HEALTH-INDIA: India Unrepresented at World Health Assembly

By IPS Correspondents Reprint | | Print |

Dev Raj

NEW DELHI, May 14 1998 (IPS) - Leading experts are dismayed that India’s health establishment has failed to send a team for the 50th World Health Assembly in Geneva and see it as part of gross official apathy towards the health sector.

Health officials cited a strike by government nurses, running into its tenth day, Thursday, for the failure of Health Minister, Dalit Ezhilmalai to lead a team to Geneva. “It is a matter of priorities,” a senior official in the health ministry said.

But Alok Mukhopadhyay, convenor of the Independent Commission on Health in India (ICHI) told IPS that anybody can see what ought to have taken priority – the health of a billion Indians rather than a strike by a few thousand nurses.

This will be the first time in 50 years that India is not fielding a team for the assembly. Besides Ezhilmalai the team should have included the Health Secretary K. B. Saxena and Director General of Health Services Dr. O.P. Agarwal.

With a threat of 40 per cent cut in the budget of the South East Asia Region (SERA) whose headquarters happens to be in New Delhi, and a possible reorganisation of the WHO’s regional system, India should have been out there, Mr. Mukhopadhyay said.

Areas of concern to South Asia include the encouragement of market-oriented privatisation of medical supply and the promotion of technology as a solution to public health problems. These were among issues identified at a recent meeting here of eminent health experts from the region.

After discussing in detail the draft WHO document “Health for all (HFA) in the 21st century,” the experts said the world body was straying from the Alma Ata spirit and that serious efforts would be need to get the vision of justice and equity back on the road.

The experts, who included Zafrulla Chaudhury, from Bangladesh and Shanta Lal Mulmi and Prof. Mathura Shrestha from Nepal said the draft document failed to highlight the reasons why the Alma Ata declaration on HFA could not be implemented.

According to the South Asian experts, globalisation has tended to stunt the growth of local initiatives for solution to local problems.

“Unless great care is taken to moderate the play of globalisation in areas such as pharmaceuticals, technology, and health risk industries such as tobacco and liquor the primary goal of equity in health will not be achieved,” the experts said in a statement.

Of serious concern, said Mukhopadhyay, who took part in the discussion of the draft document, is the overwhelming dominance in international health funding of the World Bank, the Regional Development Band and selected bilateral donors.

“The WHO is systematically being marginalised in the absence of large funding capacities and the ability of other institutions to bypass the WHO even for technical advise,” Mukhopadhyay said.

Assistance from new donors comes with conditionalities and usage patterns for civil works, high cost equipment and consultancy which leaves little freedom and flexibility for recipient countries, he said.

Serious objection was taken to the attempt in the draft to club the voluntary sector along with the private sector in medicine, which, the experts noted was increasingly getting commercialised.

A major omission was that of essential drugs and loss in focus on the pharmaceutical industry by the WHO. “No other global network in trade is more powerful than the international pharmaceutical industry and thier prices are going out of the reach of ordinary Indians,” Mukhopadhyay said.

“Naturally important decision on drug pricing policy, drug licensing, trademarks and issues such as sale of drugs over the internet will be negotiated without India although this country is going to be seriously affected,” Mukhopadhyay said.

Mukhopadhyay said much hope was being placed on the election of former Norwegian Prime Minister, Dr. Gro Harlem Brundtland as the new Director-General of the WHO. “As a woman, a doctor and someone who has made a mark on environment we expect her to be sensitive issues in South Asia,” he said.

Meanwhile, the ICHI presented to Indian prime minister Atal Behari Vajpayee, Thursday, a document showing the serious deterioration of the health and family welfare services in the country over the last two decades.

India according to the document is living under two shadows –

the familiar one of infectious diseases like malaria and tuberculosis but additionally it now faced chronic non-infectious diseases like cancer and coronary diseases.

The large widespread health infrastructure set up throughout the country is non-functional and unresponsive and instead of moving forward to meet health challenges is sliding backwards, the document said.

Failure of the government system has allowed the growth of the private sector in both primary and secondary health care which is driven by the free market technology and does not provide quality health care at a reasonable cost.

On the population front, two and a half decades of following an aggressive, unimaginative target-oriented approach has only swallowed up huge investments without producing the desired results.

The grim tale of poverty and underdevelopment of millions of Indian was brought home repeatedly to the ICHI teams when they visited the states of Rajasthan, Uttar Pradesh, Orissa Madhya Pradesh and Assam.

India, said the document, was in serious danger of entering the 21 st century as a nation with diverse unsolved ailments and chronic ill health.