DEVELOPMENT-INDIA: Support for Public Health Still Weak

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Mar 7 2003 (IPS) - India’s continued lack of commitment toward public health is reflected in the government’s latest budget, which public health experts and funders say is pushing it deeper into the privatisation of services that overlook the needs of the most needy.

On Thursday, Richard Feachem, executive director of the Global Fund to Fight AIDS, TB and Malaria, expressed disappointment with India’s annual budget proposals for 2003-2004, which were presented last week and had little to offer to public health, except incentives to private players and insurance companies.

Feachem, who committed 40 million U.S. dollars to India’s anti-tuberculosis programmes and 100 million dollars for HIV/AIDS prevention and treatment, described the budget as a ”move in the opposite direction”.

That is because India’s own stated goal of increasing spending on publicly funded health services from a ”low” 0.9 percent of Gross Domestic Product to a ”modest and reasonable” two percent by 2010.

That figure may have come down to 0.8 percent of GDP after the current budget, according to initial assessments by Ravi Duggal, an expert on health and the economy at the Mumbai-based Centre for Enquiry into Health and Allied Themes (CEHAT), a non-governmental organisation..

Duggal pronounced as ”unworkable” a ‘community health insurance scheme’ announced in the budget, under which a premium of two cents a day paid by an individual will would entitle a person to reimbursement of medical reimbursement of hospitalisation expense of up to 600 dollars.

The government announced that it would contribute two dollars a year towards annual premiums for people below the poverty line opting for the scheme. But Duggal said similar attempts had failed in the past, as might be expected in a poor third world country like India where average purchasing power is abysmal.

Private healthcare providers were delighted by income tax and customs concessions to the rapidly expanding hospital industry, which caters to the well-to-do, with a view to making the country a ‘global health care destination’.

Suneeta Reddy, director of the Apollo Hospital group here that what is rated as the world’s second biggest private hospital, said she now expected ”quality health care” to improve so that ”every Indian and every person from South-east Asia can benefit”. But Feachem said too little money was being invested in primary health care and said contributors to the Fund have commented that India was far too reliant on international donors to handle public health issues. This critics say, suggested a lack of ”national commitment.”

The Global Fund was created to fight the global HIV/AIDS, tuberculosis and malaria epidemics by sharing resources and expertise across national boundaries and between private and public sectors and follows a concept set out at the Okinawa G-8 summit in July 2000.

At the urging of U.N. Secretary General Kofi Annan and other leaders, the concept was unanimously endorsed in June 2001. By July that year, G-8 leaders had committed 1.3 billion dollars to the Fund.

Both India and China have a high reliance on foreign resources when it comes to HIV/AIDS, Feachem noted. ”A greater domestic commitment from these and other countries to fight the AIDS epidemic is required,” he said.

But India’s case was worse and Feachem noted that India was still plagued by ”infectious killers of the poor” such as tuberculosis, diarrhoea, pneumonia and leishmaniasis, which ”typically” called for publicly financed efforts rather than be left to the private sector to handle.

Criticism of the budget’s emphasis on private players in India’s health sector has already been voiced by leading public health experts like Mohan Rao at the Jawaharlal Nehru University’s Centre of Social Medicine and Community Health.

”It seems to have been forgotten that India is a poor country where medical expenditure is already the leading cause of indebtednessàinsurance schemes are no answer to the huge problems faced by the health sector,” Rao said.

India’s National Health Policy, released in 2002, acknowledged that public health investment in the country had actually declined from 1.3 percent in 1990 to 0.9 percent in 1999, the decade in which it undertook a programme of liberalisation and structural adjustment.

According to the policy note, aggregate expenditure on the health sector was 5.2 percent of GDP. But only 17 percent of this was accounted for by public health spending with the balance being ‘out-of-pocket’ expenditure.

In comparison, neighbouring China – an even more populous country – spends 2.7 percent of its GDP on aggregate health expenditure with public health spending accounting for 25 percent of it. India’s small neighbour to the south, Sri Lanka, spends three percent of its GDP on total health expenditure and public health accounted for a high 45.4 percent.

The result of the low public health spending was reflected in such indices as infant mortality, which is 70 per thousand births in India against 31 in China and 16 in Sri Lanka.

The policy calculated annual per capita public health expenditure in the country at less than four dollars.

But where the policy had called for ”the injection of substantial resources into the health sector from the central budget,” the 2003-2004 outlay on the sector has actually been pared down even further, Rao pointed out.

In January, Jeffrey Sachs, special adviser to the U.N. secretary general, said during a trop here that if India could push up life expectancy by about 6 to 8 years, its Gross National Product would get a boost by a full percentage or even more.