Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 150
You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 150
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 97
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98
Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 151
You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 151
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 97
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98
Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
if (Configure::read('debug')) {
trigger_error($message, E_USER_WARNING);
} else {
$response = object(Cake\Http\Response) {
'status' => (int) 200,
'contentType' => 'text/html',
'headers' => [
'Content-Type' => [
[maximum depth reached]
]
],
'file' => null,
'fileRange' => [],
'cookies' => object(Cake\Http\Cookie\CookieCollection) {},
'cacheDirectives' => [],
'body' => '<!DOCTYPE html>
<!--[if lt IE 7 ]>
<html class="ie ie6" lang='en'> <![endif]-->
<!--[if IE 7 ]>
<html class="ie ie7" lang='en'> <![endif]-->
<!--[if IE 8 ]>
<html class="ie ie8" lang='en'> <![endif]-->
<!--[if (gte IE 9)|!(IE)]><!-->
<html lang='en'>
<!--<![endif]-->
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title>
LATEST NEWS UPDATES | Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna </title>
<meta name="description" content="
While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it..."/>
<meta name="keywords" content="Health"/>
<meta name="news_keywords" content="Health">
<link rel="alternate" type="application/rss+xml" title="ROR" href="/ror.xml"/>
<link rel="alternate" type="application/rss+xml" title="RSS 2.0" href="/feeds/"/>
<link rel="stylesheet" href="/css/bootstrap.min.css?1697864993"/> <link rel="stylesheet" href="/css/style.css?v=1.1.2"/> <link rel="stylesheet" href="/css/style-inner.css?1577045210"/> <link rel="stylesheet" id="Oswald-css"
href="https://fonts.googleapis.com/css?family=Oswald%3Aregular%2C700&ver=3.8.1" type="text/css"
media="all">
<link rel="stylesheet" href="/css/jquery.modal.min.css?1578285302"/> <script src="/js/jquery-1.10.2.js?1575549704"></script> <script src="/js/jquery-migrate.min.js?1575549704"></script> <link rel="shortcut icon" href="/favicon.ico" title="Favicon">
<link rel="stylesheet" href="/css/jquery-ui.css?1580720609"/> <script src="/js/jquery-ui.js?1575549704"></script> <link rel="preload" as="style" href="https://www.im4change.org/css/custom.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery.modal.min.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery-ui.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/li-scroller.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<!-- <link rel="preload" as="style" href="https://www.im4change.org/css/style.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous"> -->
<link rel="preload" as="style" href="https://www.im4change.org/css/style-inner.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel='dns-prefetch' href="//im4change.org/css/custom.css" crossorigin >
<link rel="preload" as="script" href="https://www.im4change.org/js/bootstrap.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.li-scroller.1.0.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.modal.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.ui.totop.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-1.10.2.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-migrate.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-ui.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/setting.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/tie-scripts.js">
<!--[if IE]>
<script type="text/javascript">jQuery(document).ready(function () {
jQuery(".menu-item").has("ul").children("a").attr("aria-haspopup", "true");
});</script>
<![endif]-->
<!--[if lt IE 9]>
<script src="/js/html5.js"></script>
<script src="/js/selectivizr-min.js"></script>
<![endif]-->
<!--[if IE 8]>
<link rel="stylesheet" type="text/css" media="all" href="/css/ie8.css"/>
<![endif]-->
<meta property="og:title" content="LATEST NEWS UPDATES | Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna" />
<meta property="og:url" content="https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html" />
<meta property="og:type" content="article" />
<meta property="og:description" content="
While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it..." />
<meta property="og:image" content="" />
<meta property="fb:app_id" content="0" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
<link rel="apple-touch-icon-precomposed" sizes="144x144" href="https://im4change.in/images/apple1.png">
<link rel="apple-touch-icon-precomposed" sizes="120x120" href="https://im4change.in/images/apple2.png">
<link rel="apple-touch-icon-precomposed" sizes="72x72" href="https://im4change.in/images/apple3.png">
<link rel="apple-touch-icon-precomposed" href="https://im4change.in/images/apple4.png">
<style>
.gsc-results-wrapper-overlay{
top: 38% !important;
height: 50% !important;
}
.gsc-search-button-v2{
border-color: #035588 !important;
background-color: #035588 !important;
}
.gsib_a{
height: 30px !important;
padding: 2px 8px 1px 6px !important;
}
.gsc-search-button-v2{
height: 41px !important;
}
input.gsc-input{
background: none !important;
}
@media only screen and (max-width: 600px) {
.gsc-results-wrapper-overlay{
top: 11% !important;
width: 87% !important;
left: 9% !important;
height: 43% !important;
}
.gsc-search-button-v2{
padding: 10px 10px !important;
}
.gsc-input-box{
height: 28px !important;
}
/* .gsib_a {
padding: 0px 9px 4px 9px !important;
}*/
}
@media only screen and (min-width: 1200px) and (max-width: 1920px) {
table.gsc-search-box{
width: 15% !important;
float: right !important;
margin-top: -118px !important;
}
.gsc-search-button-v2 {
padding: 6px !important;
}
}
</style>
<script>
$(function () {
$("#accordion").accordion({
event: "click hoverintent"
});
});
/*
* hoverIntent | Copyright 2011 Brian Cherne
* http://cherne.net/brian/resources/jquery.hoverIntent.html
* modified by the jQuery UI team
*/
$.event.special.hoverintent = {
setup: function () {
$(this).bind("mouseover", jQuery.event.special.hoverintent.handler);
},
teardown: function () {
$(this).unbind("mouseover", jQuery.event.special.hoverintent.handler);
},
handler: function (event) {
var currentX, currentY, timeout,
args = arguments,
target = $(event.target),
previousX = event.pageX,
previousY = event.pageY;
function track(event) {
currentX = event.pageX;
currentY = event.pageY;
}
;
function clear() {
target
.unbind("mousemove", track)
.unbind("mouseout", clear);
clearTimeout(timeout);
}
function handler() {
var prop,
orig = event;
if ((Math.abs(previousX - currentX) +
Math.abs(previousY - currentY)) < 7) {
clear();
event = $.Event("hoverintent");
for (prop in orig) {
if (!(prop in event)) {
event[prop] = orig[prop];
}
}
// Prevent accessing the original event since the new event
// is fired asynchronously and the old event is no longer
// usable (#6028)
delete event.originalEvent;
target.trigger(event);
} else {
previousX = currentX;
previousY = currentY;
timeout = setTimeout(handler, 100);
}
}
timeout = setTimeout(handler, 100);
target.bind({
mousemove: track,
mouseout: clear
});
}
};
</script>
<script type="text/javascript">
var _gaq = _gaq || [];
_gaq.push(['_setAccount', 'UA-472075-3']);
_gaq.push(['_trackPageview']);
(function () {
var ga = document.createElement('script');
ga.type = 'text/javascript';
ga.async = true;
ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
var s = document.getElementsByTagName('script')[0];
s.parentNode.insertBefore(ga, s);
})();
</script>
<link rel="stylesheet" href="/css/custom.css?v=1.16"/> <script src="/js/jquery.ui.totop.js?1575549704"></script> <script src="/js/setting.js?1575549704"></script> <link rel="manifest" href="/manifest.json">
<meta name="theme-color" content="#616163" />
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="apple-mobile-web-app-title" content="im4change">
<link rel="apple-touch-icon" href="/icons/logo-192x192.png">
</head>
<body id="top" class="home inner blog">
<div class="background-cover"></div>
<div class="wrapper animated">
<header id="theme-header" class="header_inner" style="position: relative;">
<div class="logo inner_logo" style="left:20px !important">
<a title="Home" href="https://im4change.in/">
<img src="https://im4change.in/images/logo2.jpg?1582080632" class="logo_image" alt="im4change"/> </a>
</div>
<div class="langhindi" style="color: #000;display:none;"
href="https://im4change.in/">
<a class="more-link" href="https://im4change.in/">Home</a>
<a href="https://im4change.in/hindi/" class="langbutton ">हिन्दी</a>
</div>
<nav class="fade-in animated2" id="main-nav">
<div class="container">
<div class="main-menu">
<ul class="menu" id="menu-main">
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
style="left: -40px;"><a
target="_blank" href="https://im4change.in/">Home</a>
</li>
<li class="menu-item mega-menu menu-item-type-taxonomy mega-menu menu-item-object-category mega-menu menu-item-has-children parent-list"
style=" margin-left: -40px;"><a href="#">KNOWLEDGE GATEWAY <span class="sub-indicator"></span>
</a>
<div class="mega-menu-block background_menu" style="padding-top:25px;">
<div class="container">
<div class="mega-menu-content">
<div class="mega-menu-item">
<h3><b>Farm Crisis</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/farmers039-suicides-14.html"
class="left postionrel">Farm Suicides </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/unemployment-30.html"
class="left postionrel">Unemployment </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/rural-distress-70.html"
class="left postionrel">Rural distress </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/migration-34.html"
class="left postionrel">Migration </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/key-facts-72.html"
class="left postionrel">Key Facts </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/debt-trap-15.html"
class="left postionrel">Debt Trap </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Empowerment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/union-budget-73.html"
class="left postionrel">Union Budget And Other Economic Policies </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/forest-and-tribal-rights-61.html"
class="left postionrel">Forest and Tribal Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-education-60.html"
class="left postionrel">Right to Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-food-59.html"
class="left postionrel">Right to Food </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/displacement-3279.html"
class="left postionrel">Displacement </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-work-mg-nrega-39.html"
class="left postionrel">Right to Work (MG-NREGA) </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/gender-3280.html"
class="left postionrel">GENDER </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-information-58.html"
class="left postionrel">Right to Information </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/social-audit-48.html"
class="left postionrel">Social Audit </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Hunger / HDI</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/poverty-and-inequality-20499.html"
class="left postionrel">Poverty and inequality </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/malnutrition-41.html"
class="left postionrel">Malnutrition </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/public-health-51.html"
class="left postionrel">Public Health </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/education-50.html"
class="left postionrel">Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hunger-overview-40.html"
class="left postionrel">Hunger Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hdi-overview-45.html"
class="left postionrel">HDI Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/pds-ration-food-security-42.html"
class="left postionrel">PDS/ Ration/ Food Security </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/sdgs-113.html"
class="left postionrel">SDGs </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/mid-day-meal-scheme-mdms-53.html"
class="left postionrel">Mid Day Meal Scheme (MDMS) </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Environment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/time-bomb-ticking-52.html"
class="left postionrel">Time Bomb Ticking </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/water-and-sanitation-55.html"
class="left postionrel">Water and Sanitation </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/impact-on-agriculture-54.html"
class="left postionrel">Impact on Agriculture </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Law & Justice</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/social-justice-20500.html"
class="left postionrel">Social Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/access-to-justice-47.html"
class="left postionrel">Access to Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/human-rights-56.html"
class="left postionrel">Human Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/corruption-35.html"
class="left postionrel">Corruption </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/general-insecurity-46.html"
class="left postionrel">General Insecurity </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/disaster-relief-49.html"
class="left postionrel">Disaster & Relief </a>
</p>
</div>
</div>
</div>
</div>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page "><a target="_blank" href="https://im4change.in/nceus_reports.php">NCEUS reports</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children parent-list ">
<a target="_blank" href="https://im4change.in/about-us-9.html">About Us <span
class="sub-indicator"></span></a>
<ul class="sub-menu aboutmenu">
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/objectives-8.html">Objectives</a>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/contactus.php">Contact
Us</a></li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/about-us-9.html">About
Us</a></li>
</ul>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children ">
<a target="_blank" href="https://im4change.in/fellowships.php" title="Fellowships">Fellowships</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/media-workshops.php">Workshops</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/research.php">Research</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/links-64">Partners</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
id="menu-item-539"><a target="_blank" href="https://im4change.in/hindi/"
class="langbutton langlinkfont17">हिन्दी</a></li>
</ul>
</div> </div>
<!-- <div style="float: right;">
<script async src="https://cse.google.com/cse.js?cx=18b4f2e0f11bed3dd"></script>
<div class="gcse-search"></div>
</div> -->
<div class="search-block" style=" margin-left: 8px; margin-right: 7px;">
<form method="get" id="searchform" name="searchform"
action="https://im4change.in/search"
onsubmit="return searchvalidate();">
<button class="search-button" type="submit" value="Search"></button>
<input type="text" id="s" name="qryStr" value=""
onfocus="if (this.value == 'Search...') {this.value = '';}"
onblur="if (this.value == '') {this.value = 'Search...';}">
</form>
</div>
</nav>
</header>
<div class="container">
<div id="main-content" class=" main1 container fade-in animated3 sidebar-narrow-left">
<div class="content-wrap">
<div class="content" style="width: 900px;min-height: 500px;">
<section class="cat-box recent-box innerCatRecent">
<h1 class="cat-box-title">Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna</h1>
<a href="JavaScript:void(0);" onclick="return shareArticle(13230);">
<img src="https://im4change.in/images/email.png?1582080630" border="0" width="24" align="right" alt="Share this article"/> </a>
<a href="https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352/print"
rel="nofollow">
<img src="https://im4change.in/images/icon-print.png?1582080630" border="0" width="24" align="right" alt="Share this article"/>
</a>
</section>
<section class="recent-box innerCatRecent">
<small class="pb-1"><span class="dateIcn">
<img src="https://im4change.in/images/published.svg?1582080666" alt="published"/>
Published on</span><span class="text-date"> Feb 24, 2012</span>
<span
class="dateIcn">
<img src="https://im4change.in/images/modified.svg?1582080666" alt="modified"/> Modified on </span><span class="text-date"> Feb 24, 2012</span>
</small>
</section>
<div class="clear"></div>
<div style="padding-top: 10px;">
<div class="innerLineHeight">
<div class="middleContent innerInput latest-news-updates">
<table>
<tr>
<td>
<div>
<div style="text-align: justify"><br /></div><div style="text-align: justify"><em>While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it explores the political dimension, which comprises the forces and interests that come into play to shape and reconfigure administrative policy and its implementation.</em></div><div style="text-align: justify"><em> </em></div><div style="text-align: justify"><em>We are grateful to Anand Zachariah and Susie Tharu for their insightful comments on the report. In particular, Zachariah’s inputs on medical colleges as apex tertiary medical care institutions in districts and Tharu’s stress on the importance of practice need mention. (See Zachariah et al 2010 for a conceptual background).</em></div><div style="text-align: justify"><em><br /></em></div><div style="text-align: justify"><em>R Srivatsan (r.srivats@gmail.com) is with the Anveshi Research Centre for Women’s Studies, Hyderabad and Veena Shatrugna (veenashatrugna@yahoo.com) was with the National Institute of Nutrition, Hyderabad.</em></div><div style="text-align: justify"> </div><div style="text-align: justify">The report of the High Level Ex­pert Group (HLEG) on Universal Health Coverage (UHC) for India is to be welcomed for its comprehensive vision of healthcare. After the neo-liberal proposals on selective primary health care articulated by Walsh and Warren (1979) doubted if providing comprehensive healthcare in a third world country was a feasible goal and the World Bank’s Investing in Health report (1993) put forth an influential model incorporating that view, the HLEG report reaffirms the goal of UHC. This is an important development, which shows that India is at a political and economic stage that no longer needs to repeat the minimalist solutions of selective primary health care – diphtheria-pertussis-tetanus (DPT) immunisation, tetanus toxoid to pregnant w­omen, breastfeeding, chloroquine for malaria and oral rehydration solution (ORS) for diarrhoea. It is indeed worth pausing and pondering over the significance of this moment.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Many of the recommendations (and there are many) in the HLEG report are well-conceived – elimination of cost to the patient; funding through taxation; elimination of insurance; making medical colleges the apex tertiary care providers to the health system at the district level; putting the pharmaceutical industry under the control of the Ministry of Health and Family Welfare, and so on. The single question we would like to a­ddress is: What are the conditions u­nder which the report’s promise will bear fruit?</div><div style="text-align: justify"><br /></div><div style="text-align: justify">To answer this, we explore a dimension that is peculiarly invisible in the report, the political. By the term “political” we mean the different forces and interests that come into play to shape and reconfigure administrative policy and its implementation. Generally speaking, there are two levels at which the proposals of the HLEG report will be reshaped – the local and the international.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Local Architecture</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">Any programme to implement a developmental policy in this country, for instance, universal primary education, the Integrated Child Development Services (ICDS), mid-day meals, the National R­ural Health Mission (NRHM), and so on, is practically reconfigured to align with the logic of political forces and possibilities at the local level. Top-down planning initiatives always trickle down without disturbing the power hierarchy along paths of least resistance. Such measures do not result in substantive benefits to the people targeted and also suppress critical questions from the ground level.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The current distribution of 300 calories a day under the ICDS consists of a nearly inedible powdered mixture, which is conceived by the powers-that-be as a dole to recipients habitually imagined as objects of charity. If the programme had been forged through an a­ctive political consensus with the dalits and other castes, it would have resulted in a far more substantial diet, including milk and eggs. This has been the case in Tamil Nadu for more than two decades. Characteristically, the packaging of these “nutritive” powders generates super-profits for businessmen in the loop.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Similarly, from the 1970s onwards, countless teachers on government school rolls ran businesses in towns, captured the textbook industry and opened tutorial institutes and colleges. In short, they did everything except teach, presenting themselves once a month to collect salaries. The alter­native configurations that have emerged over time to utilise the money made available by policy to both education and the ICDS remain very stable, deeply rooted and protected.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">To cite a different example, the NRHM has a regulation that pregnant women should deliver in institutions to prevent maternal mortalities. This has resulted in confusion regarding the roles of the dais (traditional birth attendants) and auxiliary nurses and midwives (ANMs), who played crucial roles at the village and sub-centre levels. As a result of this directive, deliveries are turned away from health sub-centres. Preventing mortalities implies the availability of an anaesthetist, facilities for a caesarean section and blood for transfusion in case of an emergency. These are avail­able at district hospitals. There is predictably an unmanageable rush at these institutions and women are sent home three to 12 hours after delivery. Cash incentives to compensate for the increased cost of institutional deliveries without strengthening the system only exacerbates the problem.