Riding on a saffron surge and charisma of Narendra Modi, the BJP-led NDA government is back with an overwhelming mandate and a full majority in the Lok Sabha, for the second time. The landslide victory not only ensured Modi government to achieve a super-size number of 350 out of 542 seats in the lower house of the Indian Parliament, but also helped form a strong and stable government with the potential to usher in economic reforms and take decisive steps in the national interest without any coalition conundrums.
Both India Inc and the stock markets congratulated a ‘stronger’ Modi 2.0. India’s benchmark index BSE Sensex breached all records to cross 40,000 and the corporates envision it as a time for transformation for growth parameters to improve.
There are huge expectations riding on Narendra Modi as he kickstarts his second innings. So where does health figure in the new government’s agenda?
“Experts claim Ayushman Bharat may not be the panacea for public health it has been promoted as. Despite initial successes, implementation has been a big cause of concern”
His victory speech dropped a hint. He expressed his concern for the health of the country’s people. The victory, he said, was not his, but that of the ‘beemar vyakti’ (ailing person), who was unable to afford medical treatment for several years and has now been able to do so under the NDA government.
The Modi government has been credited for ushering in two big reforms linked to public health – Swachh Bharat Abhiyan and Ayushman Bharat.
In his speech he was clearly referring to his flagship scheme, Ayushman Bharat or the Pradhan Mantri Jan Aarogya Yojana (PMJAY), touted as the world’s largest health insurance scheme worth Rs 6400 crore for 500 million economically vulnerable Indians. With a success rate of over one million patients thus far, it is being seen as a life-saver for a country like India which has over 62.58 percent of the population paying for their healthcare needs out of pocket. 55 million Indians are pushed into poverty because of rising healthcare burden and over 25 percent of households struggling with catastrophic health expenditure.
However, experts claim Ayushman Bharat may not be the panacea for public health it has been promoted as. Despite initial successes, implementation has been a big cause of concern for Ayushman Bharat.
“For Ayushman Bharat to be a success, the government needs to ensure a good balance between preventive healthcare and tertiary health. Funding is another big concern that requires serious financial management.”
Meenakshi Datta Ghosh, Former Special Secretary in the Ministry of Health, told Health Issues India as part of our Health for Polls campaign, “Ayushman Bharat has not only dangerously diluted the focus on public health sector strengthening which was introduced with the rollout of National Rural Health Mission but also aided privatisation of healthcare and will only end up increasing the out of pocket expenditure.”
On the other hand, Vibhav Garg, Vice President of Health Policy and Government Affairs at GE Healthcare,is optimistic. He stated, “health and wellness centres would play a key role in strengthening the primary healthcare segment. It looks very promising on paper and if implemented successfully, it will only help empower Indian healthcare”.
Hence for Ayushman Bharat to be a success, the government needs to ensure a good balance between preventive healthcare and tertiary health. Funding is another big concern that requires serious financial management.
In its vision document ahead of the general elections, the BJP promised to increase the coverage of Ayushman Bharat to include the establishment of 1.5 lakh healthcare centres. However, the document was silent when it came to increasing the budgetary allocation for healthcare which has been a trend of the BJP government. Increases to the healthcare sector’s allocations in this year’s Union Budget devoted a huge amount of funding to Ayushman Bharat, while the other aspects of the sector met with relatively incremental gains.
““Significant improvement has been seen in door to door collection, primary and secondary collection, transportation to outside city limits and cleaning roads…Key challenges are in treatment and disposal aspects, policies in waste-to-energy, and quality of service delivery standards.””
Outside of Ayushman Bharat, Swachh Bharat Abhiyan – or the Clean India campaign – was seen as a significant step in improving access to toilets and solid waste management, with a massive budget of Rs 15,343 crore. With a goal to make India open defecation free by October 2, 2019, with the construction of twelve crore toilets, the government claimed to have constructed over nine crore toilets in rural India. Though study by the Research Institute for Compassionate Economics found open defecation had reduced by 26 percent in the four years since Swachh Bharat was launched. Access to household toilets shot up from 37 percent in 2014 to 71 percent in 2018. However, despite expanded access to toilets, 23 percent of people continue to defecate in the open.
The objectives also included creating sustainable solid and liquid waste management systems, promoting social inclusion by improving sanitation for women and marginalised communities, and eradicating manual scavenging. However, since its rollout, the Centre has sanctioned 51 percent of its share of the urban budget towards toilet construction, and only 38 percent towards solid waste management. Manual scavenging continues to be widely practised despite being illegal, at great risk to workers’ health and lives.
“Significant improvement has been seen in door to door collection, primary and secondary collection, transportation to outside city limits and cleaning roads,” Professor Srinivas Chary Vedala, Administrative Staff College of India, said at the Global Dialogue on Waste, “Key challenges are in treatment and disposal aspects, policies in waste-to-energy, and quality of service delivery standards.”
“Health centres and hospitals are the second most important issues for voters and drinking water is third. The study claims the government fared ‘below average’ in handling these two.”
According to an analysis by the Association for Democratic Reforms, health centres and hospitals are the second most important issues for voters and drinking water is third. The study claims the government fared ‘below average’ in handling these two. It quoted the Comptroller and Auditor General, saying more than 163 million Indians do not have access to safe drinking water. The National Rural Drinking Water Programme, too, failed to achieve its targets despite spending ninety percent of the Rs 89,956-crore budgeted over five years to 2017. This is a clear indication that a lot needs to be done to fulfil these objectives.
To understand the NDA government’s vision for health it is important to scan through their pledge document.
In its manifesto, the BJP stated its aim to integrate artificial intelligence technology and utilisation of health data for an effective healthcare delivery system. As such, it recommends provisioning of telemedicine and diagnostic laboratory at health and wellness centres by 2022, to ensure quality primary medical care to the poor at his doorstep.
To bridge the dismal patient-doctor gap of just one doctor for every 11,000+ patients, the BJP proposes to set up one medical college or postgraduate medical college in every district, through public or private participation, by 2024.
Ganga will again be a priority for the BJP which had earlier promised to clean the holy river by 2019. As the river’s cleanliness has figured prominently in the pretentious political narrative, the failure of the government fulfil its promises at various levels was made explicit. During our election coverage, Health Issues India highlighted the unfulfilled promises – most notably that a body convened for the cleaning of the Ganga has not even met once since its inception.
Apart from successful implementation of its schemes, the government can’t ignore targets it has set for itself such as eliminating malaria by 2030 and tuberculosis by 2025) as well as strengthening screening measures to reduce the rising burden of non-communicable diseases such as diabetes and hypertension.
Addressing India’s health challenges is a huge task and expectations are high as the Modi government starts its second term in office, with significant support from the electorate. Will it fulfil the promises and take a step in the right direction? Health Issues India will keep a close eye.