The Indian government’s draft National Health Policy 2015 clearly articulates its goals and principles going forward, which is a laudable departure from previous policy pronouncements. It is very candid in its acceptance of the failures of past health initiatives, but does not identify the reasons for such failure. By failing to do so, the solutions pro-offered for existing problems seem to be an effort to patch over past oversights, rather than policy actions that can achieve future progress.
The policy explicitly talks of the difficulties in enhancing public expenditure on healthcare, and prefers to limit its expectations to a modest 2.5% of the GDP. But no country in the world has achieved universal health coverage with such low levels of investment in health and the policy overlooks that. No policy actions can work without appropriate fiscal allocation and this is where the policy does not meet the identified gaps in healthcare provision.
Moreover, the policy seeks to garner additional resources for health through a health cess (tax collected and exclusively earmarked for health) and sin taxes on tobacco, alcohol, and other products—and this is regressive. The universal health cess will not be equitable, as those at the lower ends of the income quintiles will pay a higher proportion of their incomes when compared to those at higher income levels, which is morally unacceptable.
The policy looks to market driven expansion to meet the workforce needs for providing comprehensive primary healthcare. Yet the very same market forces have failed so far to provide even rudimentary primary healthcare.
The draft policy has recognised the relevance of medical technologies for a robust healthcare delivery system, but has situated medical devices within the legal framework of the Drugs and Cosmetics Act, 1940, instead of treating them as conceptually different from drugs. This does a disservice to the medical devices industry, and also to end users who will not have the protection of effective regulations for devices.
The policy proposes to make healthcare “affordable” instead of universal. It does not recognise or enact two essential principles necessary for universal healthcare access in a federal system: solidarity and portability. The principle of solidarity provides the moral basis for making care available for those who aren’t always able to pay, and the principle of portability enables citizens to have the right to healthcare across all the states of the country, which is very important in a federal political system. By failing to make this policy jump from affordable to universal, the government abdicates on its responsibility towards securing equality of status and opportunity for its citizens.
This commentary is based on the comments made by participants at a meeting organised to discuss the draft National Health Policy 2015 at the Achutha Menon Centre for Health Science Studies, SCTIMST, Trivandrum, Kerala, on 7 February 2015.
Mala Ramanathan and Raman Kutty V are both faculty members and professors at the Achutha Menon Centre for Health Science Studies, SCTIMST, Trivandrum.
Competing interests: None declared.