UHC Conference on HLEG April11-12, 2012

The UHC Conference in Delhi was a good pitch for the HLEG recommendations and very useful and insightful debate happened amongst a wide array of stakeholders. The discussions were good but there was one glaring deficit. I think the most problematic issue with HLEG report is that the Ministries of Health have been sidelined, both at the Centre and in States. The central problem is that even if the Planning Commission accepts it lock stock and barrel (which apparently it is not as we see differences with the Steering Committee Report and what may finally come into the 12th Plan) the Health Ministries get alienated and being the implementers of healthcare programs the latter are often at variance with the Planning Commission. The HLEG has also fallen into the same trap and despite reasonably good and broadly acceptable recommendations they are not going to be accepted because of not taking the Health Ministries fully into confidence. The role of Health Ministries have been marginal at best in developing the HLEG recommendations. The April 11-12 consultation on UHC in Delhi precisely suffered from that deficiency. An opportunity to get Ministries of Health on board was lost. The presence of secretaries from two states was only a consolation and there was no significant engagement with the Union Ministry of Health either. So it is not surprising that the grapevine is ripe with stories of the disjunct between the Planning Commission and the Ministry of Health on 12th Plan lines of action. So a lot of useful effort of HLEG is going to be wasted. During the 8th-10th Plan periods on various working groups of the PC I had raised this issue of sidelining the Ministry of Health in developing the trajectories of the Plans for health but these have been ignored and that is the reason after the 10th Plan I have turned down requests to be on any committees.
The above trajectory of the role being played by the Planning Commission seems to be across the board - the recent mess up with the Railways budget, which for the first time was influenced by the Planning Commission is a case in point; the Planning Commission wants to take it in the direction of privatization. These dangerous trends within the Planning Commission need to be monitored and countered.

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 www.mfcindia.org 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?