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Though in different ways, these examples illustrate a failure of plan intentions. The issue here is not so much corruption (the favourite scapegoat) or even a lack of “merit” or competence, as the inability of planners to gauge reality on the ground and to convincingly communicate and negotiate with people who implement and use their programmes. Without processes carefully designed to overcome hurdles, plans fail. The HLEG report clearly acknowledges the importance of people’s participation, but not adequately. It shows inadequate comprehension of the fundamental rift between planning perspectives in their current top-down form and the demands of a practical and functioning UHC service.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>International and National Business Interests</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">It is clear that the impetus to set up UHC in India comes from big business and the state’s agenda for growth. Quite tellingly, the World Bank and other international funding institutions like the Rockefeller Foundation have endorsed the Aarogyasri programme of healthcare for the poor in Andhra Pradesh (Shukla et al 2011). Indeed, it is commonly believed that the Planning Commission constituted the HLEG and gave it the responsibility to come up with a way to spend 2.5% of the gross domestic product (GDP) in the healthcare sector. This figure was presumably predetermined and this is the likely reason the report starts with the subject of finance (instead of ground-level considerations such as disease burden, health goals and system weaknesses). With assured Plan allocations and the high profile “success” of the Aarogyasri model, an insurance-based, expensive, tertiary care based universal healthcare system for India is likely.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Given this reality, and from the trends observable in the Aarogyasri pr0gramme, if the state does not have a role, it is ­almost certain that the healthcare ­system will be an e­xorbitant, interventionist, high technology tertiary care one. In this context, the HLEG report ­emphasises that public institutions have a key role to play. Unfortunately, many of these institutions have been reduced to agencies implementing donor-driven national programmes like family planning, the current drive for the introduction of newer vaccines, etc. As a way out, we feel that both the private and public sectors must be engaged, but configured in such a way that they act as checks on the un­accountability and rank opportunism of the private sector on the one hand, and the insensitive and unresponsive character of the public sector on the other. This will also facilitate the HLEG’s agenda of pushing for broader investments in the social determinants of health such as food, sanitation and housing.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Historical Snapshots</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">An important factor in the success of different UHC systems in the world has been the circumstances in which they emerged. The UK’s National Health Service and the Beveridge report that led to it followed the Great Depression and the second world war and it had the approval of both the Conservative and Labour parties. There was a desperate need to raise morale and work a way out of a national debt, estimated at about £3,300 million. It was this configuration of circumstances that held a shared appreciation of the health system in place, leading to its success.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">In Brazil, the 1988 constitution marked the end of 20 years of military rule and the emergence of democracy (Buss and Gadelha 1996). This was preceded by the Eighth National Health Conference in 1986 attended by 5,000 participants, representing users, welfare organisations and public service personnel. The conference drafted the constitutional charter on health, which ultimately led to health and social security becoming constitutional principles. It was undoubtedly the fresh spirit of freedom and an overall commitment to the well-being and social security of the population that led to the country embarking on the path of successful healthcare for its people.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Thailand also set up its UHC system during a process of democratisation when new actors entered the political arena. The slogan used to mobilise people was “30 baht to treat all diseases” (1 baht is approximately 1.43 rupees; for an account see Khanna 2010-11). It is surprising that the HLEG report misses this important dimension of a fresh start providing a stimulus to UHC in the many vig­nettes of healthcare successes across the world it provides. It narrates their stories as if putting a healthcare system in place was merely an administrative matter of bringing together logistics, planning and good intentions (though it does briefly mention political movements in the introduction to these studies).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Closer home, in Tamil Nadu, the success of the state healthcare system, which functions more effectively than most in the rest of the country, was a­ttributed by a senior official to “greater enlightenment, efficient operation and personal commitment”. All these may be traced to the history of Tamil Nadu’s struggles over the last century with the problems of political representation, self-respect and brahmin domination. These movements and the emergence of the Dravida Munnetra Kazhagam (DMK) and its offshoots have led to a strong political will and administrative commitment to the plural subaltern population constituted of various castes, nationa­lities and historical circumstances. Though the English press tends to focus largely on corruption, the state has had successes in vital areas such as health, education and food.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">What these examples teach us is that a political environment that allows for motivation, commitment and the active involvement of the people is essential for a healthcare system to succeed. Is it possible to construct a progressive hegemony around the concept of UHC? This is the question on which the success of the HLEG’s proposals hinges.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Only an extensive agreement across the chain of the implementing agencies that healthcare is an item of absolute priority will generate the organic commitment, supervision and diligence necessary to conducting its operations successfully. The absence of these today is not so much a mark of corruption, selfishness or incompetence as the mark of an elitist model of national development that has failed to carry the people (including administrative functionaries) with it. It is the insularity of elite political will obsessed with indices of rapid growth to the exclusion of the concerns of most of the people of India. Even in these circumstances, a progressive h­ege­mony may not be impossible to construct. There are many examples of partial success in India, despite some of them having somewhat dubious credentials, such as family planning, universal primary e­ducation, oral polio vaccination and the Tamil Nadu health experience.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Progressive hegemony can never be simple government propaganda. We would agree broadly with the Medico Friends Circle position (MFC 2011-12) that the government needs to engage in negotiations with different groups of people so that their (even partially arti­culated) ideas, needs and constraints are woven into the broad picture. However, this would require the involvement of not just secular people’s health assemblies and panchayati raj institutions, but also mainstream national and regional political parties (like the Congress, BJP, Shiv Sena, the Majlis-e-Ittehadul Muslimeen) and their local representatives. While it is indubitable that politicians are deeply corruptible, and invested in businesses (as was the late Y S Rajasekhara Reddy in Andhra Pradesh) they also have historically developed a degree of bilateral communication with and accountability to the people they represent. We should note that minorities and marginalised castes and tribal groups have to be important participants because they are structurally the most vulnerable in secular healthcare programmes. The political parties that address them would historically be attuned to their aspirations and felt needs.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">A recommendation that stands out in the HLEG report is the one to establish medical colleges linked to district hospitals as apex tertiary units. We feel these should largely be government-run colleges, which establish standard practices in areas for tertiary care and support primary- and secondary-care initiatives (both government and private). The proposed three-year Bachelor of Rural Health Care course (HLEG 2011: 159) will strengthen the primary and secondary-care systems.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">It is worth speculating on the several advantages medical colleges linked to district hospitals could have. One, since the college will be a government-run e­ducational institution providing tertiary care, its economics need not be profit-oriented, thus offsetting a constraint in providing accessible, advanced medical care in the hinterland. Two, the increased availability of seats for medical education is likely to make the discipline less a target of artificial academic merit measured by entrance tests and more one of a genuine concern for healthcare. Three, medical courses will be less susceptible to the current laissez-faire curriculum policy where only the most advanced specialisations imbue value to an export-oriented medical education. This will create the possibility of a curriculum that is more responsive to actual health needs.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Four, depending on a district’s case load of medical problems to teach students will exert a corrective influence on competence, understanding and inventiveness. This will also hopefully result in a research orientation that is responsive to the specific healthcare needs of the people of this country. Finally, with the medical college’s support, the medical system will be able to penetrate rural areas in a way that other initiatives of the last two or three decades have not. On the whole, it may carry forward the promise of Aarogyasri programme with the necessary radical course correction.</div><div style="text-align: justify"> </div><div style="text-align: justify"><em><strong>References</strong></em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">Buss, P and P Gadelha (1996): “Healthcare Systems in Transition: Brazil Part I: An Outline of Brazil’s Healthcare Reforms”, Journal of Public Health Medicine, (18) 3, pp 289-95.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">HLEG (2011): “High Level Expert Group Report on Universal Health Coverage for India”, Planning Commission of India, New Delhi.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Khanna, R (2010-11): “Universal Health Coverage in Thailand: What Lessons Can India Learn?”, MFC Bulletin, 342-44, August 2010-January 2011.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">MFC (2011-12): “Exploring a Road Map for Health Care for All/UAHC”, MFC Bulletin, 348-50, August 2011-January 2012.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Shukla, R, V Shatrugna and R Srivatsan (2011): “Aarogyasri Healthcare Model: Advantage Private Sector”, Economic & Political Weekly, 46 (49), pp 38-42.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Walsh, J A and K S Warren (1979): “Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries”, New England Journal of Medicine, 301, pp 967-74.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">World Bank (1993): Investing in Health, World Development Report 1993 (New York: Oxford University Press).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Zachariah, A, R Srivatsan, and S Tharu (2010): T­owards a Critical Medical Practice: Reflections on the Dilemmas of Medical Culture Today (­Hyderabad: Orient BlackSwan).</div><div style="text-align: justify"><br /></div>
</div>
</td>
</tr>
</table>
</div>
</div>
</div>
<div class="clear"></div>
<br><a href="http://beta.epw.in/newsItem/comment/191039/" class="re" target="_blank">Economic and Political Weekly, Vol XLVII, No. 7, 25 February, 2012, http://beta.epw.in/newsItem/comment/191039/</a><div class="clear"></div>
<div style="padding-top: 18px;">
<p class="post-tag">Tagged with:
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Health"
title="Health">
Health </a>
</p>
</div>
<div class="clear"></div>
<br><br>
<div class="widget-top">
<h4>Related Articles</h4>
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<ul id="recentcomments">
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/fifth-report-from-gambia-implicates-indian-drug-maker-for-contaminated-syrups-banjot-kaur.html"
title="Fifth Report From Gambia Implicates Indian Drug Maker for Contaminated Syrups - Banjot Kaur">
Fifth Report From Gambia Implicates Indian Drug Maker for Contaminated Syrups - Banjot Kaur </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-may-have-seen-steepest-dip-in-multidimensional-poverty-among-110-nations-as-per-undp-data-nikhil-rampal.html"
title="India may have seen steepest dip in multidimensional poverty among 110 nations as per UNDP data - Nikhil Rampal">
India may have seen steepest dip in multidimensional poverty among 110 nations as per UNDP data - Nikhil Rampal </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/health-among-top-three-priorities-for-indian-voters-after-jobs-and-education-survey-shows-oliver-heath-jyoti-mishra-louise-tillin-sandhya-venkateswaran.html"
title="Health among top three priorities for Indian voters after jobs and education, survey shows - Oliver Heath, Jyoti Mishra, Louise Tillin & Sandhya Venkateswaran">
Health among top three priorities for Indian voters after jobs and education, survey shows - Oliver Heath, Jyoti Mishra, Louise Tillin & Sandhya Venkateswaran </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/prevalence-of-zero-food-among-infants-and-young-children-in-india-patterns-of-change-across-the-states-and-union-territories-of-india-1993-2021-the-lancet.html"
title="Prevalence of Zero-Food among infants and young children in India - The Lancet ">
Prevalence of Zero-Food among infants and young children in India - The Lancet </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-s-sustainability-goals-at-risk-because-of-extreme-heatwaves-carbon-copy.html"
title="India's Sustainability Goals at Risk Because of Extreme Heatwaves - Carbon Copy">
India's Sustainability Goals at Risk Because of Extreme Heatwaves - Carbon Copy </a>
</li>
</ul>
</div>
<div class="comment-respond" id="respond">
<a name="commentbox"> </a>
<h3 class="comment-reply-title" id="reply-title">Write Comments</h3>
<form method="post" accept-charset="utf-8" role="form" action="/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"><div style="display:none;"><input type="hidden" name="_method" value="POST"/></div> <form class="comment-form" id="commentform" method="post" action="#commentbox" onSubmit="return validate()"
name="cmtform">
<input type="hidden" name="cmttype" value="articlecmt"/>
<input type="hidden" name="article_id" value="13230"/>
<p class="comment-notes">Your email address will not be published. Required fields are marked <span
class="required">*</span></p>
<p class="comment-form-author">
<label for="commenterName">Name</label>
<span class="required">*</span>
<input type="text" aria-required="true" size="30"
value=""
name="commenterName" id="commenterName" required="true">
</p>
<p class="comment-form-email">
<label for="commenterEmail">Email</label> <span class="required">*</span>
<input aria-required="true" size="30" name="commenterEmail" id="commenterEmail" type="email"
value=""
required="true">
</p>
<p class="comment-form-contact">
<label for="commenterPh">Contact No.</label>
<input type="text" size="30"
value=""
name="commenterPh" id="commenterPh">
</p>
<p class="comment-form-comment">
<label for="comment">Comment</label>
<textarea aria-required="true" required="true" rows="8" cols="45" name="comment"
id="comment"></textarea>
</p>
<p class="comment-form-comment">
<label for="comment">Type the characters you see in the image below <span class="required">*</span><br><img
class="captchaImg"
src="https://im4change.in/securimage_show_art.php?tk=861803084" alt="captcha"/>
</label>
</p>
<input type="text" name="vrcode" required="true"/>
<p class="form-submit" style="width: 200px;">
<input type="submit" value="Post Comment" id="submit" name="submit">
</p></form>
</div>
<style>
.ui-widget-content {
height: auto !important;
}
</style>
<div id="share-modal"></div>
<style>
.middleContent a{
background-color: rgba(108,172,228,.2);
}
.middleContent a:hover{
background-color: #418fde;
border-color: #418fde;
color: #000;
}
</style>
<script>
function shareArticle(article_id) {
var options = {
modal: true,
height: 'auto',
width: 600 + 'px'
};
$('#share-modal').html("");
$('#share-modal').load('https://im4change.in/share_article?article_id=' + article_id).dialog(options).dialog('open');
}
function postShare() {
var param = 'article_id=' + $("#article_id").val();
param = param + '&y_name=' + $("#y_name").val();
param = param + '&y_email=' + $("#y_email").val();
param = param + '&f_name=' + $("#f_name").val();
param = param + '&f_email=' + $("#f_email").val();
param = param + '&y_msg=' + $("#y_msg").val();
$.ajax({
type: "POST",
url: 'https://im4change.in/post_share_article',
data: param,
success: function (response) {
$('#share-modal').html("Thank You, Your message posted to ");
}
});
return false;
}
</script> </div>
</div>
<!-- Right Side Section Start -->
<!-- MAP Section START -->
<aside class="sidebar indexMarg">
<div class="ad-cell">
<a href="https://im4change.in/statemap.php" title="">
<img src="https://im4change.in/images/map_new_version.png?1582080666" alt="India State Map" class="indiamap" width="232" height="252"/> </a>
<div class="rightmapbox">
<div id="sideOne" class="docltitle"><a href="https://im4change.in/state-report/india/36" target="_blank">DOCUMENTS/
REPORTS</a></div>
<div id="sideTwo" class="statetitle"><a href="https://im4change.in/states.php"target="_blank">STATE DATA/
HDRs.</a></div>
</div>
<div class="widget widgePadTop"></div>
</div>
</aside>
<!-- MAP Section END -->
<aside class="sidebar sidePadbottom">
<div class="rightsmlbox1" >
<a href="https://im4change.in/knowledge_gateway" target="_blank" style="color: #035588;
font-size: 17px;">
KNOWLEDGE GATEWAY
</a>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/newsletter" target="_blank">
NEWSLETTER
</a>
</p>
</div>
</div>
<div class="rightsmlbox1" style="height: 325px;">
<div>
<p class="rightsmlbox1_title">
Interview with Prof. Ravi Srivastava
</p>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/video/interview-with-prof-ravi-srivastava-on-current-economic-crisis">
<img width="250" height="200" src="/images/interview_video_home.jpg" alt="Interview with Prof. Ravi Srivastava"/>
</a>
<!--
<iframe width="250" height="200" src="https://www.youtube.com/embed/MmaTlntk-wc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe>-->
</p>
<a href="https://im4change.in/videogallery" class="more-link CatArchalAnch1" target="_blank">
More videos
</a>
</div>
</div>
<div class="rightsmlbox1">
<div>
<!--div id="sstory" class="rightboxicons"></div--->
<p class="rightsmlbox1_title"><a href="https://im4change.in/list-success-stories" target="_blank">Success Stories</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/interviews" target="_blank">Interviews</a>
</p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a href="https://www.commoncause.in/page.php?id=10" >Donate</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/marquee"
class="isf_link more-link" title="India Focus?" style="border: 4px solid #fdd922;width: 90%;background-color: #fdd922;text-align: center;color: #000000;font-size:18px" target="_blank">India Focus</a></p> </div>
</div>
<div class="rightsmlbox1" style="height: 104px !important;">
<a href="https://im4change.in/quarterly_reports.php" target="_blank">
Quarterly Reports on Effect of Economic Slowdown on Employment in India (2008 - 2015)
</a>
</div>
<!-- <div class="rightsmlbox1">
<a href="https://play.google.com/store/apps/details?id=com.im4.im4change" target="_blank">
</a></div> -->
<!-- <section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">Most Visited</h2>
</section> -->
<!-- accordion Starts here -->
<!-- <div id="accordion" class="accordMarg">
</div> -->
<!-- accordion ends here -->
<!-- Widget Tag Cloud Starts here -->
<div id="tag_cloud-2" class="widget widget_tag_cloud">
<section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">MOST VISITED TAGS</h2>
</section>
<div class="widget-top wiPdTp">
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<div class="tagcloud">
<a href="https://im4change.in/search?qryStr=Agriculture"
target="_blank" class="tag-link-4 font4">Agriculture</a>
<a href="https://im4change.in/search?qryStr=Food Security"
target="_blank" class="tag-link-4 font4">Food Security</a>
<a href="https://im4change.in/search?qryStr=Law and Justice"
target="_blank" class="tag-link-4 font4">Law and Justice</a>
<a href="https://im4change.in/search?qryStr=Health"
target="_blank" class="tag-link-4 font4">Health</a>
<a href="https://im4change.in/search?qryStr=Right to Food"
target="_blank" class="tag-link-4 font4">Right to Food</a>
<a href="https://im4change.in/search?qryStr=Corruption"
target="_blank" class="tag-link-4 font4">Corruption</a>
<a href="https://im4change.in/search?qryStr=farming"
target="_blank" class="tag-link-4 font4">farming</a>
<a href="https://im4change.in/search?qryStr=Environment"
target="_blank" class="tag-link-4 font4">Environment</a>
<a href="https://im4change.in/search?qryStr=Right to Information"
target="_blank" class="tag-link-4 font4">Right to Information</a>
<a href="https://im4change.in/search?qryStr=NREGS"
