Policy alternatives to NDA: An unhealthy report card

This assertion is obviously implausible and should be dismissed. But Mr Advani is supposed to measure his words. So let's examine his claim.

Going by every conceivable indicator -- health, longevity, freedom from bondage, social opportunity, gender equity, general level of popular education and culture, or citizens' rights--India belongs among the bottom fourth of the world.

Tap here to add The Daily Star as a trusted source

In the United Nations Human Development Index, its rank is 127th (of 175 countries). It's absurd to believe, as Mr Advani's does, that India will be an "Economic Superpower" within 15 years.

In 2001, India's per capita GDP was $462, compared to the US's $35,277, and under one-tenth the world average ($5,133). The $462 compares poorly even with developing countries like Mexico ($6,214), Malaysia ($3,695), or South Africa ($2,620). It is 64 percent lower than the Third World average ($1,270).

If India's per-capita GDP grows at the same rate as in the past half-century (2.1 percent), then it will reach only $844 by 2030. But assume India somehow grows at the "dream" rate of 8 percent. Even after 30 years (not 15), this would only raise the figure to $4,305--only one-eighth the US's present level!

In 2030, India will continue to be one of the world's unhealthiest societies -- a cesspool of disease and disability. Its under-5 infant mortality rate is an unacceptable 93 per 1,000 live-births (world average, 56). The rate of decline of mortality has slowed over the past decade.

Sixty percent of children's deaths are caused by entirely preventable infections and diseases like diarrhoea. We fail to provide minimum care to our most precious people, children. Half of them are undernourished. Half our women are anaemic. More women die during childbirth than seven years ago.

TB annually kills half-a-million Indians--a number unchanged since Independence! Two million malaria cases are annually added to the national total of 14 million. Nearly half are potentially fatal falciparum cases.

There's a resurgence of other communicable diseases like encephalitis, Kala-azar and dengue. In addition, cancer claims three lakh lives, half of them tobacco-related and preventable. HIV-AIDS afflicts four million-plus.

These terrible averages hide worse disparities. Infant mortality among the poorest 20 percent is 2½ times higher than that in the richest 20 percent.

A girl is 1½ times likelier to die than a boy before reaching her fifth birthday! Female-to-male ratios for children have rapidly declined from 945 to 927 per 1000 over a decade. Dalit women are 1½

times more likely to suffer chronic malnutrition than others.

Inequalities in healthcare access are worse. The poorest 20 percent of the people are six times less likely to go to a hospital than the richest fifth. Childbirth among the poor is six times less likely to be attended by a trained person than the delivery of well-off mothers. Villages have 15 times fewer hospital beds to people than cities.

The government bears only 17 percent of India's total health expenditure. This is criminally low. Our health system is overwhelmingly privatised. In 1991, 57 percent of India's hospitals were private. A decade later, 75 percent were private!

By contrast, in the UK, public spending accounts for 85 percent of health expenditure, in Latin America, 50 percent, and Southeast Asia, 40 percent-plus. Only five other countries spend less than India: Burundi, Myanmar, Pakistan, Sudan and Cambodia!

The WHO standard for public health expenditure is 5 percent of GDP. But India spends only 0.9 percent. This is just one-third the developing countries' average!

India's worst performers in health are the vital Primary Health Centres. They are badly under-funded. Only 38 percent have all the critical staff. Only 31 percent have all the critical supplies. Only 3 percent offer abortion.

Privatisation has made healthcare unaffordable for millions. Between 1986 and 1995, the percentage of such people increased from 10 to 21 in cities, and 15 to 24 in villages.

Forty percent of people who get hospitalised have to borrow money or sell assets. Over 20 million Indians are pushed into poverty every year because of a major family illness.

Private hospitals are unregulated and often run by incompetent or scalpel-happy doctors and quacks. Sixtythree percent of all medical prescriptions are for unnecessary or irrational drugs. In Mumbai, 65 percent of babies born in private hospitals are delivered through Caesarean operations. (WHO norm, 10 to 15 percent.)

India's already-bad healthcare situation became worse under the 1990s' neoliberal policies, with further cuts in budgets, introduction of user fees, and freezing of recruitment.

Official policy now favours "contracting out" health services and encouraging private hospitals through tax waivers, reduced duties and subsidised land. We are promoting "health tourism" for foreigners, while denying basic services to Indians!

One component of this policy is deregulation of drug prices. Drugs under (reasonable) price control have decreased from 360 to just 74, and might fall to 25. With new tight patents beginning in 2005, drug prices will become unaffordable for the majority.

This grave health crisis cannot be resolved through tinkering--for example, via health insurance. We must bring the state back into health and make it accountable, as part of the larger democratic agenda. This entails a radical policy change, including making health a fundamental right.

On March 12, the Jana Swasthya Abhiyan campaign organised a dialogue in Delhi between healthcare activists and political parties. The notable absentees were the BJP and Congress. The BJP isn't known to care for the poor. But the Congress must show it does.

It must fight for health as a fundamental right. It's not enough to say, "Congress ka Haath, Aam Aadmi ke Saath". This slogan must be translated into concrete policies. Or else, the electorate will deliver the Congress another rebuff.

Praful Bidwai is an eminent Indian columnist.