“How Healthy are Election Manifestos in India? A Health Policy Perspective”

by Raghavendra Madhu (Health Governance and Policy Practicioner) and Lalit Yadav (Research Fellow at the George Institute for Global Health)

With the general elections 2014 in full swing in the world’s largest democracy, it is interesting to see the proposition of party manifestos in terms of healthcare.  Although India has a multi-party system, here we examine the manifestos of the two major national parties:  the Bharatiya Janata Party (BJP) and the Indian National Congress.

In the past decade India has seen significant progress under the National Rural Health Mission (NRHM) which has facilitated healthcare services to people in low-resource settings. Since 2005, NRHM has operated with an objective of improving the appalling healthcare delivery system across rural India. To address the health inequities among urban poor the National Urban Health Mission (NUHM) has been recently proposed and comprehensively unified under the new National Health Mission in course of the XII five year plan.

Captivatingly, the BJP manifesto  proposes a reorganization of the Ministry of Health and Family Welfare. This new arrangement would place several departments charged with healthcare services, food and nutrition and pharmaceuticals, under one roof for more effective delivery of healthcare services.

The BJP manifesto has also proposed the revitalization of local health traditions and encouraging science and research in indigenous systems of medicines such as Ayurveda and Siddha. Issues such as validating the indigenous medicines are essential. BJP plans to promote institutions and launch programs to standardize and validate the Ayurvedic medicine. There is not much novelty in the sanitation initiatives proposed in the BJP manifesto as it is already being implemented through the Total Sanitation Campaign (TSC) scheme.

The Indian National Congress possessed the past decade fiduciary obligation of Federal healthcare governance, yet their manifesto falls short of addressing serious healthcare issues that face the citizens of India. Their manifesto for 2014 promises an increase in health expenditure to 3percent of India’s GDP and will provide universal and quality health care for all Indians, including access to free medicines. Yet the Indian National Congress falls short of the standard established by the World Health Organization, calling states to dedicate 5 percent of their GDP  to health. The manifesto of the Indian National Congress commits to expand the India’s Federal health insurance (with partial funding from States), also known as RSBY, to enable access to a continuum of comprehensive primary, secondary and tertiary care. According to the Universal Health Coverage for India report submitted to the Planning Commission of India, despite the rapid expansion of RSBY over the past few years, coverage remains low with financial protection available only for hospitalization, and not for out-patient care.  The manifesto forecasts that their plan will create six million new jobs in the health sector by 2020 by training and expanding the current teaching programs for healthcare professionals, particularly in the public sector institutions. However, these optimistic forecasts aren’t without its critics. From 2005 until 2014, the Indian National Congress created one million social health activists, which have been mobilized at the grassroots level. Given this track record, it could be perceived by some as a daunting challenge to create 6 million jobs in healthcare sector within the next six years.

All things considered, both the political party manifestos have fallen short of addressing all of the serious health issues that are facing Indian families. With the growing middle class, there needs to be a focus on enabling healthy employment conditions in workplaces. Occupational health should be introduced into the political debate; effective implementation of existing policies and devising more policies for providing holistic health should be encouraged. The vision of healthcare and its allied policies in India should not only serve holistic health of the people, but also pave way for such engagements with the private players in healthcare to prepare India as global healthcare provider. For example, according to a recent study done under the Knowledge Partnership Programme, highlights India supplies more than 50 percent drugs to Sub-Saharan Africa. Investing in drug quality control and strengthening the management of logistics and supply chain of pharmaceutical industry can improve India’s position on the global pharmacy map and better the accessibility to quality medicines in India as well.

Raghavendra Madhu is a health governance and policy practitioner. He has worked at multi-levels with State and Federal Government in India.  Lalit Yadav is a research fellow at the George Institute for Global Health, India. Views expressed are solely of the authors.