target="_blank" class="tag-link-4 font4">NREGS</a>
<a href="https://im4change.in/search?qryStr=Human Rights"
target="_blank" class="tag-link-4 font4">Human Rights</a>
<a href="https://im4change.in/search?qryStr=Governance"
target="_blank" class="tag-link-4 font4">Governance</a>
<a href="https://im4change.in/search?qryStr=PDS"
target="_blank" class="tag-link-4 font4">PDS</a>
<a href="https://im4change.in/search?qryStr=COVID-19"
target="_blank" class="tag-link-4 font4">COVID-19</a>
<a href="https://im4change.in/search?qryStr=Land Acquisition"
target="_blank" class="tag-link-4 font4">Land Acquisition</a>
<a href="https://im4change.in/search?qryStr=mgnrega"
target="_blank" class="tag-link-4 font4">mgnrega</a>
<a href="https://im4change.in/search?qryStr=Farmers"
target="_blank" class="tag-link-4 font4">Farmers</a>
<a href="https://im4change.in/search?qryStr=transparency"
target="_blank" class="tag-link-4 font4">transparency</a>
<a href="https://im4change.in/search?qryStr=Gender"
target="_blank" class="tag-link-4 font4">Gender</a>
<a href="https://im4change.in/search?qryStr=Poverty"
target="_blank" class="tag-link-4 font4">Poverty</a>
<a href="https://im4change.in/search?qryStr=Farm Laws" target="_blank" class="tag-link-4 font4">Farm Laws
</a>
<a href="https://im4change.in/search?qryStr=Citizenship Amendment Act" target="_blank" class="tag-link-4 font4">Citizenship Amendment Act
</a>
<a href="https://im4change.in/search?qryStr=CAA NPR NRIC" target="_blank" class="tag-link-4 font4">CAA NPR NRIC
</a>
<a href="https://im4change.in/search?qryStr=Job Losses" target="_blank" class="tag-link-4 font4">Job Losses
</a>
<a href="https://im4change.in/search?qryStr=Migrant Workers" target="_blank" class="tag-link-4 font4">Migrant Workers
</a>
<a href="https://im4change.in/search?qryStr=Unemployment" target="_blank" class="tag-link-4 font4">Unemployment
</a>
<a href="https://im4change.in/search?qryStr=PMGKAY" target="_blank" class="tag-link-4 font4">PMGKAY
</a>
<a href="https://im4change.in/search?qryStr=PM-KISAN" target="_blank" class="tag-link-4 font4">PM-KISAN
</a>
<a href="https://im4change.in/search?qryStr=PM-CARES" target="_blank" class="tag-link-4 font4">PM-CARES
</a>
<a href="https://im4change.in/search?qryStr=LFPR" target="_blank" class="tag-link-4 font4">LFPR
</a>
</div>
</div>
</div>
<!-- Widget Tag Cloud Ends here -->
</aside>
<!-- Right Side Section End -->
</div>
<section class="cat-box cats-review-box footerSec">
<h2 class="cat-box-title vSec CatArcha">Video
Archives</h2>
<h2 class="cat-box-title CatArchaTitle">Archives</h2>
<div class="cat-box-content">
<div class="reviews-cat">
<div class="CatArchaDiv1">
<div class="CatArchaDiv2">
<ul>
<li>
<a href="https://im4change.in/news-alerts-57/moving-upstream-luni-fellowship.html" target="_blank">
Moving Upstream: Luni – Fellowship </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/135-million-indians-exited-multidimensional-poverty-as-per-government-figures-is-that-the-same-as-poverty-reduction.html" target="_blank">
135 Million Indians Exited “Multidimensional" Poverty as per Government... </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/explainer-why-are-tomato-prices-on-fire.html" target="_blank">
Explainer: Why are Tomato Prices on Fire? </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/nsso-survey-only-39-1-of-all-households-have-drinking-water-within-dwelling-46-7-of-rural-households-use-firewood-for-cooking.html" target="_blank">
NSSO Survey: Only 39.1% of all Households have Drinking... </a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/news-alerts-57"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/I51LYnP8BOk/1.jpg"
alt=" Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Short-Video-on-im4change-Hindi-website-Inclusive-Media-for-Change" target="_blank">
Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/kNqha-SwfIY/1.jpg"
alt=" "Session 1: Scope of IDEA and AgriStack" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-1- Scope-of-IDEA-and-AgriStack-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 1: Scope of IDEA and AgriStack" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/6kIVjlgZItk/1.jpg"
alt=" "Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-2-Farmer-Centric-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/2BeHTu0y7xc/1.jpg"
alt=" "Session 3: Future of Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-3-Future-of-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 3: Future of Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="divWidth">
<ul class="divWidthMarg">
<li>
<a href="https://im4change.in/video/Public-Spending-on-Agriculture-in-India-Source-Foundation-for-Agrarian-Studies"
title="Public Spending on Agriculture in India (Source: Foundation for Agrarian Studies)" target="_blank">
Public Spending on Agriculture in India (Source: Foundation for...</a>
</li>
<li>
<a href="https://im4change.in/video/Agrarian-Change-Seminar-Protests-against-the-New-Farm-Laws-in-India-by-Prof-Vikas-Rawal-JNU-Source-Journal-Of-Agrarian-Change"
title="Agrarian Change Seminar: 'Protests against the New Farm Laws in India' by Prof. Vikas Rawal, JNU (Source: Journal Of Agrarian Change) " target="_blank">
Agrarian Change Seminar: 'Protests against the New Farm Laws...</a>
</li>
<li>
<a href="https://im4change.in/video/Webinar-Ramrao-The-Story-of-India-Farm-Crisis-Source-Azim-Premji-University"
title="Webinar: Ramrao - The Story of India's Farm Crisis (Source: Azim Premji University)" target="_blank">
Webinar: Ramrao - The Story of India's Farm Crisis...</a>
</li>
<li>
<a href="https://im4change.in/video/water-and-agricultural-transformation-in-India"
title="Water and Agricultural Transformation in India: A Symbiotic Relationship (Source: IGIDR)" target="_blank">
Water and Agricultural Transformation in India: A Symbiotic Relationship...</a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/videogallery"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
</div>
</div>
</div>
</section> </div>
<div class="clear"></div>
<!-- Footer option Starts here -->
<div class="footer-bottom fade-in animated4">
<div class="container">
<div class="social-icons icon_flat">
<p class="SocialMargTop"> Website Developed by <a target="_blank" title="Web Development"
class="wot right"
href="http://www.ravinderkhurana.com/" rel="nofollow">
RAVINDErkHURANA.com</a></p>
</div>
<div class="alignleft">
<a
target="_blank" href="https://im4change.in/objectives-8.html"
class="link"
title="Objectives">Objectives</a> | <a
target="_blank" href="https://im4change.in/about-us-9.html"
class="link" title="About Us">About Us</a> | <a
target="_blank" href="https://im4change.in/media-workshops.php"
class="ucwords">Workshops</a> | <a
target="_blank" href="https://im4change.in/disclaimer/disclaimer-149.html"
title="Disclaimer">Disclaimer</a> </div>
</div>
</div>
<!-- Footer option ends here -->
</div>
<div id="connect">
<a target="_blank"
href="http://www.facebook.com/sharer.php?u=https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"
title="Share on Facebook">
<img src="https://im4change.in/images/Facebook.png?1582080640" alt="share on Facebook" class="ImgBorder"/>
</a><br/>
<a target="_blank"
href="http://twitter.com/share?text=Im4change&url=https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"
title="Share on Twitter">
<img src="https://im4change.in/images/twitter.png?1582080632" alt="Twitter" class="ImgBorder"/> </a>
<br/>
<a href="/feeds" title="RSS Feed" target="_blank">
<img src="https://im4change.in/images/rss.png?1582080632" alt="RSS" class="ImgBorder"/>
</a>
<br/>
<a class="feedback-link" id="feedbackFormLink" href="#">
<img src="https://im4change.in/images/feedback.png?1582080630" alt="Feedback" class="ImgBorder"/>
</a> <br/>
<a href="javascript:function iprl5(){var d=document,z=d.createElement('scr'+'ipt'),b=d.body,l=d.location;try{if(!b)throw(0);d.title='(Saving...) '+d.title;z.setAttribute('src',l.protocol+'//www.instapaper.com/j/WKrH3R7ORD5p?u='+encodeURIComponent(l.href)+'&t='+(new Date().getTime()));b.appendChild(z);}catch(e){alert('Please wait until the page has loaded.');}}iprl5();void(0)"
class="bookmarklet" onclick="return explain_bookmarklet();">
<img src="https://im4change.in/images/read-it-later.png?1582080632" alt="Read Later" class="ImgBorder"/> </a>
</div>
<!-- Feedback form Starts here -->
<div id="feedbackForm" class="overlay_form" class="ImgBorder">
<h2>Contact Form</h2>
<div id="contactform1">
<div id="formleft">
<form id="submitform" action="/contactus.php" method="post">
<input type="hidden" name="submitform" value="submitform"/>
<input type="hidden" name="salt_key" value="a0e0f2c6a0644a70e57ad2c96829709a"/>
<input type="hidden" name="ref" value="feedback"/>
<fieldset>
<label>Name :</label>
<input type="text" name="name" class="tbox" required/>
</fieldset>
<fieldset>
<label>Email :</label>
<input type="text" name="email" class="tbox" required/>
</fieldset>
<fieldset>
<label>Message :</label>
<textarea rows="5" cols="20" name="message" required></textarea>
</fieldset>
<fieldset>
Please enter security code
<div class="clear"></div>
<input type="text" name="vrcode" class="tbox"/>
</fieldset>
<fieldset>
<input type="submit" class="button" value="Submit"/>
<a href="#" id="closefeedbakcformLink">Close</a>
</fieldset>
</form>
</div>
<div class="clearfix"></div>
</div>
</div>
<div id="donate_popup" class="modal" style="max-width: 800px;">
<table width="100%" border="1">
<tr>
<td colspan="2" align="center">
<b>Support im4change</b>
</td>
</tr>
<tr>
<td width="25%" valign="middle">
<img src="https://im4change.in/images/logo2.jpg?1582080632" alt="" width="100%"/> </td>
<td style="padding-left:10px;padding-top:10px;">
<form action="https://im4change.in/donate" method="get">
<table width="100%" cellpadding="2" cellspacing="2">
<tr>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
10
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
100
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
1000
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
50
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
500
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
<input type="text" name="price" placeholder="?" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td colspan="3" align="right">
<input type="button" name="Pay" value="Pay"
style="width: 200px;background-color: rgb(205, 35, 36);color: #ffffff;"/>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</div><script type='text/javascript'>
/* <![CDATA[ */
var tievar = {'go_to': 'Go to...'};
/* ]]> */
</script>
<script src="/js/tie-scripts.js?1575549704"></script><script src="/js/bootstrap.js?1575549704"></script><script src="/js/jquery.modal.min.js?1578284310"></script><script>
$(document).ready(function() {
// tell the autocomplete function to get its data from our php script
$('#s').autocomplete({
source: "/autocomplete"
});
});
</script>
<script src="/vj-main-sw-register.js" async></script>
<script>function init(){var imgDefer=document.getElementsByTagName('img');for(var i=0;i<imgDefer.length;i++){if(imgDefer[i].getAttribute('data-src')){imgDefer[i].setAttribute('src',imgDefer[i].getAttribute('data-src'))}}}
window.onload=init;</script>
</body>
</html>'
}
$maxBufferLength = (int) 8192
$file = '/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php'
$line = (int) 853
$message = 'Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853'
Cake\Http\ResponseEmitter::emit() - CORE/src/Http/ResponseEmitter.php, line 48
Cake\Http\Server::emit() - CORE/src/Http/Server.php, line 141
[main] - ROOT/webroot/index.php, line 39
Warning (2): Cannot modify header information - headers already sent by (output started at /home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php:853) [CORE/src/Http/ResponseEmitter.php, line 148]
$response = object(Cake\Http\Response) {
'status' => (int) 200,
'contentType' => 'text/html',
'headers' => [
'Content-Type' => [
[maximum depth reached]
]
],
'file' => null,
'fileRange' => [],
'cookies' => object(Cake\Http\Cookie\CookieCollection) {},
'cacheDirectives' => [],
'body' => '<!DOCTYPE html>
<!--[if lt IE 7 ]>
<html class="ie ie6" lang='en'> <![endif]-->
<!--[if IE 7 ]>
<html class="ie ie7" lang='en'> <![endif]-->
<!--[if IE 8 ]>
<html class="ie ie8" lang='en'> <![endif]-->
<!--[if (gte IE 9)|!(IE)]><!-->
<html lang='en'>
<!--<![endif]-->
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title>
LATEST NEWS UPDATES | Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna </title>
<meta name="description" content="
While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it..."/>
<meta name="keywords" content="Health"/>
<meta name="news_keywords" content="Health">
<link rel="alternate" type="application/rss+xml" title="ROR" href="/ror.xml"/>
<link rel="alternate" type="application/rss+xml" title="RSS 2.0" href="/feeds/"/>
<link rel="stylesheet" href="/css/bootstrap.min.css?1697864993"/> <link rel="stylesheet" href="/css/style.css?v=1.1.2"/> <link rel="stylesheet" href="/css/style-inner.css?1577045210"/> <link rel="stylesheet" id="Oswald-css"
href="https://fonts.googleapis.com/css?family=Oswald%3Aregular%2C700&ver=3.8.1" type="text/css"
media="all">
<link rel="stylesheet" href="/css/jquery.modal.min.css?1578285302"/> <script src="/js/jquery-1.10.2.js?1575549704"></script> <script src="/js/jquery-migrate.min.js?1575549704"></script> <link rel="shortcut icon" href="/favicon.ico" title="Favicon">
<link rel="stylesheet" href="/css/jquery-ui.css?1580720609"/> <script src="/js/jquery-ui.js?1575549704"></script> <link rel="preload" as="style" href="https://www.im4change.org/css/custom.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery.modal.min.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery-ui.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/li-scroller.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<!-- <link rel="preload" as="style" href="https://www.im4change.org/css/style.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous"> -->
<link rel="preload" as="style" href="https://www.im4change.org/css/style-inner.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel='dns-prefetch' href="//im4change.org/css/custom.css" crossorigin >
<link rel="preload" as="script" href="https://www.im4change.org/js/bootstrap.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.li-scroller.1.0.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.modal.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.ui.totop.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-1.10.2.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-migrate.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-ui.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/setting.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/tie-scripts.js">
<!--[if IE]>
<script type="text/javascript">jQuery(document).ready(function () {
jQuery(".menu-item").has("ul").children("a").attr("aria-haspopup", "true");
});</script>
<![endif]-->
<!--[if lt IE 9]>
<script src="/js/html5.js"></script>
<script src="/js/selectivizr-min.js"></script>
<![endif]-->
<!--[if IE 8]>
<link rel="stylesheet" type="text/css" media="all" href="/css/ie8.css"/>
<![endif]-->
<meta property="og:title" content="LATEST NEWS UPDATES | Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna" />
<meta property="og:url" content="https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html" />
<meta property="og:type" content="article" />
<meta property="og:description" content="
While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it..." />
<meta property="og:image" content="" />
<meta property="fb:app_id" content="0" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
<link rel="apple-touch-icon-precomposed" sizes="144x144" href="https://im4change.in/images/apple1.png">
<link rel="apple-touch-icon-precomposed" sizes="120x120" href="https://im4change.in/images/apple2.png">
<link rel="apple-touch-icon-precomposed" sizes="72x72" href="https://im4change.in/images/apple3.png">
<link rel="apple-touch-icon-precomposed" href="https://im4change.in/images/apple4.png">
<style>
.gsc-results-wrapper-overlay{
top: 38% !important;
height: 50% !important;
}
.gsc-search-button-v2{
border-color: #035588 !important;
background-color: #035588 !important;
}
.gsib_a{
height: 30px !important;
padding: 2px 8px 1px 6px !important;
}
.gsc-search-button-v2{
height: 41px !important;
}
input.gsc-input{
background: none !important;
}
@media only screen and (max-width: 600px) {
.gsc-results-wrapper-overlay{
top: 11% !important;
width: 87% !important;
left: 9% !important;
height: 43% !important;
}
.gsc-search-button-v2{
padding: 10px 10px !important;
}
.gsc-input-box{
height: 28px !important;
}
/* .gsib_a {
padding: 0px 9px 4px 9px !important;
}*/
}
@media only screen and (min-width: 1200px) and (max-width: 1920px) {
table.gsc-search-box{
width: 15% !important;
float: right !important;
margin-top: -118px !important;
}
.gsc-search-button-v2 {
padding: 6px !important;
}
}
</style>
<script>
$(function () {
$("#accordion").accordion({
event: "click hoverintent"
});
});
/*
* hoverIntent | Copyright 2011 Brian Cherne
* http://cherne.net/brian/resources/jquery.hoverIntent.html
* modified by the jQuery UI team
*/
$.event.special.hoverintent = {
setup: function () {
$(this).bind("mouseover", jQuery.event.special.hoverintent.handler);
},
teardown: function () {
$(this).unbind("mouseover", jQuery.event.special.hoverintent.handler);
},
handler: function (event) {
var currentX, currentY, timeout,
args = arguments,
target = $(event.target),
previousX = event.pageX,
previousY = event.pageY;
function track(event) {
currentX = event.pageX;
currentY = event.pageY;
}
;
function clear() {
target
.unbind("mousemove", track)
.unbind("mouseout", clear);
clearTimeout(timeout);
}
function handler() {
var prop,
orig = event;
if ((Math.abs(previousX - currentX) +
Math.abs(previousY - currentY)) < 7) {
clear();
event = $.Event("hoverintent");
for (prop in orig) {
if (!(prop in event)) {
event[prop] = orig[prop];
}
}
// Prevent accessing the original event since the new event
// is fired asynchronously and the old event is no longer
// usable (#6028)
delete event.originalEvent;
target.trigger(event);
} else {
previousX = currentX;
previousY = currentY;
timeout = setTimeout(handler, 100);
}
}
timeout = setTimeout(handler, 100);
target.bind({
mousemove: track,
mouseout: clear
});
}
};
</script>
<script type="text/javascript">
var _gaq = _gaq || [];
_gaq.push(['_setAccount', 'UA-472075-3']);
_gaq.push(['_trackPageview']);
(function () {
var ga = document.createElement('script');
ga.type = 'text/javascript';
ga.async = true;
ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
var s = document.getElementsByTagName('script')[0];
s.parentNode.insertBefore(ga, s);
})();
</script>
<link rel="stylesheet" href="/css/custom.css?v=1.16"/> <script src="/js/jquery.ui.totop.js?1575549704"></script> <script src="/js/setting.js?1575549704"></script> <link rel="manifest" href="/manifest.json">
<meta name="theme-color" content="#616163" />
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="apple-mobile-web-app-title" content="im4change">
<link rel="apple-touch-icon" href="/icons/logo-192x192.png">
</head>
<body id="top" class="home inner blog">
<div class="background-cover"></div>
<div class="wrapper animated">
<header id="theme-header" class="header_inner" style="position: relative;">
<div class="logo inner_logo" style="left:20px !important">
<a title="Home" href="https://im4change.in/">
<img src="https://im4change.in/images/logo2.jpg?1582080632" class="logo_image" alt="im4change"/> </a>
</div>
<div class="langhindi" style="color: #000;display:none;"
href="https://im4change.in/">
<a class="more-link" href="https://im4change.in/">Home</a>
<a href="https://im4change.in/hindi/" class="langbutton ">हिन्दी</a>
</div>
<nav class="fade-in animated2" id="main-nav">
<div class="container">
<div class="main-menu">
<ul class="menu" id="menu-main">
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
style="left: -40px;"><a
target="_blank" href="https://im4change.in/">Home</a>
</li>
<li class="menu-item mega-menu menu-item-type-taxonomy mega-menu menu-item-object-category mega-menu menu-item-has-children parent-list"
style=" margin-left: -40px;"><a href="#">KNOWLEDGE GATEWAY <span class="sub-indicator"></span>
</a>
<div class="mega-menu-block background_menu" style="padding-top:25px;">
<div class="container">
<div class="mega-menu-content">
<div class="mega-menu-item">
<h3><b>Farm Crisis</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/farmers039-suicides-14.html"
class="left postionrel">Farm Suicides </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/unemployment-30.html"
class="left postionrel">Unemployment </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/rural-distress-70.html"
class="left postionrel">Rural distress </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/migration-34.html"
class="left postionrel">Migration </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/key-facts-72.html"
class="left postionrel">Key Facts </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/debt-trap-15.html"
class="left postionrel">Debt Trap </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Empowerment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/union-budget-73.html"
class="left postionrel">Union Budget And Other Economic Policies </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/forest-and-tribal-rights-61.html"
class="left postionrel">Forest and Tribal Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-education-60.html"
class="left postionrel">Right to Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-food-59.html"
class="left postionrel">Right to Food </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/displacement-3279.html"
class="left postionrel">Displacement </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-work-mg-nrega-39.html"
class="left postionrel">Right to Work (MG-NREGA) </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/gender-3280.html"
class="left postionrel">GENDER </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-information-58.html"
class="left postionrel">Right to Information </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/social-audit-48.html"
class="left postionrel">Social Audit </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Hunger / HDI</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/poverty-and-inequality-20499.html"
