As we move into the New Year, it would be a good time to recall that in the year 2000, 189 nations made a pledge under the Millennium Declaration and identified 8 goals to be achieved by 2015. These became known as the Millennium Development Goals (MDGs) and they were as follows- a) Eradicate extreme hunger and poverty. b) Achieve universal primary education c) Promote gender equality and empower women d) Reduce child mortality e) Improve Maternal Health f) Combat HIV/AIDS, Malaria and other diseases g) Ensure environmental stability h) Develop a Global Partnership for development.
Taking all the 12 target points into consideration India’s progress as per the UNDP website shows as below:
|Target No.||Target Description||Progress Signs|
|1.||Halve, between 1990 and 2015, proportion of population below national poverty line||Δ|
|2.||Halve, between 1990 and 2015, proportion of people who suffer from hunger||Θ|
|3.||Ensure that by 2015 children everywhere, boys and girls alike, will be able to complete a full course of primary education||ΔΔ|
|4.||Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015||Δ|
|5.||Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate||ΘΔ|
|6.||Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio||ΘΔ|
|7.||Have halted by 2015 and begun to reverse the spread of HIV/AIDS||Δ|
|8.||Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases||ΘΔ|
|9.||Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources||ΔΔ|
|10.||Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation||ΔΘ|
|11.||By 2020, to have achieved, a significant improvement in the lives of at least 100 million slum dwellers||Φ|
|12.||In cooperation with the private sector, make available the benefits of new technologies, especially information and communication||ΔΔ|
Δ: Moderately/almost nearly on track considering all indicators
Θ: Slow/almost off-track considering all indicators
ΔΔ: On-track or fast considering all indicators
One of the few positive targets achieved are highlighted by the progress shown on points 3,9 and 12. But what has been clear over the past several years is that the Indian Government’s priorities are misplaced, spending less than 2% annually on Healthcare expenditure and if it wouldn’t have been for the commendable efforts by the private sector, not-for-profit organizations, NGOs and CSR initiatives, India’s health statistics could be worse. With more than 80% of Healthcare IT solutions being provided by the private sector, the healthcare burden is known to push over 60 million Indians into poverty every year.
Universal Health coverage basically means that the system provides for health care and financial protection to all its citizens. But that doesn’t mean that it implies coverage for all people for everything. It is determined by three dimensions: what is covered, who is covered and how much of the cost is covered. Universal Health coverage is the need of the hour and there is now renewed hope in the form of the newly announced Universal Health Assurance Mission by the Narendra Modi led BJP government which is expected to be rolled out early next year. It would be good if the new scheme that is announced learns from the weaknesses in previous schemes such as the NRHM and JSY that were exposed in some states. The National Rural Health Mission (NRHM) which was launched in 2005, aimed at the development of health systems in eighteen focus states have had unintended consequences in some states such as misutilization of funds and corruption in the purchase of inventory. The Asian Age reported over 2,000 crore was spent by the Assam government on placing supply orders where tenders were manipulated to favour a few select group of suppliers. Although the health departments have stressed on the enforcing of prescription by generics, it still largely remains an announcement with no real action on the ground in many states. Data is skewed to favour the PHCs in order to show higher number of institutional deliveries and incentives meant for the social health activists and the women do not reach them. Uttar Pradesh and Madhya Pradesh saw the flexibility of funds under the NRHM leading to financial regularities and corruption cases.
Proposals as per the latest Universal Health Assurance Mission states that the government will provide 50 essential drugs, a bouquet of diagnostic services and 30 AYUSH drugs at all government hospitals. NHAM plans to merge with RSBY (Rashtriya Swasth Bhima Yojana) which has had some success across 25 states that it has been implemented. Over 36 miliion families are covered under this insurance scheme, where a BPL family holding a ration card pays Rs 30 and receives medical care upto Rs. 30,000 per family per year in any of the empanelled hospitals. NHAM aims to link the Aadhar numbers to check ghost beneficiaries and fraudulent claims.
Let us keep our fingers crossed and hope that the NHAM is not yet another government scheme which fails to deliver on big promises as it is expected to push the government expenditure on Healthcare to 3-4% by 2020 which is about 1.6 lakh crore or 26 billion dollars.