Thursday, February 23, 2012

Response to articles in Mint on Universal Access to Healthcare

In the "State of Healthcare" (23-2-12) you end by saying that the government must embrace the idea of health as a public good. I would add to this healthcare also as a public good. This is the key to universal access to healthcare. The High Level Expert Group on Universal Healthcare Coverage was appointed by the Planning Commission with great fanfare raising the expectation of the people that the government was serious about universal access to healthcare. It worked hard for over a year and a huge amount of resources were spent in research, meetings, consultation, background papers etc.. A reasonable report emerged as a result and now an internal coterie of the same Planning Commission is rejecting it and pitching for a larger scale private sector initiative in healthcare. This is no surprise. I have been on working groups of the Planning Commission in the 8th , 9th , and 10th Five Year Plans. We worked hard and came up with our reports and background papers but our esteemed planners did what they always do - ignore all that work and do what they had already decided. So 11th and 12th Plans I turned down being on any such working groups or committees.

When the HLEG Report came out I had a positive feeling that this time there was some serious intent but as you have reported in today's Mint the universal access story has been nixed. So history does repeat itself and ever so often! We at the Medico Friend Circle and Peoples Health Movement have been debating on universal access to healthcare for over three years and a lot of very useful literature has emerged on how to operationalize such a universal access healthcare system, how to finance it, its governance and management, it human resource requirements etc. (see for a wide range of literature and debates ). The HLEG took all this on board - they attended the mfc meetings and consultations and invited mfc and PHM members to their consultations to contribute in the development of the HLEG report. When the report was finally ready and despite some differences with it, many of us felt that the time had come when we could stop dreaming about universal access to healthcare and that the journey had begun towards realizing it. But alas our planners have forced us back to dreaming.

If we look at global performance all developing countries which saw rapid economic growth in the last two decades have made the transition to universal access to healthcare - Brazil, Mexico, Malaysia, Thailand, Sri Lanka, Venezuela etc. Why has India not seen this transformation? The answers are not difficult to seek - complete lack of political will towards public good, unwillingness on part of our bureaucracy to make structural changes, inability of our taxation system to net in all revenues due to the treasury because of poor tax administration and too many concessions and deductions to business and trade, and the private healthcare business' overpowering dominance of the health economy.

So here we stand on a threshold once again. The HLEG report is an opportunity to bring in the change. Will the Planning Commission, the PMO and the Ministry of Health recognize healthcare as a public good and take on board HLEG recommendations to implement during the 12th Plan period? 


  1. Ravi you need to wear a blue turban! Be hopeful, new statements have been issued by PMO :))

    1. Either you (whoever you are from NAMHHR)are colour blind or a poor observer. In my pic on this blog you will see I wear a blue turban!If that would help I would wear it every day!! I wish the PM was able to act on what he says. I am not very hopeful.