class="left postionrel">Poverty and inequality </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/malnutrition-41.html"
class="left postionrel">Malnutrition </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/public-health-51.html"
class="left postionrel">Public Health </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/education-50.html"
class="left postionrel">Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hunger-overview-40.html"
class="left postionrel">Hunger Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hdi-overview-45.html"
class="left postionrel">HDI Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/pds-ration-food-security-42.html"
class="left postionrel">PDS/ Ration/ Food Security </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/sdgs-113.html"
class="left postionrel">SDGs </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/mid-day-meal-scheme-mdms-53.html"
class="left postionrel">Mid Day Meal Scheme (MDMS) </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Environment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/time-bomb-ticking-52.html"
class="left postionrel">Time Bomb Ticking </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/water-and-sanitation-55.html"
class="left postionrel">Water and Sanitation </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/impact-on-agriculture-54.html"
class="left postionrel">Impact on Agriculture </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Law & Justice</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/social-justice-20500.html"
class="left postionrel">Social Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/access-to-justice-47.html"
class="left postionrel">Access to Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/human-rights-56.html"
class="left postionrel">Human Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/corruption-35.html"
class="left postionrel">Corruption </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/general-insecurity-46.html"
class="left postionrel">General Insecurity </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/disaster-relief-49.html"
class="left postionrel">Disaster & Relief </a>
</p>
</div>
</div>
</div>
</div>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page "><a target="_blank" href="https://im4change.in/nceus_reports.php">NCEUS reports</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children parent-list ">
<a target="_blank" href="https://im4change.in/about-us-9.html">About Us <span
class="sub-indicator"></span></a>
<ul class="sub-menu aboutmenu">
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/objectives-8.html">Objectives</a>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/contactus.php">Contact
Us</a></li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/about-us-9.html">About
Us</a></li>
</ul>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children ">
<a target="_blank" href="https://im4change.in/fellowships.php" title="Fellowships">Fellowships</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/media-workshops.php">Workshops</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/research.php">Research</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/links-64">Partners</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
id="menu-item-539"><a target="_blank" href="https://im4change.in/hindi/"
class="langbutton langlinkfont17">हिन्दी</a></li>
</ul>
</div> </div>
<!-- <div style="float: right;">
<script async src="https://cse.google.com/cse.js?cx=18b4f2e0f11bed3dd"></script>
<div class="gcse-search"></div>
</div> -->
<div class="search-block" style=" margin-left: 8px; margin-right: 7px;">
<form method="get" id="searchform" name="searchform"
action="https://im4change.in/search"
onsubmit="return searchvalidate();">
<button class="search-button" type="submit" value="Search"></button>
<input type="text" id="s" name="qryStr" value=""
onfocus="if (this.value == 'Search...') {this.value = '';}"
onblur="if (this.value == '') {this.value = 'Search...';}">
</form>
</div>
</nav>
</header>
<div class="container">
<div id="main-content" class=" main1 container fade-in animated3 sidebar-narrow-left">
<div class="content-wrap">
<div class="content" style="width: 900px;min-height: 500px;">
<section class="cat-box recent-box innerCatRecent">
<h1 class="cat-box-title">Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna</h1>
<a href="JavaScript:void(0);" onclick="return shareArticle(13230);">
<img src="https://im4change.in/images/email.png?1582080630" border="0" width="24" align="right" alt="Share this article"/> </a>
<a href="https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352/print"
rel="nofollow">
<img src="https://im4change.in/images/icon-print.png?1582080630" border="0" width="24" align="right" alt="Share this article"/>
</a>
</section>
<section class="recent-box innerCatRecent">
<small class="pb-1"><span class="dateIcn">
<img src="https://im4change.in/images/published.svg?1582080666" alt="published"/>
Published on</span><span class="text-date"> Feb 24, 2012</span>
<span
class="dateIcn">
<img src="https://im4change.in/images/modified.svg?1582080666" alt="modified"/> Modified on </span><span class="text-date"> Feb 24, 2012</span>
</small>
</section>
<div class="clear"></div>
<div style="padding-top: 10px;">
<div class="innerLineHeight">
<div class="middleContent innerInput latest-news-updates">
<table>
<tr>
<td>
<div>
<div style="text-align: justify"><br /></div><div style="text-align: justify"><em>While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it explores the political dimension, which comprises the forces and interests that come into play to shape and reconfigure administrative policy and its implementation.</em></div><div style="text-align: justify"><em> </em></div><div style="text-align: justify"><em>We are grateful to Anand Zachariah and Susie Tharu for their insightful comments on the report. In particular, Zachariah’s inputs on medical colleges as apex tertiary medical care institutions in districts and Tharu’s stress on the importance of practice need mention. (See Zachariah et al 2010 for a conceptual background).</em></div><div style="text-align: justify"><em><br /></em></div><div style="text-align: justify"><em>R Srivatsan (r.srivats@gmail.com) is with the Anveshi Research Centre for Women’s Studies, Hyderabad and Veena Shatrugna (veenashatrugna@yahoo.com) was with the National Institute of Nutrition, Hyderabad.</em></div><div style="text-align: justify"> </div><div style="text-align: justify">The report of the High Level Ex­pert Group (HLEG) on Universal Health Coverage (UHC) for India is to be welcomed for its comprehensive vision of healthcare. After the neo-liberal proposals on selective primary health care articulated by Walsh and Warren (1979) doubted if providing comprehensive healthcare in a third world country was a feasible goal and the World Bank’s Investing in Health report (1993) put forth an influential model incorporating that view, the HLEG report reaffirms the goal of UHC. This is an important development, which shows that India is at a political and economic stage that no longer needs to repeat the minimalist solutions of selective primary health care – diphtheria-pertussis-tetanus (DPT) immunisation, tetanus toxoid to pregnant w­omen, breastfeeding, chloroquine for malaria and oral rehydration solution (ORS) for diarrhoea. It is indeed worth pausing and pondering over the significance of this moment.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Many of the recommendations (and there are many) in the HLEG report are well-conceived – elimination of cost to the patient; funding through taxation; elimination of insurance; making medical colleges the apex tertiary care providers to the health system at the district level; putting the pharmaceutical industry under the control of the Ministry of Health and Family Welfare, and so on. The single question we would like to a­ddress is: What are the conditions u­nder which the report’s promise will bear fruit?</div><div style="text-align: justify"><br /></div><div style="text-align: justify">To answer this, we explore a dimension that is peculiarly invisible in the report, the political. By the term “political” we mean the different forces and interests that come into play to shape and reconfigure administrative policy and its implementation. Generally speaking, there are two levels at which the proposals of the HLEG report will be reshaped – the local and the international.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Local Architecture</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">Any programme to implement a developmental policy in this country, for instance, universal primary education, the Integrated Child Development Services (ICDS), mid-day meals, the National R­ural Health Mission (NRHM), and so on, is practically reconfigured to align with the logic of political forces and possibilities at the local level. Top-down planning initiatives always trickle down without disturbing the power hierarchy along paths of least resistance. Such measures do not result in substantive benefits to the people targeted and also suppress critical questions from the ground level.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The current distribution of 300 calories a day under the ICDS consists of a nearly inedible powdered mixture, which is conceived by the powers-that-be as a dole to recipients habitually imagined as objects of charity. If the programme had been forged through an a­ctive political consensus with the dalits and other castes, it would have resulted in a far more substantial diet, including milk and eggs. This has been the case in Tamil Nadu for more than two decades. Characteristically, the packaging of these “nutritive” powders generates super-profits for businessmen in the loop.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Similarly, from the 1970s onwards, countless teachers on government school rolls ran businesses in towns, captured the textbook industry and opened tutorial institutes and colleges. In short, they did everything except teach, presenting themselves once a month to collect salaries. The alter­native configurations that have emerged over time to utilise the money made available by policy to both education and the ICDS remain very stable, deeply rooted and protected.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">To cite a different example, the NRHM has a regulation that pregnant women should deliver in institutions to prevent maternal mortalities. This has resulted in confusion regarding the roles of the dais (traditional birth attendants) and auxiliary nurses and midwives (ANMs), who played crucial roles at the village and sub-centre levels. As a result of this directive, deliveries are turned away from health sub-centres. Preventing mortalities implies the availability of an anaesthetist, facilities for a caesarean section and blood for transfusion in case of an emergency. These are avail­able at district hospitals. There is predictably an unmanageable rush at these institutions and women are sent home three to 12 hours after delivery. Cash incentives to compensate for the increased cost of institutional deliveries without strengthening the system only exacerbates the problem.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Though in different ways, these examples illustrate a failure of plan intentions. The issue here is not so much corruption (the favourite scapegoat) or even a lack of “merit” or competence, as the inability of planners to gauge reality on the ground and to convincingly communicate and negotiate with people who implement and use their programmes. Without processes carefully designed to overcome hurdles, plans fail. The HLEG report clearly acknowledges the importance of people’s participation, but not adequately. It shows inadequate comprehension of the fundamental rift between planning perspectives in their current top-down form and the demands of a practical and functioning UHC service.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>International and National Business Interests</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">It is clear that the impetus to set up UHC in India comes from big business and the state’s agenda for growth. Quite tellingly, the World Bank and other international funding institutions like the Rockefeller Foundation have endorsed the Aarogyasri programme of healthcare for the poor in Andhra Pradesh (Shukla et al 2011). Indeed, it is commonly believed that the Planning Commission constituted the HLEG and gave it the responsibility to come up with a way to spend 2.5% of the gross domestic product (GDP) in the healthcare sector. This figure was presumably predetermined and this is the likely reason the report starts with the subject of finance (instead of ground-level considerations such as disease burden, health goals and system weaknesses). With assured Plan allocations and the high profile “success” of the Aarogyasri model, an insurance-based, expensive, tertiary care based universal healthcare system for India is likely.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Given this reality, and from the trends observable in the Aarogyasri pr0gramme, if the state does not have a role, it is ­almost certain that the healthcare ­system will be an e­xorbitant, interventionist, high technology tertiary care one. In this context, the HLEG report ­emphasises that public institutions have a key role to play. Unfortunately, many of these institutions have been reduced to agencies implementing donor-driven national programmes like family planning, the current drive for the introduction of newer vaccines, etc. As a way out, we feel that both the private and public sectors must be engaged, but configured in such a way that they act as checks on the un­accountability and rank opportunism of the private sector on the one hand, and the insensitive and unresponsive character of the public sector on the other. This will also facilitate the HLEG’s agenda of pushing for broader investments in the social determinants of health such as food, sanitation and housing.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Historical Snapshots</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">An important factor in the success of different UHC systems in the world has been the circumstances in which they emerged. The UK’s National Health Service and the Beveridge report that led to it followed the Great Depression and the second world war and it had the approval of both the Conservative and Labour parties. There was a desperate need to raise morale and work a way out of a national debt, estimated at about £3,300 million. It was this configuration of circumstances that held a shared appreciation of the health system in place, leading to its success.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">In Brazil, the 1988 constitution marked the end of 20 years of military rule and the emergence of democracy (Buss and Gadelha 1996). This was preceded by the Eighth National Health Conference in 1986 attended by 5,000 participants, representing users, welfare organisations and public service personnel. The conference drafted the constitutional charter on health, which ultimately led to health and social security becoming constitutional principles. It was undoubtedly the fresh spirit of freedom and an overall commitment to the well-being and social security of the population that led to the country embarking on the path of successful healthcare for its people.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Thailand also set up its UHC system during a process of democratisation when new actors entered the political arena. The slogan used to mobilise people was “30 baht to treat all diseases” (1 baht is approximately 1.43 rupees; for an account see Khanna 2010-11). It is surprising that the HLEG report misses this important dimension of a fresh start providing a stimulus to UHC in the many vig­nettes of healthcare successes across the world it provides. It narrates their stories as if putting a healthcare system in place was merely an administrative matter of bringing together logistics, planning and good intentions (though it does briefly mention political movements in the introduction to these studies).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Closer home, in Tamil Nadu, the success of the state healthcare system, which functions more effectively than most in the rest of the country, was a­ttributed by a senior official to “greater enlightenment, efficient operation and personal commitment”. All these may be traced to the history of Tamil Nadu’s struggles over the last century with the problems of political representation, self-respect and brahmin domination. These movements and the emergence of the Dravida Munnetra Kazhagam (DMK) and its offshoots have led to a strong political will and administrative commitment to the plural subaltern population constituted of various castes, nationa­lities and historical circumstances. Though the English press tends to focus largely on corruption, the state has had successes in vital areas such as health, education and food.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">What these examples teach us is that a political environment that allows for motivation, commitment and the active involvement of the people is essential for a healthcare system to succeed. Is it possible to construct a progressive hegemony around the concept of UHC? This is the question on which the success of the HLEG’s proposals hinges.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Only an extensive agreement across the chain of the implementing agencies that healthcare is an item of absolute priority will generate the organic commitment, supervision and diligence necessary to conducting its operations successfully. The absence of these today is not so much a mark of corruption, selfishness or incompetence as the mark of an elitist model of national development that has failed to carry the people (including administrative functionaries) with it. It is the insularity of elite political will obsessed with indices of rapid growth to the exclusion of the concerns of most of the people of India. Even in these circumstances, a progressive h­ege­mony may not be impossible to construct. There are many examples of partial success in India, despite some of them having somewhat dubious credentials, such as family planning, universal primary e­ducation, oral polio vaccination and the Tamil Nadu health experience.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Progressive hegemony can never be simple government propaganda. We would agree broadly with the Medico Friends Circle position (MFC 2011-12) that the government needs to engage in negotiations with different groups of people so that their (even partially arti­culated) ideas, needs and constraints are woven into the broad picture. However, this would require the involvement of not just secular people’s health assemblies and panchayati raj institutions, but also mainstream national and regional political parties (like the Congress, BJP, Shiv Sena, the Majlis-e-Ittehadul Muslimeen) and their local representatives. While it is indubitable that politicians are deeply corruptible, and invested in businesses (as was the late Y S Rajasekhara Reddy in Andhra Pradesh) they also have historically developed a degree of bilateral communication with and accountability to the people they represent. We should note that minorities and marginalised castes and tribal groups have to be important participants because they are structurally the most vulnerable in secular healthcare programmes. The political parties that address them would historically be attuned to their aspirations and felt needs.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">A recommendation that stands out in the HLEG report is the one to establish medical colleges linked to district hospitals as apex tertiary units. We feel these should largely be government-run colleges, which establish standard practices in areas for tertiary care and support primary- and secondary-care initiatives (both government and private). The proposed three-year Bachelor of Rural Health Care course (HLEG 2011: 159) will strengthen the primary and secondary-care systems.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">It is worth speculating on the several advantages medical colleges linked to district hospitals could have. One, since the college will be a government-run e­ducational institution providing tertiary care, its economics need not be profit-oriented, thus offsetting a constraint in providing accessible, advanced medical care in the hinterland. Two, the increased availability of seats for medical education is likely to make the discipline less a target of artificial academic merit measured by entrance tests and more one of a genuine concern for healthcare. Three, medical courses will be less susceptible to the current laissez-faire curriculum policy where only the most advanced specialisations imbue value to an export-oriented medical education. This will create the possibility of a curriculum that is more responsive to actual health needs.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Four, depending on a district’s case load of medical problems to teach students will exert a corrective influence on competence, understanding and inventiveness. This will also hopefully result in a research orientation that is responsive to the specific healthcare needs of the people of this country. Finally, with the medical college’s support, the medical system will be able to penetrate rural areas in a way that other initiatives of the last two or three decades have not. On the whole, it may carry forward the promise of Aarogyasri programme with the necessary radical course correction.</div><div style="text-align: justify"> </div><div style="text-align: justify"><em><strong>References</strong></em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">Buss, P and P Gadelha (1996): “Healthcare Systems in Transition: Brazil Part I: An Outline of Brazil’s Healthcare Reforms”, Journal of Public Health Medicine, (18) 3, pp 289-95.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">HLEG (2011): “High Level Expert Group Report on Universal Health Coverage for India”, Planning Commission of India, New Delhi.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Khanna, R (2010-11): “Universal Health Coverage in Thailand: What Lessons Can India Learn?”, MFC Bulletin, 342-44, August 2010-January 2011.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">MFC (2011-12): “Exploring a Road Map for Health Care for All/UAHC”, MFC Bulletin, 348-50, August 2011-January 2012.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Shukla, R, V Shatrugna and R Srivatsan (2011): “Aarogyasri Healthcare Model: Advantage Private Sector”, Economic & Political Weekly, 46 (49), pp 38-42.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Walsh, J A and K S Warren (1979): “Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries”, New England Journal of Medicine, 301, pp 967-74.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">World Bank (1993): Investing in Health, World Development Report 1993 (New York: Oxford University Press).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Zachariah, A, R Srivatsan, and S Tharu (2010): T­owards a Critical Medical Practice: Reflections on the Dilemmas of Medical Culture Today (­Hyderabad: Orient BlackSwan).</div><div style="text-align: justify"><br /></div>
