While there are promises of universal health care, new medical colleges, and increase in GDP expenditure on health, experts see it as a copy of a manifesto from each other.
When Covid-19 struck the country in 2020, it prompted a significant shift in priorities towards healthcare, sparking discussions for systemic changes.
However, as the upcoming Lok Sabha election approaches, many promises seem to have been made on the surface, but are deemed inadequate by health and policy experts as well as individuals within these fields.
While there are promises of universal healthcare, new medical colleges, and an increase in GDP expenditure on health, experts see it as political parties copying each other’s manifestoes.
“The stated intent is good and all of the manifestos are worded differently, but are similar in saying they would all prioritise public health and primary health, and make it free or pocket friendly. But what would matter is actual implementation,” Hyderabad Infection Control Academy president Dr Ranga Reddy Burri told South First.
According to the World Health Organisation (WHO), countries should allocate 4 percent of their GDP to healthcare. Yet, India — right now the fifth-largest economy in the world — currently spends only 1.2 percent of its GDP on health.
Three political parties — Congress, CPI(M), and DMK — have pledged to increase this allocation if they come to power at the Centre.
DMK aims to allocate 3 percent of the GDP to public health programmes, while CPI(M) plans to raise public expenditure on health to 5 percent of the GDP, with at least 2 percent from the Centre.
Congress has committed to increasing budget allocation for health incrementally each year, aiming to reach 4 percent of the total expenditure by 2028-29.
“Most parties said they planned to up public health spending to range from 2.7 percent to 5 percent of the GDP by 2029, the world average was already 5.8 percent in 2018,” All India Federation of Government Doctors Association National Coordinator (Medical Teachers) Dr Kiran Madhala told South First.
Congress has pledged to provide universal and free healthcare in public health centres (PHCs), covering examination, diagnostics, treatment, surgery, medicines, rehabilitation, and palliative care.
DMK plans to introduce an air ambulance scheme for easy access to high medical care centres globally, provided by the government.
CPI(M) has promised to reduce out-of-pocket expenditure on health to below 25 percent from the current 47.07 percent, strengthen the public healthcare system for free access to quality healthcare, and ensure accountability to local communities.
The party also aims to make the right to free healthcare enforceable through legislation, retain health services as a state subject, reverse healthcare privatisation, extend and reform the ESI scheme for worker health, regulate the private healthcare sector, and ensure implementation of patient rights and quality standards.
“However, we need to critically examine this aspect. One party (Congress) has been in power for over 40 years, while the other (BJP) for 15 years. Despite a somewhat pessimistic outlook on their achievements, it’s crucial to look at healthcare financing. The question is, how can we ensure they fulfil their commitments and achieve universal coverage?” asked Ranga Reddy.
Congress has pledged to upgrade PHCs to meet Indian Public Health Standards and include diagnostics in each PHC. Maternity benefits will be extended to all women, with mandatory paid maternity leave for employees.
Meanwhile, BJP has highlighted ongoing efforts to upgrade secondary and primary healthcare through the PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).
It plans to expand PM-ABHIM for robust healthcare and strengthen Ayushman Arogya Mandirs. Additionally, it aims to upgrade district hospitals and secondary healthcare centres to provide comprehensive healthcare services.
Congress has also pledged to adopt the Rajasthan Model of cashless insurance up to ₹25 lakh for universal healthcare. It also aims to encourage the introduction of health insurance schemes in both private and public sectors, redesign the current universal healthcare program to accommodate different sections of the population, and enlist private hospitals and non-profit health facilities.
On the other hand, DMK promises to increase medical insurance coverage to ₹10 lakh for families below the poverty line.
Meanwhile, CPI(M) has vowed to replace the government-funded PMJAY/Ayushman Bharat health insurance scheme with a public-centred universal healthcare system.
As for childcare, the Congress party plans to initiate a National Mission on Immunisation to ensure 100 percent immunisation coverage for children aged under five years.
This is expected to address the current shortfall, where only 76 percent of Indian children receive full immunisation.
The party also aims to combat nutritional deficiencies among children by expanding the mid-day meal scheme up to Class XII.
Additionally, it has also promised that government hospitals would offer cancer immunotherapy at reduced costs, strive for an India free of tuberculosis with community participation, establish research centres for non-infectious diseases like diabetes, and set up special medical centres for genetic diseases and birth defects.
Congress has promised that it will double the hardship allowance of doctors serving in rural areas, and provide suitable residence facilities.
It also said that it will pass a law making it an offence to commit acts of violence against doctors and other health professionals while performing their duties.
Meanwhile, DMK has said financial incentives, housing benefits, and opportunities for professional development in medicine would be provided to doctors willing to work in rural and backward areas
On the other hand, BJP has said: “We will strengthen the efforts being made to increase the training capacity for paramedics, technicians, pharmacists and nurses.”
CPI(M) has said that under it, there would be effective and appropriate regulatory oversight of the AYUSH system of medicine, while supporting evidence-based use of such systems.
Congress has also said all systems of medicine will be supported by its government. It has promised that the contribution of the Central government to the pay of frontline health workers (such as ASHA and Anganwadi workers, and mid-day meal cooks) would be doubled.
