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An Unhealthy Health Policy -Ruhi Kandhari
-Tehelka

National Health Policy 2015 draft could end up being a paper tiger

Successive governments since the reforms of 1991 have been criticised for low funding on health, lowest in the world. Nearly one percent of India's gross domestic product (GDP) is spent each year on public health. But the new government has pledged to turn the tide around by increasing government spending to 2.5 percent of GDP in the draft health policy. The policy, in its current form, also advocates that health will be a fundamental right, enshrined in the Constitution.

The picture, however, isn't that rosy as it seems.

AR Nanda, former Union health secretary, succinctly points out the first flaw in the policy. "The draft policy is a statement of intentions, not strategies," he says. "Without a broad strategy or an operational plan of action, the intentions can never be translated on the ground."

While the policy argues for universal access to healthcare services, the challenges in implementing it are plenty. First of all, the draft National Health Policy 2015, released in January this year, may end up a paper tiger because health is a state subject. The increased budget will have to be utilised by the states and for that they would need capacities. In the past, even allocated funds have gone under-utilised as states such as Bihar and Uttar Pradesh did not have the infrastructure or commitment to spend the funds. The adoption of the policy by the states, thus, will depend on their respective governments. Universal health coverage is primarily dependent on universal adoption of the policy, which is unlikely, as the states frame their own health policies and are not obligated to follow the Central policy. The policy is unclear on the role of the Central government vis-a-vis the state governments.

Further, increased funding itself does not translate into better health of the masses. The funds need to be focussed on improving access to healthcare services at primary and secondary levels, in other words, at the village and district levels, where majority of the population needs basic healthcare.

The policy, instead, is focussed on building mega national research institutes. "The focus of the draft policy is on expensive national research institutes, and not much priority is given to primary healthcare. Quite a bit of the funding will go to big institutions and not for improving access," says Nanda, based on his reading of the draft policy.

Finally, according to Dr Mohan Rao, professor at Jawaharlal Nehru University, who has studied the draft policy, it is in reality cutting back the role of the government by subsidising the private sector.