</div>
</td>
</tr>
</table>
</div>
</div>
</div>
<div class="clear"></div>
<br><a href="http://beta.epw.in/newsItem/comment/191039/" class="re" target="_blank">Economic and Political Weekly, Vol XLVII, No. 7, 25 February, 2012, http://beta.epw.in/newsItem/comment/191039/</a><div class="clear"></div>
<div style="padding-top: 18px;">
<p class="post-tag">Tagged with:
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Health"
title="Health">
Health </a>
</p>
</div>
<div class="clear"></div>
<br><br>
<div class="widget-top">
<h4>Related Articles</h4>
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<ul id="recentcomments">
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/fifth-report-from-gambia-implicates-indian-drug-maker-for-contaminated-syrups-banjot-kaur.html"
title="Fifth Report From Gambia Implicates Indian Drug Maker for Contaminated Syrups - Banjot Kaur">
Fifth Report From Gambia Implicates Indian Drug Maker for Contaminated Syrups - Banjot Kaur </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-may-have-seen-steepest-dip-in-multidimensional-poverty-among-110-nations-as-per-undp-data-nikhil-rampal.html"
title="India may have seen steepest dip in multidimensional poverty among 110 nations as per UNDP data - Nikhil Rampal">
India may have seen steepest dip in multidimensional poverty among 110 nations as per UNDP data - Nikhil Rampal </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/health-among-top-three-priorities-for-indian-voters-after-jobs-and-education-survey-shows-oliver-heath-jyoti-mishra-louise-tillin-sandhya-venkateswaran.html"
title="Health among top three priorities for Indian voters after jobs and education, survey shows - Oliver Heath, Jyoti Mishra, Louise Tillin & Sandhya Venkateswaran">
Health among top three priorities for Indian voters after jobs and education, survey shows - Oliver Heath, Jyoti Mishra, Louise Tillin & Sandhya Venkateswaran </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/prevalence-of-zero-food-among-infants-and-young-children-in-india-patterns-of-change-across-the-states-and-union-territories-of-india-1993-2021-the-lancet.html"
title="Prevalence of Zero-Food among infants and young children in India - The Lancet ">
Prevalence of Zero-Food among infants and young children in India - The Lancet </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-s-sustainability-goals-at-risk-because-of-extreme-heatwaves-carbon-copy.html"
title="India's Sustainability Goals at Risk Because of Extreme Heatwaves - Carbon Copy">
India's Sustainability Goals at Risk Because of Extreme Heatwaves - Carbon Copy </a>
</li>
</ul>
</div>
<div class="comment-respond" id="respond">
<a name="commentbox"> </a>
<h3 class="comment-reply-title" id="reply-title">Write Comments</h3>
<form method="post" accept-charset="utf-8" role="form" action="/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"><div style="display:none;"><input type="hidden" name="_method" value="POST"/></div> <form class="comment-form" id="commentform" method="post" action="#commentbox" onSubmit="return validate()"
name="cmtform">
<input type="hidden" name="cmttype" value="articlecmt"/>
<input type="hidden" name="article_id" value="13230"/>
<p class="comment-notes">Your email address will not be published. Required fields are marked <span
class="required">*</span></p>
<p class="comment-form-author">
<label for="commenterName">Name</label>
<span class="required">*</span>
<input type="text" aria-required="true" size="30"
value=""
name="commenterName" id="commenterName" required="true">
</p>
<p class="comment-form-email">
<label for="commenterEmail">Email</label> <span class="required">*</span>
<input aria-required="true" size="30" name="commenterEmail" id="commenterEmail" type="email"
value=""
required="true">
</p>
<p class="comment-form-contact">
<label for="commenterPh">Contact No.</label>
<input type="text" size="30"
value=""
name="commenterPh" id="commenterPh">
</p>
<p class="comment-form-comment">
<label for="comment">Comment</label>
<textarea aria-required="true" required="true" rows="8" cols="45" name="comment"
id="comment"></textarea>
</p>
<p class="comment-form-comment">
<label for="comment">Type the characters you see in the image below <span class="required">*</span><br><img
class="captchaImg"
src="https://im4change.in/securimage_show_art.php?tk=861803084" alt="captcha"/>
</label>
</p>
<input type="text" name="vrcode" required="true"/>
<p class="form-submit" style="width: 200px;">
<input type="submit" value="Post Comment" id="submit" name="submit">
</p></form>
</div>
<style>
.ui-widget-content {
height: auto !important;
}
</style>
<div id="share-modal"></div>
<style>
.middleContent a{
background-color: rgba(108,172,228,.2);
}
.middleContent a:hover{
background-color: #418fde;
border-color: #418fde;
color: #000;
}
</style>
<script>
function shareArticle(article_id) {
var options = {
modal: true,
height: 'auto',
width: 600 + 'px'
};
$('#share-modal').html("");
$('#share-modal').load('https://im4change.in/share_article?article_id=' + article_id).dialog(options).dialog('open');
}
function postShare() {
var param = 'article_id=' + $("#article_id").val();
param = param + '&y_name=' + $("#y_name").val();
param = param + '&y_email=' + $("#y_email").val();
param = param + '&f_name=' + $("#f_name").val();
param = param + '&f_email=' + $("#f_email").val();
param = param + '&y_msg=' + $("#y_msg").val();
$.ajax({
type: "POST",
url: 'https://im4change.in/post_share_article',
data: param,
success: function (response) {
$('#share-modal').html("Thank You, Your message posted to ");
}
});
return false;
}
</script> </div>
</div>
<!-- Right Side Section Start -->
<!-- MAP Section START -->
<aside class="sidebar indexMarg">
<div class="ad-cell">
<a href="https://im4change.in/statemap.php" title="">
<img src="https://im4change.in/images/map_new_version.png?1582080666" alt="India State Map" class="indiamap" width="232" height="252"/> </a>
<div class="rightmapbox">
<div id="sideOne" class="docltitle"><a href="https://im4change.in/state-report/india/36" target="_blank">DOCUMENTS/
REPORTS</a></div>
<div id="sideTwo" class="statetitle"><a href="https://im4change.in/states.php"target="_blank">STATE DATA/
HDRs.</a></div>
</div>
<div class="widget widgePadTop"></div>
</div>
</aside>
<!-- MAP Section END -->
<aside class="sidebar sidePadbottom">
<div class="rightsmlbox1" >
<a href="https://im4change.in/knowledge_gateway" target="_blank" style="color: #035588;
font-size: 17px;">
KNOWLEDGE GATEWAY
</a>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/newsletter" target="_blank">
NEWSLETTER
</a>
</p>
</div>
</div>
<div class="rightsmlbox1" style="height: 325px;">
<div>
<p class="rightsmlbox1_title">
Interview with Prof. Ravi Srivastava
</p>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/video/interview-with-prof-ravi-srivastava-on-current-economic-crisis">
<img width="250" height="200" src="/images/interview_video_home.jpg" alt="Interview with Prof. Ravi Srivastava"/>
</a>
<!--
<iframe width="250" height="200" src="https://www.youtube.com/embed/MmaTlntk-wc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe>-->
</p>
<a href="https://im4change.in/videogallery" class="more-link CatArchalAnch1" target="_blank">
More videos
</a>
</div>
</div>
<div class="rightsmlbox1">
<div>
<!--div id="sstory" class="rightboxicons"></div--->
<p class="rightsmlbox1_title"><a href="https://im4change.in/list-success-stories" target="_blank">Success Stories</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/interviews" target="_blank">Interviews</a>
</p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a href="https://www.commoncause.in/page.php?id=10" >Donate</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/marquee"
class="isf_link more-link" title="India Focus?" style="border: 4px solid #fdd922;width: 90%;background-color: #fdd922;text-align: center;color: #000000;font-size:18px" target="_blank">India Focus</a></p> </div>
</div>
<div class="rightsmlbox1" style="height: 104px !important;">
<a href="https://im4change.in/quarterly_reports.php" target="_blank">
Quarterly Reports on Effect of Economic Slowdown on Employment in India (2008 - 2015)
</a>
</div>
<!-- <div class="rightsmlbox1">
<a href="https://play.google.com/store/apps/details?id=com.im4.im4change" target="_blank">
</a></div> -->
<!-- <section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">Most Visited</h2>
</section> -->
<!-- accordion Starts here -->
<!-- <div id="accordion" class="accordMarg">
</div> -->
<!-- accordion ends here -->
<!-- Widget Tag Cloud Starts here -->
<div id="tag_cloud-2" class="widget widget_tag_cloud">
<section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">MOST VISITED TAGS</h2>
</section>
<div class="widget-top wiPdTp">
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<div class="tagcloud">
<a href="https://im4change.in/search?qryStr=Agriculture"
target="_blank" class="tag-link-4 font4">Agriculture</a>
<a href="https://im4change.in/search?qryStr=Food Security"
target="_blank" class="tag-link-4 font4">Food Security</a>
<a href="https://im4change.in/search?qryStr=Law and Justice"
target="_blank" class="tag-link-4 font4">Law and Justice</a>
<a href="https://im4change.in/search?qryStr=Health"
target="_blank" class="tag-link-4 font4">Health</a>
<a href="https://im4change.in/search?qryStr=Right to Food"
target="_blank" class="tag-link-4 font4">Right to Food</a>
<a href="https://im4change.in/search?qryStr=Corruption"
target="_blank" class="tag-link-4 font4">Corruption</a>
<a href="https://im4change.in/search?qryStr=farming"
target="_blank" class="tag-link-4 font4">farming</a>
<a href="https://im4change.in/search?qryStr=Environment"
target="_blank" class="tag-link-4 font4">Environment</a>
<a href="https://im4change.in/search?qryStr=Right to Information"
target="_blank" class="tag-link-4 font4">Right to Information</a>
<a href="https://im4change.in/search?qryStr=NREGS"
target="_blank" class="tag-link-4 font4">NREGS</a>
<a href="https://im4change.in/search?qryStr=Human Rights"
target="_blank" class="tag-link-4 font4">Human Rights</a>
<a href="https://im4change.in/search?qryStr=Governance"
target="_blank" class="tag-link-4 font4">Governance</a>
<a href="https://im4change.in/search?qryStr=PDS"
target="_blank" class="tag-link-4 font4">PDS</a>
<a href="https://im4change.in/search?qryStr=COVID-19"
target="_blank" class="tag-link-4 font4">COVID-19</a>
<a href="https://im4change.in/search?qryStr=Land Acquisition"
target="_blank" class="tag-link-4 font4">Land Acquisition</a>
<a href="https://im4change.in/search?qryStr=mgnrega"
target="_blank" class="tag-link-4 font4">mgnrega</a>
<a href="https://im4change.in/search?qryStr=Farmers"
target="_blank" class="tag-link-4 font4">Farmers</a>
<a href="https://im4change.in/search?qryStr=transparency"
target="_blank" class="tag-link-4 font4">transparency</a>
<a href="https://im4change.in/search?qryStr=Gender"
target="_blank" class="tag-link-4 font4">Gender</a>
<a href="https://im4change.in/search?qryStr=Poverty"
target="_blank" class="tag-link-4 font4">Poverty</a>
<a href="https://im4change.in/search?qryStr=Farm Laws" target="_blank" class="tag-link-4 font4">Farm Laws
</a>
<a href="https://im4change.in/search?qryStr=Citizenship Amendment Act" target="_blank" class="tag-link-4 font4">Citizenship Amendment Act
</a>
<a href="https://im4change.in/search?qryStr=CAA NPR NRIC" target="_blank" class="tag-link-4 font4">CAA NPR NRIC
</a>
<a href="https://im4change.in/search?qryStr=Job Losses" target="_blank" class="tag-link-4 font4">Job Losses
</a>
<a href="https://im4change.in/search?qryStr=Migrant Workers" target="_blank" class="tag-link-4 font4">Migrant Workers
</a>
<a href="https://im4change.in/search?qryStr=Unemployment" target="_blank" class="tag-link-4 font4">Unemployment
</a>
<a href="https://im4change.in/search?qryStr=PMGKAY" target="_blank" class="tag-link-4 font4">PMGKAY
</a>
<a href="https://im4change.in/search?qryStr=PM-KISAN" target="_blank" class="tag-link-4 font4">PM-KISAN
</a>
<a href="https://im4change.in/search?qryStr=PM-CARES" target="_blank" class="tag-link-4 font4">PM-CARES
</a>
<a href="https://im4change.in/search?qryStr=LFPR" target="_blank" class="tag-link-4 font4">LFPR
</a>
</div>
</div>
</div>
<!-- Widget Tag Cloud Ends here -->
</aside>
<!-- Right Side Section End -->
</div>
<section class="cat-box cats-review-box footerSec">
<h2 class="cat-box-title vSec CatArcha">Video
Archives</h2>
<h2 class="cat-box-title CatArchaTitle">Archives</h2>
<div class="cat-box-content">
<div class="reviews-cat">
<div class="CatArchaDiv1">
<div class="CatArchaDiv2">
<ul>
<li>
<a href="https://im4change.in/news-alerts-57/moving-upstream-luni-fellowship.html" target="_blank">
Moving Upstream: Luni – Fellowship </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/135-million-indians-exited-multidimensional-poverty-as-per-government-figures-is-that-the-same-as-poverty-reduction.html" target="_blank">
135 Million Indians Exited “Multidimensional" Poverty as per Government... </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/explainer-why-are-tomato-prices-on-fire.html" target="_blank">
Explainer: Why are Tomato Prices on Fire? </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/nsso-survey-only-39-1-of-all-households-have-drinking-water-within-dwelling-46-7-of-rural-households-use-firewood-for-cooking.html" target="_blank">
NSSO Survey: Only 39.1% of all Households have Drinking... </a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/news-alerts-57"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/I51LYnP8BOk/1.jpg"
alt=" Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Short-Video-on-im4change-Hindi-website-Inclusive-Media-for-Change" target="_blank">
Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/kNqha-SwfIY/1.jpg"
alt=" "Session 1: Scope of IDEA and AgriStack" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-1- Scope-of-IDEA-and-AgriStack-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 1: Scope of IDEA and AgriStack" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/6kIVjlgZItk/1.jpg"
alt=" "Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-2-Farmer-Centric-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/2BeHTu0y7xc/1.jpg"
alt=" "Session 3: Future of Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-3-Future-of-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 3: Future of Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="divWidth">
<ul class="divWidthMarg">
<li>
<a href="https://im4change.in/video/Public-Spending-on-Agriculture-in-India-Source-Foundation-for-Agrarian-Studies"
title="Public Spending on Agriculture in India (Source: Foundation for Agrarian Studies)" target="_blank">
Public Spending on Agriculture in India (Source: Foundation for...</a>
</li>
<li>
<a href="https://im4change.in/video/Agrarian-Change-Seminar-Protests-against-the-New-Farm-Laws-in-India-by-Prof-Vikas-Rawal-JNU-Source-Journal-Of-Agrarian-Change"
title="Agrarian Change Seminar: 'Protests against the New Farm Laws in India' by Prof. Vikas Rawal, JNU (Source: Journal Of Agrarian Change) " target="_blank">
Agrarian Change Seminar: 'Protests against the New Farm Laws...</a>
</li>
<li>
<a href="https://im4change.in/video/Webinar-Ramrao-The-Story-of-India-Farm-Crisis-Source-Azim-Premji-University"
title="Webinar: Ramrao - The Story of India's Farm Crisis (Source: Azim Premji University)" target="_blank">
Webinar: Ramrao - The Story of India's Farm Crisis...</a>
</li>
<li>
<a href="https://im4change.in/video/water-and-agricultural-transformation-in-India"
title="Water and Agricultural Transformation in India: A Symbiotic Relationship (Source: IGIDR)" target="_blank">
Water and Agricultural Transformation in India: A Symbiotic Relationship...</a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/videogallery"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
</div>
</div>
</div>
</section> </div>
<div class="clear"></div>
<!-- Footer option Starts here -->
<div class="footer-bottom fade-in animated4">
<div class="container">
<div class="social-icons icon_flat">
<p class="SocialMargTop"> Website Developed by <a target="_blank" title="Web Development"
class="wot right"
href="http://www.ravinderkhurana.com/" rel="nofollow">
RAVINDErkHURANA.com</a></p>
</div>
<div class="alignleft">
<a
target="_blank" href="https://im4change.in/objectives-8.html"
class="link"
title="Objectives">Objectives</a> | <a
target="_blank" href="https://im4change.in/about-us-9.html"
class="link" title="About Us">About Us</a> | <a
target="_blank" href="https://im4change.in/media-workshops.php"
class="ucwords">Workshops</a> | <a
target="_blank" href="https://im4change.in/disclaimer/disclaimer-149.html"
title="Disclaimer">Disclaimer</a> </div>
</div>
</div>
<!-- Footer option ends here -->
</div>
<div id="connect">
<a target="_blank"
href="http://www.facebook.com/sharer.php?u=https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"
title="Share on Facebook">
<img src="https://im4change.in/images/Facebook.png?1582080640" alt="share on Facebook" class="ImgBorder"/>
</a><br/>
<a target="_blank"
href="http://twitter.com/share?text=Im4change&url=https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"
title="Share on Twitter">
<img src="https://im4change.in/images/twitter.png?1582080632" alt="Twitter" class="ImgBorder"/> </a>
<br/>
<a href="/feeds" title="RSS Feed" target="_blank">
<img src="https://im4change.in/images/rss.png?1582080632" alt="RSS" class="ImgBorder"/>
</a>
<br/>
<a class="feedback-link" id="feedbackFormLink" href="#">
<img src="https://im4change.in/images/feedback.png?1582080630" alt="Feedback" class="ImgBorder"/>
</a> <br/>
<a href="javascript:function iprl5(){var d=document,z=d.createElement('scr'+'ipt'),b=d.body,l=d.location;try{if(!b)throw(0);d.title='(Saving...) '+d.title;z.setAttribute('src',l.protocol+'//www.instapaper.com/j/WKrH3R7ORD5p?u='+encodeURIComponent(l.href)+'&t='+(new Date().getTime()));b.appendChild(z);}catch(e){alert('Please wait until the page has loaded.');}}iprl5();void(0)"
class="bookmarklet" onclick="return explain_bookmarklet();">
<img src="https://im4change.in/images/read-it-later.png?1582080632" alt="Read Later" class="ImgBorder"/> </a>
</div>
<!-- Feedback form Starts here -->
<div id="feedbackForm" class="overlay_form" class="ImgBorder">
<h2>Contact Form</h2>
<div id="contactform1">
<div id="formleft">
<form id="submitform" action="/contactus.php" method="post">
<input type="hidden" name="submitform" value="submitform"/>
<input type="hidden" name="salt_key" value="a0e0f2c6a0644a70e57ad2c96829709a"/>
<input type="hidden" name="ref" value="feedback"/>
<fieldset>
<label>Name :</label>
<input type="text" name="name" class="tbox" required/>
</fieldset>
<fieldset>
<label>Email :</label>
<input type="text" name="email" class="tbox" required/>
</fieldset>
<fieldset>
<label>Message :</label>
<textarea rows="5" cols="20" name="message" required></textarea>
</fieldset>
<fieldset>
Please enter security code
<div class="clear"></div>
<input type="text" name="vrcode" class="tbox"/>
</fieldset>
<fieldset>
<input type="submit" class="button" value="Submit"/>
<a href="#" id="closefeedbakcformLink">Close</a>
</fieldset>
</form>
</div>
<div class="clearfix"></div>
</div>
</div>
<div id="donate_popup" class="modal" style="max-width: 800px;">
<table width="100%" border="1">
<tr>
<td colspan="2" align="center">
<b>Support im4change</b>
</td>
</tr>
<tr>
<td width="25%" valign="middle">
<img src="https://im4change.in/images/logo2.jpg?1582080632" alt="" width="100%"/> </td>
<td style="padding-left:10px;padding-top:10px;">
<form action="https://im4change.in/donate" method="get">
<table width="100%" cellpadding="2" cellspacing="2">
<tr>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
10
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
100
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
1000
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
50
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
500
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
<input type="text" name="price" placeholder="?" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td colspan="3" align="right">
<input type="button" name="Pay" value="Pay"
style="width: 200px;background-color: rgb(205, 35, 36);color: #ffffff;"/>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</div><script type='text/javascript'>
/* <![CDATA[ */
var tievar = {'go_to': 'Go to...'};
/* ]]> */
</script>
<script src="/js/tie-scripts.js?1575549704"></script><script src="/js/bootstrap.js?1575549704"></script><script src="/js/jquery.modal.min.js?1578284310"></script><script>
$(document).ready(function() {
// tell the autocomplete function to get its data from our php script
$('#s').autocomplete({
source: "/autocomplete"
});
});
</script>
<script src="/vj-main-sw-register.js" async></script>
<script>function init(){var imgDefer=document.getElementsByTagName('img');for(var i=0;i<imgDefer.length;i++){if(imgDefer[i].getAttribute('data-src')){imgDefer[i].setAttribute('src',imgDefer[i].getAttribute('data-src'))}}}
window.onload=init;</script>
</body>
</html>'
}
$reasonPhrase = 'OK'
header - [internal], line ??