A second ASHA would be appointed in villages with a population of over 2,500, said the Congress manifesto.
Congress has pledged to establish one government medical college-cum-hospital in each district across the country, and aims to fill all vacancies in medical and paramedical posts within three years. They also advocate for hospitals and medical colleges to operate only if 75 percent of medical, paramedical, and teaching posts are filled.
BJP has highlighted the establishment of 15 AIIMS in the past decade and vows to strengthen the AIIMS network for quality healthcare nationwide. It has also said it aims to increase undergraduate and postgraduate seats in medical education through AIIMS and various medical colleges.
DMK has promised to expedite the construction of AIIMS Madurai and aims to bring AIIMS to four more regions in Tamil Nadu. They also plan to enhance medical infrastructure in underprivileged areas in collaboration with private medical institutions.
CPI(M) prioritises setting up new public colleges to train doctors and nurses, especially in underserved areas like the North East and poorer states. It has also proposed establishing training institutes for health workers.
Meanwhile, Congress has also pledged to review the National Medical Commission Act and address any anomalies and deficiencies, ensuring full autonomy for the National Medical Commission (NMC) to fulfil its obligations.
BJP has promised to intensify efforts to eliminate diseases such as TB, leprosy, lymphatic filariasis, measles and rubella, trachoma, and Kala Azar (visceral leishmaniasis) by facilitating timely testing and access to medicines.
DMK plans to establish international standard medical research and development centres in four major cities of India under the new Union government.
Congress has pledged to subject all medicine manufacturers to strict scrutiny to ensure quality and adherence to good manufacturing practices.
It also aims to rapidly expand the number of Central government dispensaries, where both branded and generic medicines of good quality would be available at reasonable prices.
BJP plans to expand the Jan Aushadhi Kendra network to provide high-quality, low-cost medicines nationwide. It also aims to support Indian vaccine manufacturers and biopharma companies to enhance production and distribution, reducing the timeline for vaccine manufacturing.
DMK has vowed to prohibit the sale of drugs banned by the Union government on online pharmaceutical platforms and expedite the establishment of the National Institute of Pharmaceutical Education and Research (NIPER) in Madurai.
CPI(M) has advocated for a people-centred, rational pharmaceutical policy with cost-based price controls and availability of essential drugs free of cost at all public healthcare facilities. It has also proposed to revive public sector pharmaceutical units, strict regulation of clinical trials, and resisting the dilution of India’s patent laws.
It has also said it would make the Ethical Code on Marketing Practices of Medicines compulsory.
Dr Kiran Madhala highlighted significant health issues that were not given priority in party manifestos, such as the prevalence of non-communicable diseases, the need to prioritise underserved areas, and the importance of research funding.
He also pointed to “the lack of attention to critical health issues such as doctors’ salaries, recruitment, and protection, emphasising the importance of ensuring the safety and well-being of health personnel”.
He noted the absence of mention regarding the utilisation of artificial intelligence in healthcare.
While acknowledging the importance of initiatives like mid-day meal programmes to address malnutrition among children, Madala stressed the necessity of exploring alternative solutions, especially considering India’s persistent struggle with childhood malnutrition.
He also pointed out discrepancies in proposed public health spending by political parties, emphasising the need for sufficient funding to support universal health insurance and reduce out-of-pocket expenditure, which often leads to extreme poverty for a significant portion of the population.
“The absence of strategies to tackle lifestyle diseases stemming from physical inactivity, consumption of junk food, obesity, and substance abuse,” noted Madala.
He also pointed to the lack of emphasis on creating health awareness among the masses and ensuring health as a fundamental right for citizens.
United Doctors Front Association President Dr Lakshya Mittal asked for one stipend for doctors across the country. “There should also be only one bond policy for the medical students across the country, and there should also be fixed duty hours for the doctors,” he told South First.
He added that the government should also ensure proper disbursal of stipends to interns and postgraduate resident doctors who are the frontline doctors at the government medical colleges.
“Also, the government should prioritise improving the quality of existing medical colleges and hospitals, ensuring basic investigations are available. Then, efforts can be made to increase the number of seats or establish medical colleges nationwide,” he said.
Both Madala and Mittal stressed the urgency of establishing Indian Medical Services and the importance of including it in party agendas to address the healthcare needs of the country comprehensively.
Meanwhile, Dr Ranga Reddy said that parties were all talking about universal health coverage and building capacity through paramedics and doctors. Essentially, they all echo similar promises without any significant deviation.
He added: “But, the best illustration of effective healthcare provision can be seen in Andhra Pradesh, where the government has implemented a doorstep delivery service through the Family Physician Programme and volunteers. This innovative approach hasn’t been replicated elsewhere, and no party has promised such comprehensive service in terms of universal healthcare.”
He also points out that the most significant challenge facing Indian healthcare is the consistent lack of adequate financing and misplaced priorities.
“For instance, there is a focus on specialised curative infrastructure rather than preventive measures, such as building new dialysis centres or cancer hospitals without addressing the root causes of these health issues,” said Dr Reddy.
(Edited by Arkadev Ghoshal)
Apr 29, 2024
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