials, pursuit of good manufacturing practices, and supervision of medical education and medical ethics (not subjects of this column) will all continue to suffer and things remain in the doldrums as they are.

What creates the greatest foreboding is the record of governance so far of the National Democratic Alliance, which has come to power with such a clear mandate. Not one but two chief vigilance officers (CVOs) on the turf of the Union health ministry who were doing their job with vigour have been moved out of their positions, obviously as a result of lobbying by those at the receiving end of investigations.

H K Jethi, the CVO of the Medical Council of India (MCI) that supervises medical education and conduct, was shunted out when he recommended that three members of the ethics committee of the MCI be investigated for misleading the World Medical Association (WMA) into believing that the Central Bureau of Investigation (CBI)'s probes against the former MCI president, Ketan Desai, had been withdrawn. This led to Dr Desai being chosen the president of the WMA.

The case of the CVO of the All India Institute of Medical Sciences (AIIMS), who has been shifted out of his position, is similar. This officer, Sanjiv Chaturvedi, who has become a crusader against corruption, was shifted out by the then Union health minister, Harsh Vardhan. But what is worse, the minister himself has been replaced by J P Nadda, Bharatiya Janata Party national general secretary and member of Parliament - whose representations were in the first place instrumental in the shifting out of Mr Chaturvedi!

Misgovernance at the Union health ministry had been endemic under Ghulam Nabi Azad through the entire life of the second United Progressive Alliance government. The Supreme Court ordered an overhaul of the regulation of clinical trials in India and the US regulator, Food and Drug Administration, questioned the manufacturing practices of Indian pharma companies. Tangling with the MCI led to the abrupt transfer of Keshav Desiraju from the post of health secretary. Prominent healthcare activists said his sin was reluctance to notify the reinduction of Dr Desai into the MCI from whence he had been ejected earlier, when he lost his licence to practise as a doctor after he was arrested for taking a bribe to favour a medical college.

subirkroy@gmail.com