Cake\Http\ResponseEmitter::emitStatusLine() - CORE/src/Http/ResponseEmitter.php, line 148
Cake\Http\ResponseEmitter::emit() - CORE/src/Http/ResponseEmitter.php, line 54
Cake\Http\Server::emit() - CORE/src/Http/Server.php, line 141
[main] - ROOT/webroot/index.php, line 39
Warning (2): Cannot modify header information - headers already sent by (output started at /home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php:853) [CORE/src/Http/ResponseEmitter.php, line 181]
$response = object(Cake\Http\Response) {
'status' => (int) 200,
'contentType' => 'text/html',
'headers' => [
'Content-Type' => [
[maximum depth reached]
]
],
'file' => null,
'fileRange' => [],
'cookies' => object(Cake\Http\Cookie\CookieCollection) {},
'cacheDirectives' => [],
'body' => '<!DOCTYPE html>
<!--[if lt IE 7 ]>
<html class="ie ie6" lang='en'> <![endif]-->
<!--[if IE 7 ]>
<html class="ie ie7" lang='en'> <![endif]-->
<!--[if IE 8 ]>
<html class="ie ie8" lang='en'> <![endif]-->
<!--[if (gte IE 9)|!(IE)]><!-->
<html lang='en'>
<!--<![endif]-->
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title>
LATEST NEWS UPDATES | Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna </title>
<meta name="description" content="
While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it..."/>
<meta name="keywords" content="Health"/>
<meta name="news_keywords" content="Health">
<link rel="alternate" type="application/rss+xml" title="ROR" href="/ror.xml"/>
<link rel="alternate" type="application/rss+xml" title="RSS 2.0" href="/feeds/"/>
<link rel="stylesheet" href="/css/bootstrap.min.css?1697864993"/> <link rel="stylesheet" href="/css/style.css?v=1.1.2"/> <link rel="stylesheet" href="/css/style-inner.css?1577045210"/> <link rel="stylesheet" id="Oswald-css"
href="https://fonts.googleapis.com/css?family=Oswald%3Aregular%2C700&ver=3.8.1" type="text/css"
media="all">
<link rel="stylesheet" href="/css/jquery.modal.min.css?1578285302"/> <script src="/js/jquery-1.10.2.js?1575549704"></script> <script src="/js/jquery-migrate.min.js?1575549704"></script> <link rel="shortcut icon" href="/favicon.ico" title="Favicon">
<link rel="stylesheet" href="/css/jquery-ui.css?1580720609"/> <script src="/js/jquery-ui.js?1575549704"></script> <link rel="preload" as="style" href="https://www.im4change.org/css/custom.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery.modal.min.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery-ui.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/li-scroller.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<!-- <link rel="preload" as="style" href="https://www.im4change.org/css/style.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous"> -->
<link rel="preload" as="style" href="https://www.im4change.org/css/style-inner.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel='dns-prefetch' href="//im4change.org/css/custom.css" crossorigin >
<link rel="preload" as="script" href="https://www.im4change.org/js/bootstrap.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.li-scroller.1.0.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.modal.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.ui.totop.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-1.10.2.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-migrate.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-ui.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/setting.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/tie-scripts.js">
<!--[if IE]>
<script type="text/javascript">jQuery(document).ready(function () {
jQuery(".menu-item").has("ul").children("a").attr("aria-haspopup", "true");
});</script>
<![endif]-->
<!--[if lt IE 9]>
<script src="/js/html5.js"></script>
<script src="/js/selectivizr-min.js"></script>
<![endif]-->
<!--[if IE 8]>
<link rel="stylesheet" type="text/css" media="all" href="/css/ie8.css"/>
<![endif]-->
<meta property="og:title" content="LATEST NEWS UPDATES | Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna" />
<meta property="og:url" content="https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html" />
<meta property="og:type" content="article" />
<meta property="og:description" content="
While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it..." />
<meta property="og:image" content="" />
<meta property="fb:app_id" content="0" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
<link rel="apple-touch-icon-precomposed" sizes="144x144" href="https://im4change.in/images/apple1.png">
<link rel="apple-touch-icon-precomposed" sizes="120x120" href="https://im4change.in/images/apple2.png">
<link rel="apple-touch-icon-precomposed" sizes="72x72" href="https://im4change.in/images/apple3.png">
<link rel="apple-touch-icon-precomposed" href="https://im4change.in/images/apple4.png">
<style>
.gsc-results-wrapper-overlay{
top: 38% !important;
height: 50% !important;
}
.gsc-search-button-v2{
border-color: #035588 !important;
background-color: #035588 !important;
}
.gsib_a{
height: 30px !important;
padding: 2px 8px 1px 6px !important;
}
.gsc-search-button-v2{
height: 41px !important;
}
input.gsc-input{
background: none !important;
}
@media only screen and (max-width: 600px) {
.gsc-results-wrapper-overlay{
top: 11% !important;
width: 87% !important;
left: 9% !important;
height: 43% !important;
}
.gsc-search-button-v2{
padding: 10px 10px !important;
}
.gsc-input-box{
height: 28px !important;
}
/* .gsib_a {
padding: 0px 9px 4px 9px !important;
}*/
}
@media only screen and (min-width: 1200px) and (max-width: 1920px) {
table.gsc-search-box{
width: 15% !important;
float: right !important;
margin-top: -118px !important;
}
.gsc-search-button-v2 {
padding: 6px !important;
}
}
</style>
<script>
$(function () {
$("#accordion").accordion({
event: "click hoverintent"
});
});
/*
* hoverIntent | Copyright 2011 Brian Cherne
* http://cherne.net/brian/resources/jquery.hoverIntent.html
* modified by the jQuery UI team
*/
$.event.special.hoverintent = {
setup: function () {
$(this).bind("mouseover", jQuery.event.special.hoverintent.handler);
},
teardown: function () {
$(this).unbind("mouseover", jQuery.event.special.hoverintent.handler);
},
handler: function (event) {
var currentX, currentY, timeout,
args = arguments,
target = $(event.target),
previousX = event.pageX,
previousY = event.pageY;
function track(event) {
currentX = event.pageX;
currentY = event.pageY;
}
;
function clear() {
target
.unbind("mousemove", track)
.unbind("mouseout", clear);
clearTimeout(timeout);
}
function handler() {
var prop,
orig = event;
if ((Math.abs(previousX - currentX) +
Math.abs(previousY - currentY)) < 7) {
clear();
event = $.Event("hoverintent");
for (prop in orig) {
if (!(prop in event)) {
event[prop] = orig[prop];
}
}
// Prevent accessing the original event since the new event
// is fired asynchronously and the old event is no longer
// usable (#6028)
delete event.originalEvent;
target.trigger(event);
} else {
previousX = currentX;
previousY = currentY;
timeout = setTimeout(handler, 100);
}
}
timeout = setTimeout(handler, 100);
target.bind({
mousemove: track,
mouseout: clear
});
}
};
</script>
<script type="text/javascript">
var _gaq = _gaq || [];
_gaq.push(['_setAccount', 'UA-472075-3']);
_gaq.push(['_trackPageview']);
(function () {
var ga = document.createElement('script');
ga.type = 'text/javascript';
ga.async = true;
ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
var s = document.getElementsByTagName('script')[0];
s.parentNode.insertBefore(ga, s);
})();
</script>
<link rel="stylesheet" href="/css/custom.css?v=1.16"/> <script src="/js/jquery.ui.totop.js?1575549704"></script> <script src="/js/setting.js?1575549704"></script> <link rel="manifest" href="/manifest.json">
<meta name="theme-color" content="#616163" />
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="apple-mobile-web-app-title" content="im4change">
<link rel="apple-touch-icon" href="/icons/logo-192x192.png">
</head>
<body id="top" class="home inner blog">
<div class="background-cover"></div>
<div class="wrapper animated">
<header id="theme-header" class="header_inner" style="position: relative;">
<div class="logo inner_logo" style="left:20px !important">
<a title="Home" href="https://im4change.in/">
<img src="https://im4change.in/images/logo2.jpg?1582080632" class="logo_image" alt="im4change"/> </a>
</div>
<div class="langhindi" style="color: #000;display:none;"
href="https://im4change.in/">
<a class="more-link" href="https://im4change.in/">Home</a>
<a href="https://im4change.in/hindi/" class="langbutton ">हिन्दी</a>
</div>
<nav class="fade-in animated2" id="main-nav">
<div class="container">
<div class="main-menu">
<ul class="menu" id="menu-main">
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
style="left: -40px;"><a
target="_blank" href="https://im4change.in/">Home</a>
</li>
<li class="menu-item mega-menu menu-item-type-taxonomy mega-menu menu-item-object-category mega-menu menu-item-has-children parent-list"
style=" margin-left: -40px;"><a href="#">KNOWLEDGE GATEWAY <span class="sub-indicator"></span>
</a>
<div class="mega-menu-block background_menu" style="padding-top:25px;">
<div class="container">
<div class="mega-menu-content">
<div class="mega-menu-item">
<h3><b>Farm Crisis</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/farmers039-suicides-14.html"
class="left postionrel">Farm Suicides </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/unemployment-30.html"
class="left postionrel">Unemployment </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/rural-distress-70.html"
class="left postionrel">Rural distress </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/migration-34.html"
class="left postionrel">Migration </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/key-facts-72.html"
class="left postionrel">Key Facts </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/debt-trap-15.html"
class="left postionrel">Debt Trap </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Empowerment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/union-budget-73.html"
class="left postionrel">Union Budget And Other Economic Policies </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/forest-and-tribal-rights-61.html"
class="left postionrel">Forest and Tribal Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-education-60.html"
class="left postionrel">Right to Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-food-59.html"
class="left postionrel">Right to Food </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/displacement-3279.html"
class="left postionrel">Displacement </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-work-mg-nrega-39.html"
class="left postionrel">Right to Work (MG-NREGA) </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/gender-3280.html"
class="left postionrel">GENDER </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-information-58.html"
class="left postionrel">Right to Information </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/social-audit-48.html"
class="left postionrel">Social Audit </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Hunger / HDI</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/poverty-and-inequality-20499.html"
class="left postionrel">Poverty and inequality </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/malnutrition-41.html"
class="left postionrel">Malnutrition </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/public-health-51.html"
class="left postionrel">Public Health </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/education-50.html"
class="left postionrel">Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hunger-overview-40.html"
class="left postionrel">Hunger Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hdi-overview-45.html"
class="left postionrel">HDI Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/pds-ration-food-security-42.html"
class="left postionrel">PDS/ Ration/ Food Security </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/sdgs-113.html"
class="left postionrel">SDGs </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/mid-day-meal-scheme-mdms-53.html"
class="left postionrel">Mid Day Meal Scheme (MDMS) </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Environment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/time-bomb-ticking-52.html"
class="left postionrel">Time Bomb Ticking </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/water-and-sanitation-55.html"
class="left postionrel">Water and Sanitation </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/impact-on-agriculture-54.html"
class="left postionrel">Impact on Agriculture </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Law & Justice</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/social-justice-20500.html"
class="left postionrel">Social Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/access-to-justice-47.html"
class="left postionrel">Access to Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/human-rights-56.html"
class="left postionrel">Human Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/corruption-35.html"
class="left postionrel">Corruption </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/general-insecurity-46.html"
class="left postionrel">General Insecurity </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/disaster-relief-49.html"
class="left postionrel">Disaster & Relief </a>
</p>
</div>
</div>
</div>
</div>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page "><a target="_blank" href="https://im4change.in/nceus_reports.php">NCEUS reports</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children parent-list ">
<a target="_blank" href="https://im4change.in/about-us-9.html">About Us <span
class="sub-indicator"></span></a>
<ul class="sub-menu aboutmenu">
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/objectives-8.html">Objectives</a>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/contactus.php">Contact
Us</a></li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/about-us-9.html">About
Us</a></li>
</ul>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children ">
<a target="_blank" href="https://im4change.in/fellowships.php" title="Fellowships">Fellowships</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/media-workshops.php">Workshops</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/research.php">Research</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/links-64">Partners</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
id="menu-item-539"><a target="_blank" href="https://im4change.in/hindi/"
class="langbutton langlinkfont17">हिन्दी</a></li>
</ul>
</div> </div>
<!-- <div style="float: right;">
<script async src="https://cse.google.com/cse.js?cx=18b4f2e0f11bed3dd"></script>
<div class="gcse-search"></div>
</div> -->
<div class="search-block" style=" margin-left: 8px; margin-right: 7px;">
<form method="get" id="searchform" name="searchform"
action="https://im4change.in/search"
onsubmit="return searchvalidate();">
<button class="search-button" type="submit" value="Search"></button>
<input type="text" id="s" name="qryStr" value=""
onfocus="if (this.value == 'Search...') {this.value = '';}"
onblur="if (this.value == '') {this.value = 'Search...';}">
</form>
</div>
</nav>
</header>
<div class="container">
<div id="main-content" class=" main1 container fade-in animated3 sidebar-narrow-left">
<div class="content-wrap">
<div class="content" style="width: 900px;min-height: 500px;">
<section class="cat-box recent-box innerCatRecent">
<h1 class="cat-box-title">Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna</h1>
<a href="JavaScript:void(0);" onclick="return shareArticle(13230);">
<img src="https://im4change.in/images/email.png?1582080630" border="0" width="24" align="right" alt="Share this article"/> </a>
<a href="https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352/print"
rel="nofollow">
<img src="https://im4change.in/images/icon-print.png?1582080630" border="0" width="24" align="right" alt="Share this article"/>
</a>
</section>
<section class="recent-box innerCatRecent">
<small class="pb-1"><span class="dateIcn">
<img src="https://im4change.in/images/published.svg?1582080666" alt="published"/>
Published on</span><span class="text-date"> Feb 24, 2012</span>
<span
class="dateIcn">
<img src="https://im4change.in/images/modified.svg?1582080666" alt="modified"/> Modified on </span><span class="text-date"> Feb 24, 2012</span>
</small>
</section>
<div class="clear"></div>
<div style="padding-top: 10px;">
<div class="innerLineHeight">
<div class="middleContent innerInput latest-news-updates">
<table>
<tr>
<td>
<div>
<div style="text-align: justify"><br /></div><div style="text-align: justify"><em>While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it explores the political dimension, which comprises the forces and interests that come into play to shape and reconfigure administrative policy and its implementation.</em></div><div style="text-align: justify"><em> </em></div><div style="text-align: justify"><em>We are grateful to Anand Zachariah and Susie Tharu for their insightful comments on the report. In particular, Zachariah’s inputs on medical colleges as apex tertiary medical care institutions in districts and Tharu’s stress on the importance of practice need mention. (See Zachariah et al 2010 for a conceptual background).</em></div><div style="text-align: justify"><em><br /></em></div><div style="text-align: justify"><em>R Srivatsan (r.srivats@gmail.com) is with the Anveshi Research Centre for Women’s Studies, Hyderabad and Veena Shatrugna (veenashatrugna@yahoo.com) was with the National Institute of Nutrition, Hyderabad.</em></div><div style="text-align: justify"> </div><div style="text-align: justify">The report of the High Level Ex­pert Group (HLEG) on Universal Health Coverage (UHC) for India is to be welcomed for its comprehensive vision of healthcare. After the neo-liberal proposals on selective primary health care articulated by Walsh and Warren (1979) doubted if providing comprehensive healthcare in a third world country was a feasible goal and the World Bank’s Investing in Health report (1993) put forth an influential model incorporating that view, the HLEG report reaffirms the goal of UHC. This is an important development, which shows that India is at a political and economic stage that no longer needs to repeat the minimalist solutions of selective primary health care – diphtheria-pertussis-tetanus (DPT) immunisation, tetanus toxoid to pregnant w­omen, breastfeeding, chloroquine for malaria and oral rehydration solution (ORS) for diarrhoea. It is indeed worth pausing and pondering over the significance of this moment.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Many of the recommendations (and there are many) in the HLEG report are well-conceived – elimination of cost to the patient; funding through taxation; elimination of insurance; making medical colleges the apex tertiary care providers to the health system at the district level; putting the pharmaceutical industry under the control of the Ministry of Health and Family Welfare, and so on. The single question we would like to a­ddress is: What are the conditions u­nder which the report’s promise will bear fruit?</div><div style="text-align: justify"><br /></div><div style="text-align: justify">To answer this, we explore a dimension that is peculiarly invisible in the report, the political. By the term “political” we mean the different forces and interests that come into play to shape and reconfigure administrative policy and its implementation. Generally speaking, there are two levels at which the proposals of the HLEG report will be reshaped – the local and the international.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Local Architecture</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">Any programme to implement a developmental policy in this country, for instance, universal primary education, the Integrated Child Development Services (ICDS), mid-day meals, the National R­ural Health Mission (NRHM), and so on, is practically reconfigured to align with the logic of political forces and possibilities at the local level. Top-down planning initiatives always trickle down without disturbing the power hierarchy along paths of least resistance. Such measures do not result in substantive benefits to the people targeted and also suppress critical questions from the ground level.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The current distribution of 300 calories a day under the ICDS consists of a nearly inedible powdered mixture, which is conceived by the powers-that-be as a dole to recipients habitually imagined as objects of charity. If the programme had been forged through an a­ctive political consensus with the dalits and other castes, it would have resulted in a far more substantial diet, including milk and eggs. This has been the case in Tamil Nadu for more than two decades. Characteristically, the packaging of these “nutritive” powders generates super-profits for businessmen in the loop.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Similarly, from the 1970s onwards, countless teachers on government school rolls ran businesses in towns, captured the textbook industry and opened tutorial institutes and colleges. In short, they did everything except teach, presenting themselves once a month to collect salaries. The alter­native configurations that have emerged over time to utilise the money made available by policy to both education and the ICDS remain very stable, deeply rooted and protected.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">To cite a different example, the NRHM has a regulation that pregnant women should deliver in institutions to prevent maternal mortalities. This has resulted in confusion regarding the roles of the dais (traditional birth attendants) and auxiliary nurses and midwives (ANMs), who played crucial roles at the village and sub-centre levels. As a result of this directive, deliveries are turned away from health sub-centres. Preventing mortalities implies the availability of an anaesthetist, facilities for a caesarean section and blood for transfusion in case of an emergency. These are avail­able at district hospitals. There is predictably an unmanageable rush at these institutions and women are sent home three to 12 hours after delivery. Cash incentives to compensate for the increased cost of institutional deliveries without strengthening the system only exacerbates the problem.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Though in different ways, these examples illustrate a failure of plan intentions. The issue here is not so much corruption (the favourite scapegoat) or even a lack of “merit” or competence, as the inability of planners to gauge reality on the ground and to convincingly communicate and negotiate with people who implement and use their programmes. Without processes carefully designed to overcome hurdles, plans fail. The HLEG report clearly acknowledges the importance of people’s participation, but not adequately. It shows inadequate comprehension of the fundamental rift between planning perspectives in their current top-down form and the demands of a practical and functioning UHC service.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>International and National Business Interests</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">It is clear that the impetus to set up UHC in India comes from big business and the state’s agenda for growth. Quite tellingly, the World Bank and other international funding institutions like the Rockefeller Foundation have endorsed the Aarogyasri programme of healthcare for the poor in Andhra Pradesh (Shukla et al 2011). Indeed, it is commonly believed that the Planning Commission constituted the HLEG and gave it the responsibility to come up with a way to spend 2.5% of the gross domestic product (GDP) in the healthcare sector. This figure was presumably predetermined and this is the likely reason the report starts with the subject of finance (instead of ground-level considerations such as disease burden, health goals and system weaknesses). With assured Plan allocations and the high profile “success” of the Aarogyasri model, an insurance-based, expensive, tertiary care based universal healthcare system for India is likely.