By Dr Arun Mitra
That out of a population of 100,000 in our country, 32 persons die due to tuberculosis every year, is a matter of grave concern and shame. Recently, we have seen death of large number of children having fallen prey to dengue fever and encephalitis in Uttar Pradesh. Similar is the situation with diarrhoea, malaria and many other communicable diseases. Needless to mention, the havoc caused by the pandemic where we failed to prevent several thousand deaths because of mismanagement and skewed priorities. It is not only the communicable diseases; the non-communicable diseases too are on the rise.
It is estimated that 29.8 per cent of Indians have hypertension, with 33 per cent prevalence in urban and 25 per cent in rural India. As of 2017, India had 72.9 million diabetes patients-second only to China (114.3 million), and is soon likely to become the diabetes capital of the world. About one in every two Indians (47 per cent) living with diabetes is unaware of their condition, and only about a quarter (24 per cent) manage to bring it under control.
All this requires a comprehensive health planning by the state with resolve to provide equitable health care to the citizens. The World Health Organisation (WHO) has termed “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
To promote a wider discussion and implementation of the goals for equitable health, a declaration was signed by the participants including India in the international conference at Alma Ata in 1978 – and concluded with the Alma Ata declaration. Health planning in our country started way back in mid 1940s when Joseph Bhore Committee submitted its report in 1946. It had highlighted that health services should be based on equity. Safe drinking water & sanitation, adequate nutrition, proper housing, quality education, safe working conditions and sufficient wages form the basis of health for all.
Despite all the above happenings, the Constitution of India does not expressly guarantee a fundamental right to health. The references to the state’s responsibility to health of the people are mentioned in the directive principles in Part IV of the Indian Constitution. These provide a basis for the right to health. Article 39 (E) directs the State to secure health of workers. Article 42 directs the State to just and humane conditions of work and maternity relief. Article 47 casts a duty on the state to raise the nutrition levels and standard of living of people and to improve public health. Article 21 guarantees the right to life.
There has been a paradigm shift in the approach from the first National Health Policy – 1983 which emphasized on promotive, preventive curative and rehabilitative services. The National Health Policy – 2002 shifted its emphasis towards the provision of health care through private sector and opening up secondary and tertiary level health care for private investment. The spirit and principles of Primary health care was compromised by shirking the responsibility for health by the public sector.
The National Rural Health Mission was launched in 2005. It was later extended to urban areas also as National Urban Health Mission in 2011. Consequently, the two were merged as National Health Mission in year 2013. However, implementation of national health mission remained fragmentary and half-hearted.
India has roughly 20 health workers per 10,000 population, with 39.6 per cent doctors, 30.5 per cent nurses and midwives, and 1.2 per cent dentists. Of all doctors, 77.2 per cent are allopathic and 22.8 per cent are ayurvedic, homeopathic or unani. Total doctor-population ratio 1:1445. It is to be noted that Govt doctor-population ratio is 1:11,926 in contrast to the desired 1:1,000. This is a major cause of in equality in healthcare to the marginalized sections who are dependent solely on state healthcare system.
WHO recommends minimum of 5 per cent of the GDP as expenditure on Health? The Planning Commission of India had said that the state spending on health will be 2.5 per cent of GDP by end of 12th five-year plan and 3 per cent by 2022. (IPA)