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Given this reality, and from the trends observable in the Aarogyasri pr0gramme, if the state does not have a role, it is ­almost certain that the healthcare ­system will be an e­xorbitant, interventionist, high technology tertiary care one. In this context, the HLEG report ­emphasises that public institutions have a key role to play. Unfortunately, many of these institutions have been reduced to agencies implementing donor-driven national programmes like family planning, the current drive for the introduction of newer vaccines, etc. As a way out, we feel that both the private and public sectors must be engaged, but configured in such a way that they act as checks on the un­accountability and rank opportunism of the private sector on the one hand, and the insensitive and unresponsive character of the public sector on the other. This will also facilitate the HLEG’s agenda of pushing for broader investments in the social determinants of health such as food, sanitation and housing.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Historical Snapshots</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">An important factor in the success of different UHC systems in the world has been the circumstances in which they emerged. The UK’s National Health Service and the Beveridge report that led to it followed the Great Depression and the second world war and it had the approval of both the Conservative and Labour parties. There was a desperate need to raise morale and work a way out of a national debt, estimated at about £3,300 million. It was this configuration of circumstances that held a shared appreciation of the health system in place, leading to its success.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">In Brazil, the 1988 constitution marked the end of 20 years of military rule and the emergence of democracy (Buss and Gadelha 1996). This was preceded by the Eighth National Health Conference in 1986 attended by 5,000 participants, representing users, welfare organisations and public service personnel. The conference drafted the constitutional charter on health, which ultimately led to health and social security becoming constitutional principles. It was undoubtedly the fresh spirit of freedom and an overall commitment to the well-being and social security of the population that led to the country embarking on the path of successful healthcare for its people.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Thailand also set up its UHC system during a process of democratisation when new actors entered the political arena. The slogan used to mobilise people was “30 baht to treat all diseases” (1 baht is approximately 1.43 rupees; for an account see Khanna 2010-11). It is surprising that the HLEG report misses this important dimension of a fresh start providing a stimulus to UHC in the many vig­nettes of healthcare successes across the world it provides. It narrates their stories as if putting a healthcare system in place was merely an administrative matter of bringing together logistics, planning and good intentions (though it does briefly mention political movements in the introduction to these studies).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Closer home, in Tamil Nadu, the success of the state healthcare system, which functions more effectively than most in the rest of the country, was a­ttributed by a senior official to “greater enlightenment, efficient operation and personal commitment”. All these may be traced to the history of Tamil Nadu’s struggles over the last century with the problems of political representation, self-respect and brahmin domination. These movements and the emergence of the Dravida Munnetra Kazhagam (DMK) and its offshoots have led to a strong political will and administrative commitment to the plural subaltern population constituted of various castes, nationa­lities and historical circumstances. Though the English press tends to focus largely on corruption, the state has had successes in vital areas such as health, education and food.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">What these examples teach us is that a political environment that allows for motivation, commitment and the active involvement of the people is essential for a healthcare system to succeed. Is it possible to construct a progressive hegemony around the concept of UHC? This is the question on which the success of the HLEG’s proposals hinges.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Only an extensive agreement across the chain of the implementing agencies that healthcare is an item of absolute priority will generate the organic commitment, supervision and diligence necessary to conducting its operations successfully. The absence of these today is not so much a mark of corruption, selfishness or incompetence as the mark of an elitist model of national development that has failed to carry the people (including administrative functionaries) with it. It is the insularity of elite political will obsessed with indices of rapid growth to the exclusion of the concerns of most of the people of India. Even in these circumstances, a progressive h­ege­mony may not be impossible to construct. There are many examples of partial success in India, despite some of them having somewhat dubious credentials, such as family planning, universal primary e­ducation, oral polio vaccination and the Tamil Nadu health experience.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Progressive hegemony can never be simple government propaganda. We would agree broadly with the Medico Friends Circle position (MFC 2011-12) that the government needs to engage in negotiations with different groups of people so that their (even partially arti­culated) ideas, needs and constraints are woven into the broad picture. However, this would require the involvement of not just secular people’s health assemblies and panchayati raj institutions, but also mainstream national and regional political parties (like the Congress, BJP, Shiv Sena, the Majlis-e-Ittehadul Muslimeen) and their local representatives. While it is indubitable that politicians are deeply corruptible, and invested in businesses (as was the late Y S Rajasekhara Reddy in Andhra Pradesh) they also have historically developed a degree of bilateral communication with and accountability to the people they represent. We should note that minorities and marginalised castes and tribal groups have to be important participants because they are structurally the most vulnerable in secular healthcare programmes. The political parties that address them would historically be attuned to their aspirations and felt needs.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">A recommendation that stands out in the HLEG report is the one to establish medical colleges linked to district hospitals as apex tertiary units. We feel these should largely be government-run colleges, which establish standard practices in areas for tertiary care and support primary- and secondary-care initiatives (both government and private). The proposed three-year Bachelor of Rural Health Care course (HLEG 2011: 159) will strengthen the primary and secondary-care systems.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">It is worth speculating on the several advantages medical colleges linked to district hospitals could have. One, since the college will be a government-run e­ducational institution providing tertiary care, its economics need not be profit-oriented, thus offsetting a constraint in providing accessible, advanced medical care in the hinterland. Two, the increased availability of seats for medical education is likely to make the discipline less a target of artificial academic merit measured by entrance tests and more one of a genuine concern for healthcare. Three, medical courses will be less susceptible to the current laissez-faire curriculum policy where only the most advanced specialisations imbue value to an export-oriented medical education. This will create the possibility of a curriculum that is more responsive to actual health needs.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Four, depending on a district’s case load of medical problems to teach students will exert a corrective influence on competence, understanding and inventiveness. This will also hopefully result in a research orientation that is responsive to the specific healthcare needs of the people of this country. Finally, with the medical college’s support, the medical system will be able to penetrate rural areas in a way that other initiatives of the last two or three decades have not. On the whole, it may carry forward the promise of Aarogyasri programme with the necessary radical course correction.</div><div style="text-align: justify"> </div><div style="text-align: justify"><em><strong>References</strong></em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">Buss, P and P Gadelha (1996): “Healthcare Systems in Transition: Brazil Part I: An Outline of Brazil’s Healthcare Reforms”, Journal of Public Health Medicine, (18) 3, pp 289-95.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">HLEG (2011): “High Level Expert Group Report on Universal Health Coverage for India”, Planning Commission of India, New Delhi.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Khanna, R (2010-11): “Universal Health Coverage in Thailand: What Lessons Can India Learn?”, MFC Bulletin, 342-44, August 2010-January 2011.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">MFC (2011-12): “Exploring a Road Map for Health Care for All/UAHC”, MFC Bulletin, 348-50, August 2011-January 2012.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Shukla, R, V Shatrugna and R Srivatsan (2011): “Aarogyasri Healthcare Model: Advantage Private Sector”, Economic & Political Weekly, 46 (49), pp 38-42.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Walsh, J A and K S Warren (1979): “Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries”, New England Journal of Medicine, 301, pp 967-74.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">World Bank (1993): Investing in Health, World Development Report 1993 (New York: Oxford University Press).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Zachariah, A, R Srivatsan, and S Tharu (2010): T­owards a Critical Medical Practice: Reflections on the Dilemmas of Medical Culture Today (­Hyderabad: Orient BlackSwan).</div><div style="text-align: justify"><br /></div>
</div>
</td>
</tr>
</table>
</div>
</div>
</div>
<div class="clear"></div>
<br><a href="http://beta.epw.in/newsItem/comment/191039/" class="re" target="_blank">Economic and Political Weekly, Vol XLVII, No. 7, 25 February, 2012, http://beta.epw.in/newsItem/comment/191039/</a><div class="clear"></div>
<div style="padding-top: 18px;">
<p class="post-tag">Tagged with:
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Health"
title="Health">
Health </a>
</p>
</div>
<div class="clear"></div>
<br><br>
<div class="widget-top">
<h4>Related Articles</h4>
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<ul id="recentcomments">
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/fifth-report-from-gambia-implicates-indian-drug-maker-for-contaminated-syrups-banjot-kaur.html"
title="Fifth Report From Gambia Implicates Indian Drug Maker for Contaminated Syrups - Banjot Kaur">
Fifth Report From Gambia Implicates Indian Drug Maker for Contaminated Syrups - Banjot Kaur </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-may-have-seen-steepest-dip-in-multidimensional-poverty-among-110-nations-as-per-undp-data-nikhil-rampal.html"
title="India may have seen steepest dip in multidimensional poverty among 110 nations as per UNDP data - Nikhil Rampal">
India may have seen steepest dip in multidimensional poverty among 110 nations as per UNDP data - Nikhil Rampal </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/health-among-top-three-priorities-for-indian-voters-after-jobs-and-education-survey-shows-oliver-heath-jyoti-mishra-louise-tillin-sandhya-venkateswaran.html"
title="Health among top three priorities for Indian voters after jobs and education, survey shows - Oliver Heath, Jyoti Mishra, Louise Tillin & Sandhya Venkateswaran">
Health among top three priorities for Indian voters after jobs and education, survey shows - Oliver Heath, Jyoti Mishra, Louise Tillin & Sandhya Venkateswaran </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/prevalence-of-zero-food-among-infants-and-young-children-in-india-patterns-of-change-across-the-states-and-union-territories-of-india-1993-2021-the-lancet.html"
title="Prevalence of Zero-Food among infants and young children in India - The Lancet ">
Prevalence of Zero-Food among infants and young children in India - The Lancet </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-s-sustainability-goals-at-risk-because-of-extreme-heatwaves-carbon-copy.html"
title="India's Sustainability Goals at Risk Because of Extreme Heatwaves - Carbon Copy">
India's Sustainability Goals at Risk Because of Extreme Heatwaves - Carbon Copy </a>
</li>
</ul>
</div>
<div class="comment-respond" id="respond">
<a name="commentbox"> </a>
<h3 class="comment-reply-title" id="reply-title">Write Comments</h3>
<form method="post" accept-charset="utf-8" role="form" action="/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"><div style="display:none;"><input type="hidden" name="_method" value="POST"/></div> <form class="comment-form" id="commentform" method="post" action="#commentbox" onSubmit="return validate()"
name="cmtform">
<input type="hidden" name="cmttype" value="articlecmt"/>
<input type="hidden" name="article_id" value="13230"/>
<p class="comment-notes">Your email address will not be published. Required fields are marked <span
class="required">*</span></p>
<p class="comment-form-author">
<label for="commenterName">Name</label>
<span class="required">*</span>
<input type="text" aria-required="true" size="30"
value=""
name="commenterName" id="commenterName" required="true">
</p>
<p class="comment-form-email">
<label for="commenterEmail">Email</label> <span class="required">*</span>
<input aria-required="true" size="30" name="commenterEmail" id="commenterEmail" type="email"
value=""
required="true">
</p>
<p class="comment-form-contact">
<label for="commenterPh">Contact No.</label>
<input type="text" size="30"
value=""
name="commenterPh" id="commenterPh">
</p>
<p class="comment-form-comment">
<label for="comment">Comment</label>
<textarea aria-required="true" required="true" rows="8" cols="45" name="comment"
id="comment"></textarea>
</p>
<p class="comment-form-comment">
<label for="comment">Type the characters you see in the image below <span class="required">*</span><br><img
class="captchaImg"
src="https://im4change.in/securimage_show_art.php?tk=861803084" alt="captcha"/>
</label>
</p>
<input type="text" name="vrcode" required="true"/>
<p class="form-submit" style="width: 200px;">
<input type="submit" value="Post Comment" id="submit" name="submit">
</p></form>
</div>
<style>
.ui-widget-content {
height: auto !important;
}
</style>
<div id="share-modal"></div>
<style>
.middleContent a{
background-color: rgba(108,172,228,.2);
}
.middleContent a:hover{
background-color: #418fde;
border-color: #418fde;
color: #000;
}
</style>
<script>
function shareArticle(article_id) {
var options = {
modal: true,
height: 'auto',
width: 600 + 'px'
};
$('#share-modal').html("");
$('#share-modal').load('https://im4change.in/share_article?article_id=' + article_id).dialog(options).dialog('open');
}
function postShare() {
var param = 'article_id=' + $("#article_id").val();
param = param + '&y_name=' + $("#y_name").val();
param = param + '&y_email=' + $("#y_email").val();
param = param + '&f_name=' + $("#f_name").val();
param = param + '&f_email=' + $("#f_email").val();
param = param + '&y_msg=' + $("#y_msg").val();
$.ajax({
type: "POST",
url: 'https://im4change.in/post_share_article',
data: param,
success: function (response) {
$('#share-modal').html("Thank You, Your message posted to ");
}
});
return false;
}
</script> </div>
</div>
<!-- Right Side Section Start -->
<!-- MAP Section START -->
<aside class="sidebar indexMarg">
<div class="ad-cell">
<a href="https://im4change.in/statemap.php" title="">
<img src="https://im4change.in/images/map_new_version.png?1582080666" alt="India State Map" class="indiamap" width="232" height="252"/> </a>
<div class="rightmapbox">
<div id="sideOne" class="docltitle"><a href="https://im4change.in/state-report/india/36" target="_blank">DOCUMENTS/
REPORTS</a></div>
<div id="sideTwo" class="statetitle"><a href="https://im4change.in/states.php"target="_blank">STATE DATA/
HDRs.</a></div>
</div>
<div class="widget widgePadTop"></div>
</div>
</aside>
<!-- MAP Section END -->
<aside class="sidebar sidePadbottom">
<div class="rightsmlbox1" >
<a href="https://im4change.in/knowledge_gateway" target="_blank" style="color: #035588;
font-size: 17px;">
KNOWLEDGE GATEWAY
</a>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/newsletter" target="_blank">
NEWSLETTER
</a>
</p>
</div>
</div>
<div class="rightsmlbox1" style="height: 325px;">
<div>
<p class="rightsmlbox1_title">
Interview with Prof. Ravi Srivastava
</p>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/video/interview-with-prof-ravi-srivastava-on-current-economic-crisis">
<img width="250" height="200" src="/images/interview_video_home.jpg" alt="Interview with Prof. Ravi Srivastava"/>
</a>
<!--
<iframe width="250" height="200" src="https://www.youtube.com/embed/MmaTlntk-wc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe>-->
</p>
<a href="https://im4change.in/videogallery" class="more-link CatArchalAnch1" target="_blank">
More videos
</a>
</div>
</div>
<div class="rightsmlbox1">
<div>
<!--div id="sstory" class="rightboxicons"></div--->
<p class="rightsmlbox1_title"><a href="https://im4change.in/list-success-stories" target="_blank">Success Stories</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/interviews" target="_blank">Interviews</a>
</p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a href="https://www.commoncause.in/page.php?id=10" >Donate</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/marquee"
class="isf_link more-link" title="India Focus?" style="border: 4px solid #fdd922;width: 90%;background-color: #fdd922;text-align: center;color: #000000;font-size:18px" target="_blank">India Focus</a></p> </div>
</div>
<div class="rightsmlbox1" style="height: 104px !important;">
<a href="https://im4change.in/quarterly_reports.php" target="_blank">
Quarterly Reports on Effect of Economic Slowdown on Employment in India (2008 - 2015)
</a>
</div>
<!-- <div class="rightsmlbox1">
<a href="https://play.google.com/store/apps/details?id=com.im4.im4change" target="_blank">
</a></div> -->
<!-- <section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">Most Visited</h2>
</section> -->
<!-- accordion Starts here -->
<!-- <div id="accordion" class="accordMarg">
</div> -->
<!-- accordion ends here -->
<!-- Widget Tag Cloud Starts here -->
<div id="tag_cloud-2" class="widget widget_tag_cloud">
<section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">MOST VISITED TAGS</h2>
</section>
<div class="widget-top wiPdTp">
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<div class="tagcloud">
<a href="https://im4change.in/search?qryStr=Agriculture"
target="_blank" class="tag-link-4 font4">Agriculture</a>
<a href="https://im4change.in/search?qryStr=Food Security"
target="_blank" class="tag-link-4 font4">Food Security</a>
<a href="https://im4change.in/search?qryStr=Law and Justice"
target="_blank" class="tag-link-4 font4">Law and Justice</a>
<a href="https://im4change.in/search?qryStr=Health"
target="_blank" class="tag-link-4 font4">Health</a>
<a href="https://im4change.in/search?qryStr=Right to Food"
target="_blank" class="tag-link-4 font4">Right to Food</a>
<a href="https://im4change.in/search?qryStr=Corruption"
target="_blank" class="tag-link-4 font4">Corruption</a>
<a href="https://im4change.in/search?qryStr=farming"
target="_blank" class="tag-link-4 font4">farming</a>
<a href="https://im4change.in/search?qryStr=Environment"
target="_blank" class="tag-link-4 font4">Environment</a>
<a href="https://im4change.in/search?qryStr=Right to Information"
target="_blank" class="tag-link-4 font4">Right to Information</a>
<a href="https://im4change.in/search?qryStr=NREGS"
target="_blank" class="tag-link-4 font4">NREGS</a>
<a href="https://im4change.in/search?qryStr=Human Rights"
target="_blank" class="tag-link-4 font4">Human Rights</a>
<a href="https://im4change.in/search?qryStr=Governance"
target="_blank" class="tag-link-4 font4">Governance</a>
<a href="https://im4change.in/search?qryStr=PDS"
target="_blank" class="tag-link-4 font4">PDS</a>
<a href="https://im4change.in/search?qryStr=COVID-19"
target="_blank" class="tag-link-4 font4">COVID-19</a>
<a href="https://im4change.in/search?qryStr=Land Acquisition"
target="_blank" class="tag-link-4 font4">Land Acquisition</a>
<a href="https://im4change.in/search?qryStr=mgnrega"
target="_blank" class="tag-link-4 font4">mgnrega</a>
<a href="https://im4change.in/search?qryStr=Farmers"
target="_blank" class="tag-link-4 font4">Farmers</a>
<a href="https://im4change.in/search?qryStr=transparency"
target="_blank" class="tag-link-4 font4">transparency</a>
<a href="https://im4change.in/search?qryStr=Gender"
target="_blank" class="tag-link-4 font4">Gender</a>
<a href="https://im4change.in/search?qryStr=Poverty"
target="_blank" class="tag-link-4 font4">Poverty</a>
<a href="https://im4change.in/search?qryStr=Farm Laws" target="_blank" class="tag-link-4 font4">Farm Laws
</a>
<a href="https://im4change.in/search?qryStr=Citizenship Amendment Act" target="_blank" class="tag-link-4 font4">Citizenship Amendment Act
</a>
<a href="https://im4change.in/search?qryStr=CAA NPR NRIC" target="_blank" class="tag-link-4 font4">CAA NPR NRIC
</a>
<a href="https://im4change.in/search?qryStr=Job Losses" target="_blank" class="tag-link-4 font4">Job Losses
</a>
<a href="https://im4change.in/search?qryStr=Migrant Workers" target="_blank" class="tag-link-4 font4">Migrant Workers
</a>
<a href="https://im4change.in/search?qryStr=Unemployment" target="_blank" class="tag-link-4 font4">Unemployment
</a>
<a href="https://im4change.in/search?qryStr=PMGKAY" target="_blank" class="tag-link-4 font4">PMGKAY
</a>
<a href="https://im4change.in/search?qryStr=PM-KISAN" target="_blank" class="tag-link-4 font4">PM-KISAN
</a>
<a href="https://im4change.in/search?qryStr=PM-CARES" target="_blank" class="tag-link-4 font4">PM-CARES
</a>
<a href="https://im4change.in/search?qryStr=LFPR" target="_blank" class="tag-link-4 font4">LFPR
</a>
</div>
</div>
</div>
<!-- Widget Tag Cloud Ends here -->
</aside>
<!-- Right Side Section End -->
</div>
<section class="cat-box cats-review-box footerSec">
<h2 class="cat-box-title vSec CatArcha">Video
Archives</h2>
<h2 class="cat-box-title CatArchaTitle">Archives</h2>
<div class="cat-box-content">
<div class="reviews-cat">
<div class="CatArchaDiv1">
<div class="CatArchaDiv2">
<ul>
<li>
<a href="https://im4change.in/news-alerts-57/moving-upstream-luni-fellowship.html" target="_blank">
Moving Upstream: Luni – Fellowship </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/135-million-indians-exited-multidimensional-poverty-as-per-government-figures-is-that-the-same-as-poverty-reduction.html" target="_blank">
135 Million Indians Exited “Multidimensional" Poverty as per Government... </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/explainer-why-are-tomato-prices-on-fire.html" target="_blank">
Explainer: Why are Tomato Prices on Fire? </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/nsso-survey-only-39-1-of-all-households-have-drinking-water-within-dwelling-46-7-of-rural-households-use-firewood-for-cooking.html" target="_blank">
NSSO Survey: Only 39.1% of all Households have Drinking... </a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/news-alerts-57"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/I51LYnP8BOk/1.jpg"
alt=" Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Short-Video-on-im4change-Hindi-website-Inclusive-Media-for-Change" target="_blank">
Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/kNqha-SwfIY/1.jpg"
alt=" "Session 1: Scope of IDEA and AgriStack" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-1- Scope-of-IDEA-and-AgriStack-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 1: Scope of IDEA and AgriStack" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/6kIVjlgZItk/1.jpg"
alt=" "Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-2-Farmer-Centric-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/2BeHTu0y7xc/1.jpg"
alt=" "Session 3: Future of Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-3-Future-of-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 3: Future of Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="divWidth">
<ul class="divWidthMarg">
<li>
<a href="https://im4change.in/video/Public-Spending-on-Agriculture-in-India-Source-Foundation-for-Agrarian-Studies"
title="Public Spending on Agriculture in India (Source: Foundation for Agrarian Studies)" target="_blank">
Public Spending on Agriculture in India (Source: Foundation for...</a>
</li>
<li>
<a href="https://im4change.in/video/Agrarian-Change-Seminar-Protests-against-the-New-Farm-Laws-in-India-by-Prof-Vikas-Rawal-JNU-Source-Journal-Of-Agrarian-Change"
title="Agrarian Change Seminar: 'Protests against the New Farm Laws in India' by Prof. Vikas Rawal, JNU (Source: Journal Of Agrarian Change) " target="_blank">
Agrarian Change Seminar: 'Protests against the New Farm Laws...</a>
</li>
<li>
<a href="https://im4change.in/video/Webinar-Ramrao-The-Story-of-India-Farm-Crisis-Source-Azim-Premji-University"
title="Webinar: Ramrao - The Story of India's Farm Crisis (Source: Azim Premji University)" target="_blank">
Webinar: Ramrao - The Story of India's Farm Crisis...</a>
</li>
<li>
<a href="https://im4change.in/video/water-and-agricultural-transformation-in-India"
title="Water and Agricultural Transformation in India: A Symbiotic Relationship (Source: IGIDR)" target="_blank">
Water and Agricultural Transformation in India: A Symbiotic Relationship...</a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/videogallery"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
</div>
</div>
</div>
</section> </div>
<div class="clear"></div>
<!-- Footer option Starts here -->
<div class="footer-bottom fade-in animated4">
<div class="container">
<div class="social-icons icon_flat">
<p class="SocialMargTop"> Website Developed by <a target="_blank" title="Web Development"
class="wot right"
href="http://www.ravinderkhurana.com/" rel="nofollow">
RAVINDErkHURANA.com</a></p>
</div>
<div class="alignleft">
<a
target="_blank" href="https://im4change.in/objectives-8.html"
class="link"
title="Objectives">Objectives</a> | <a
target="_blank" href="https://im4change.in/about-us-9.html"
class="link" title="About Us">About Us</a> | <a
target="_blank" href="https://im4change.in/media-workshops.php"
class="ucwords">Workshops</a> | <a
target="_blank" href="https://im4change.in/disclaimer/disclaimer-149.html"
title="Disclaimer">Disclaimer</a> </div>
</div>
</div>
<!-- Footer option ends here -->
</div>
<div id="connect">
<a target="_blank"
href="http://www.facebook.com/sharer.php?u=https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"
title="Share on Facebook">
<img src="https://im4change.in/images/Facebook.png?1582080640" alt="share on Facebook" class="ImgBorder"/>
</a><br/>
<a target="_blank"
href="http://twitter.com/share?text=Im4change&url=https://im4change.in/latest-news-updates/political-challenges-to-universal-access-to-healthcare-by-r-srivatsan-veena-shatrugna-13352.html"
title="Share on Twitter">
<img src="https://im4change.in/images/twitter.png?1582080632" alt="Twitter" class="ImgBorder"/> </a>
<br/>
<a href="/feeds" title="RSS Feed" target="_blank">
<img src="https://im4change.in/images/rss.png?1582080632" alt="RSS" class="ImgBorder"/>
</a>
<br/>
<a class="feedback-link" id="feedbackFormLink" href="#">
<img src="https://im4change.in/images/feedback.png?1582080630" alt="Feedback" class="ImgBorder"/>
</a> <br/>
<a href="javascript:function iprl5(){var d=document,z=d.createElement('scr'+'ipt'),b=d.body,l=d.location;try{if(!b)throw(0);d.title='(Saving...) '+d.title;z.setAttribute('src',l.protocol+'//www.instapaper.com/j/WKrH3R7ORD5p?u='+encodeURIComponent(l.href)+'&t='+(new Date().getTime()));b.appendChild(z);}catch(e){alert('Please wait until the page has loaded.');}}iprl5();void(0)"
class="bookmarklet" onclick="return explain_bookmarklet();">
<img src="https://im4change.in/images/read-it-later.png?1582080632" alt="Read Later" class="ImgBorder"/> </a>
</div>
<!-- Feedback form Starts here -->
<div id="feedbackForm" class="overlay_form" class="ImgBorder">
<h2>Contact Form</h2>
<div id="contactform1">
<div id="formleft">
<form id="submitform" action="/contactus.php" method="post">
<input type="hidden" name="submitform" value="submitform"/>
<input type="hidden" name="salt_key" value="a0e0f2c6a0644a70e57ad2c96829709a"/>
<input type="hidden" name="ref" value="feedback"/>
<fieldset>
<label>Name :</label>
<input type="text" name="name" class="tbox" required/>
</fieldset>
<fieldset>
<label>Email :</label>
<input type="text" name="email" class="tbox" required/>
</fieldset>
<fieldset>
<label>Message :</label>
<textarea rows="5" cols="20" name="message" required></textarea>
</fieldset>
<fieldset>
Please enter security code
<div class="clear"></div>
<input type="text" name="vrcode" class="tbox"/>
</fieldset>
<fieldset>
<input type="submit" class="button" value="Submit"/>
<a href="#" id="closefeedbakcformLink">Close</a>
</fieldset>
</form>
</div>
<div class="clearfix"></div>
</div>
</div>
<div id="donate_popup" class="modal" style="max-width: 800px;">
<table width="100%" border="1">
<tr>
<td colspan="2" align="center">
<b>Support im4change</b>
</td>
</tr>
<tr>
<td width="25%" valign="middle">
<img src="https://im4change.in/images/logo2.jpg?1582080632" alt="" width="100%"/> </td>
<td style="padding-left:10px;padding-top:10px;">
<form action="https://im4change.in/donate" method="get">
<table width="100%" cellpadding="2" cellspacing="2">
<tr>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
10
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
100
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
1000
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
50
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
500
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
<input type="text" name="price" placeholder="?" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td colspan="3" align="right">
<input type="button" name="Pay" value="Pay"
style="width: 200px;background-color: rgb(205, 35, 36);color: #ffffff;"/>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</div><script type='text/javascript'>
/* <![CDATA[ */
var tievar = {'go_to': 'Go to...'};
/* ]]> */
</script>
<script src="/js/tie-scripts.js?1575549704"></script><script src="/js/bootstrap.js?1575549704"></script><script src="/js/jquery.modal.min.js?1578284310"></script><script>
$(document).ready(function() {
// tell the autocomplete function to get its data from our php script
$('#s').autocomplete({
source: "/autocomplete"
});
});
</script>
<script src="/vj-main-sw-register.js" async></script>
<script>function init(){var imgDefer=document.getElementsByTagName('img');for(var i=0;i<imgDefer.length;i++){if(imgDefer[i].getAttribute('data-src')){imgDefer[i].setAttribute('src',imgDefer[i].getAttribute('data-src'))}}}
window.onload=init;</script>
</body>
</html>'
}
$cookies = []
$values = [
(int) 0 => 'text/html; charset=UTF-8'
]
$name = 'Content-Type'
$first = true
$value = 'text/html; charset=UTF-8'
header - [internal], line ??
Cake\Http\ResponseEmitter::emitHeaders() - CORE/src/Http/ResponseEmitter.php, line 181
Cake\Http\ResponseEmitter::emit() - CORE/src/Http/ResponseEmitter.php, line 55
Cake\Http\Server::emit() - CORE/src/Http/Server.php, line 141
[main] - ROOT/webroot/index.php, line 39
LATEST NEWS UPDATES | Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna
Political Challenges to Universal Access to Healthcare by R Srivatsan & Veena Shatrugna
Published on Feb 24, 2012
Modified on Feb 24, 2012
While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it explores the political dimension, which comprises the forces and interests that come into play to shape and reconfigure administrative policy and its implementation.
We are grateful to Anand Zachariah and Susie Tharu for their insightful comments on the report. In particular, Zachariah’s inputs on medical colleges as apex tertiary medical care institutions in districts and Tharu’s stress on the importance of practice need mention. (See Zachariah et al 2010 for a conceptual background).
R Srivatsan (r.srivats@gmail.com) is with the Anveshi Research Centre for Women’s Studies, Hyderabad and Veena Shatrugna (veenashatrugna@yahoo.com) was with the National Institute of Nutrition, Hyderabad.
The report of the High Level Expert Group (HLEG) on Universal Health Coverage (UHC) for India is to be welcomed for its comprehensive vision of healthcare. After the neo-liberal proposals on selective primary health care articulated by Walsh and Warren (1979) doubted if providing comprehensive healthcare in a third world country was a feasible goal and the World Bank’s Investing in Health report (1993) put forth an influential model incorporating that view, the HLEG report reaffirms the goal of UHC. This is an important development, which shows that India is at a political and economic stage that no longer needs to repeat the minimalist solutions of selective primary health care – diphtheria-pertussis-tetanus (DPT) immunisation, tetanus toxoid to pregnant women, breastfeeding, chloroquine for malaria and oral rehydration solution (ORS) for diarrhoea. It is indeed worth pausing and pondering over the significance of this moment.
Many of the recommendations (and there are many) in the HLEG report are well-conceived – elimination of cost to the patient; funding through taxation; elimination of insurance; making medical colleges the apex tertiary care providers to the health system at the district level; putting the pharmaceutical industry under the control of the Ministry of Health and Family Welfare, and so on. The single question we would like to address is: What are the conditions under which the report’s promise will bear fruit?
To answer this, we explore a dimension that is peculiarly invisible in the report, the political. By the term “political” we mean the different forces and interests that come into play to shape and reconfigure administrative policy and its implementation. Generally speaking, there are two levels at which the proposals of the HLEG report will be reshaped – the local and the international.
Local Architecture
Any programme to implement a developmental policy in this country, for instance, universal primary education, the Integrated Child Development Services (ICDS), mid-day meals, the National Rural Health Mission (NRHM), and so on, is practically reconfigured to align with the logic of political forces and possibilities at the local level. Top-down planning initiatives always trickle down without disturbing the power hierarchy along paths of least resistance. Such measures do not result in substantive benefits to the people targeted and also suppress critical questions from the ground level.
The current distribution of 300 calories a day under the ICDS consists of a nearly inedible powdered mixture, which is conceived by the powers-that-be as a dole to recipients habitually imagined as objects of charity. If the programme had been forged through an active political consensus with the dalits and other castes, it would have resulted in a far more substantial diet, including milk and eggs. This has been the case in Tamil Nadu for more than two decades. Characteristically, the packaging of these “nutritive” powders generates super-profits for businessmen in the loop.
Similarly, from the 1970s onwards, countless teachers on government school rolls ran businesses in towns, captured the textbook industry and opened tutorial institutes and colleges. In short, they did everything except teach, presenting themselves once a month to collect salaries. The alternative configurations that have emerged over time to utilise the money made available by policy to both education and the ICDS remain very stable, deeply rooted and protected.
To cite a different example, the NRHM has a regulation that pregnant women should deliver in institutions to prevent maternal mortalities. This has resulted in confusion regarding the roles of the dais (traditional birth attendants) and auxiliary nurses and midwives (ANMs), who played crucial roles at the village and sub-centre levels. As a result of this directive, deliveries are turned away from health sub-centres. Preventing mortalities implies the availability of an anaesthetist, facilities for a caesarean section and blood for transfusion in case of an emergency. These are available at district hospitals. There is predictably an unmanageable rush at these institutions and women are sent home three to 12 hours after delivery. Cash incentives to compensate for the increased cost of institutional deliveries without strengthening the system only exacerbates the problem.
Though in different ways, these examples illustrate a failure of plan intentions. The issue here is not so much corruption (the favourite scapegoat) or even a lack of “merit” or competence, as the inability of planners to gauge reality on the ground and to convincingly communicate and negotiate with people who implement and use their programmes. Without processes carefully designed to overcome hurdles, plans fail. The HLEG report clearly acknowledges the importance of people’s participation, but not adequately. It shows inadequate comprehension of the fundamental rift between planning perspectives in their current top-down form and the demands of a practical and functioning UHC service.
International and National Business Interests
It is clear that the impetus to set up UHC in India comes from big business and the state’s agenda for growth. Quite tellingly, the World Bank and other international funding institutions like the Rockefeller Foundation have endorsed the Aarogyasri programme of healthcare for the poor in Andhra Pradesh (Shukla et al 2011). Indeed, it is commonly believed that the Planning Commission constituted the HLEG and gave it the responsibility to come up with a way to spend 2.5% of the gross domestic product (GDP) in the healthcare sector. This figure was presumably predetermined and this is the likely reason the report starts with the subject of finance (instead of ground-level considerations such as disease burden, health goals and system weaknesses). With assured Plan allocations and the high profile “success” of the Aarogyasri model, an insurance-based, expensive, tertiary care based universal healthcare system for India is likely.
Given this reality, and from the trends observable in the Aarogyasri pr0gramme, if the state does not have a role, it is almost certain that the healthcare system will be an exorbitant, interventionist, high technology tertiary care one. In this context, the HLEG report emphasises that public institutions have a key role to play. Unfortunately, many of these institutions have been reduced to agencies implementing donor-driven national programmes like family planning, the current drive for the introduction of newer vaccines, etc. As a way out, we feel that both the private and public sectors must be engaged, but configured in such a way that they act as checks on the unaccountability and rank opportunism of the private sector on the one hand, and the insensitive and unresponsive character of the public sector on the other. This will also facilitate the HLEG’s agenda of pushing for broader investments in the social determinants of health such as food, sanitation and housing.
Historical Snapshots
An important factor in the success of different UHC systems in the world has been the circumstances in which they emerged. The UK’s National Health Service and the Beveridge report that led to it followed the Great Depression and the second world war and it had the approval of both the Conservative and Labour parties. There was a desperate need to raise morale and work a way out of a national debt, estimated at about £3,300 million. It was this configuration of circumstances that held a shared appreciation of the health system in place, leading to its success.
In Brazil, the 1988 constitution marked the end of 20 years of military rule and the emergence of democracy (Buss and Gadelha 1996). This was preceded by the Eighth National Health Conference in 1986 attended by 5,000 participants, representing users, welfare organisations and public service personnel. The conference drafted the constitutional charter on health, which ultimately led to health and social security becoming constitutional principles. It was undoubtedly the fresh spirit of freedom and an overall commitment to the well-being and social security of the population that led to the country embarking on the path of successful healthcare for its people.
Thailand also set up its UHC system during a process of democratisation when new actors entered the political arena. The slogan used to mobilise people was “30 baht to treat all diseases” (1 baht is approximately 1.43 rupees; for an account see Khanna 2010-11). It is surprising that the HLEG report misses this important dimension of a fresh start providing a stimulus to UHC in the many vignettes of healthcare successes across the world it provides. It narrates their stories as if putting a healthcare system in place was merely an administrative matter of bringing together logistics, planning and good intentions (though it does briefly mention political movements in the introduction to these studies).
Closer home, in Tamil Nadu, the success of the state healthcare system, which functions more effectively than most in the rest of the country, was attributed by a senior official to “greater enlightenment, efficient operation and personal commitment”. All these may be traced to the history of Tamil Nadu’s struggles over the last century with the problems of political representation, self-respect and brahmin domination. These movements and the emergence of the Dravida Munnetra Kazhagam (DMK) and its offshoots have led to a strong political will and administrative commitment to the plural subaltern population constituted of various castes, nationalities and historical circumstances. Though the English press tends to focus largely on corruption, the state has had successes in vital areas such as health, education and food.
What these examples teach us is that a political environment that allows for motivation, commitment and the active involvement of the people is essential for a healthcare system to succeed. Is it possible to construct a progressive hegemony around the concept of UHC? This is the question on which the success of the HLEG’s proposals hinges.
Only an extensive agreement across the chain of the implementing agencies that healthcare is an item of absolute priority will generate the organic commitment, supervision and diligence necessary to conducting its operations successfully. The absence of these today is not so much a mark of corruption, selfishness or incompetence as the mark of an elitist model of national development that has failed to carry the people (including administrative functionaries) with it. It is the insularity of elite political will obsessed with indices of rapid growth to the exclusion of the concerns of most of the people of India. Even in these circumstances, a progressive hegemony may not be impossible to construct. There are many examples of partial success in India, despite some of them having somewhat dubious credentials, such as family planning, universal primary education, oral polio vaccination and the Tamil Nadu health experience.
Progressive hegemony can never be simple government propaganda. We would agree broadly with the Medico Friends Circle position (MFC 2011-12) that the government needs to engage in negotiations with different groups of people so that their (even partially articulated) ideas, needs and constraints are woven into the broad picture. However, this would require the involvement of not just secular people’s health assemblies and panchayati raj institutions, but also mainstream national and regional political parties (like the Congress, BJP, Shiv Sena, the Majlis-e-Ittehadul Muslimeen) and their local representatives. While it is indubitable that politicians are deeply corruptible, and invested in businesses (as was the late Y S Rajasekhara Reddy in Andhra Pradesh) they also have historically developed a degree of bilateral communication with and accountability to the people they represent. We should note that minorities and marginalised castes and tribal groups have to be important participants because they are structurally the most vulnerable in secular healthcare programmes. The political parties that address them would historically be attuned to their aspirations and felt needs.
A recommendation that stands out in the HLEG report is the one to establish medical colleges linked to district hospitals as apex tertiary units. We feel these should largely be government-run colleges, which establish standard practices in areas for tertiary care and support primary- and secondary-care initiatives (both government and private). The proposed three-year Bachelor of Rural Health Care course (HLEG 2011: 159) will strengthen the primary and secondary-care systems.
It is worth speculating on the several advantages medical colleges linked to district hospitals could have. One, since the college will be a government-run educational institution providing tertiary care, its economics need not be profit-oriented, thus offsetting a constraint in providing accessible, advanced medical care in the hinterland. Two, the increased availability of seats for medical education is likely to make the discipline less a target of artificial academic merit measured by entrance tests and more one of a genuine concern for healthcare. Three, medical courses will be less susceptible to the current laissez-faire curriculum policy where only the most advanced specialisations imbue value to an export-oriented medical education. This will create the possibility of a curriculum that is more responsive to actual health needs.
Four, depending on a district’s case load of medical problems to teach students will exert a corrective influence on competence, understanding and inventiveness. This will also hopefully result in a research orientation that is responsive to the specific healthcare needs of the people of this country. Finally, with the medical college’s support, the medical system will be able to penetrate rural areas in a way that other initiatives of the last two or three decades have not. On the whole, it may carry forward the promise of Aarogyasri programme with the necessary radical course correction.
References
Buss, P and P Gadelha (1996): “Healthcare Systems in Transition: Brazil Part I: An Outline of Brazil’s Healthcare Reforms”, Journal of Public Health Medicine, (18) 3, pp 289-95.
HLEG (2011): “High Level Expert Group Report on Universal Health Coverage for India”, Planning Commission of India, New Delhi.
Khanna, R (2010-11): “Universal Health Coverage in Thailand: What Lessons Can India Learn?”, MFC Bulletin, 342-44, August 2010-January 2011.
MFC (2011-12): “Exploring a Road Map for Health Care for All/UAHC”, MFC Bulletin, 348-50, August 2011-January 2012.
Shukla, R, V Shatrugna and R Srivatsan (2011): “Aarogyasri Healthcare Model: Advantage Private Sector”, Economic & Political Weekly, 46 (49), pp 38-42.
Walsh, J A and K S Warren (1979): “Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries”, New England Journal of Medicine, 301, pp 967-74.
World Bank (1993): Investing in Health, World Development Report 1993 (New York: Oxford University Press).
Zachariah, A, R Srivatsan, and S Tharu (2010): Towards a Critical Medical Practice: Reflections on the Dilemmas of Medical Culture Today (Hyderabad: Orient BlackSwan).
Write Comments