Obamacare vs Manmohan cares
Time magazine, in an article, dubbed Prime Minister Manmohan Singh as an "underachiever", stating his unwillingness "to stick his neck out" on reforms has put India off the growth track. The magazine further stated that the people are losing confidence in his government and advised him to bring populist measures and win back voters' trust. It is ironical that the criterion of populist reform changes as one travels between the opposite time zones of the US and India. In the US presidential elections, healthcare reform has been a momentous campaign issue in past and will continue to remain so even in the future.
In 2008, the then presidential candidate, Barak Obama, promised Universal Health Coverage for all citizens. Soon after his election, he announced the Healthcare for America Plan alias Obamacare. His plan went through major twist and turns and, after 3 years of roller coaster ride, was upheld by the US Supreme Court as constitutional. Despite little progress on his healthcare promise till date, President Obama will be looking to capitalise on this ruling and seek for his re-election on the issue considered a hot button for the Americans. On the other side of the globe, in India, PM Manmohan Singh's government introduced innovative and inclusive healthcare schemes like NRHM, RSBY and RGSEAG-SABLA to bring about a healthy change in the lives of the common man. Still he is given little credit for all his efforts in improving India's healthcare indicators. Does it mean that If Dr. Manmohan Singh were the President of the US, where healthcare is considered a significant campaign issue, or if the Indian electorate considered the healthcare issue as much important as the US electorate does, he would be tagged as "moderate" if not "overachiever"?
A quick glance at India's improved health indicators could concretise our theory of "Manmohan cares". As per economic survey, "The combined revenue and capital expenditure of the Centre and states on medical and public health, water supply and sanitation and family welfare has increased from Rs 53,057 crore in 2006-07 to Rs 96,672 crore in 2010-11." In 2005, the Government of India initiated the National Rural Health Mission (NRHM), known to be "the most ambitious rural health initiatives ever."
NRHM aimed at providing effective healthcare to rural population, especially women and children. With an annual budget increased to Rs 21,000 crore, NRHM has been able to reduce Infant Mortality Rate by 13 points to 49, Total Fertility Rate from 2.8 to 2.6 and Crude Birth Rate from 24.2 to 22.2. Similarly, the government introduced the Janani Shishu Suraksha Karyakram (JSSK) with an aim to lower the Maternal Mortality Ratio by facilitating the institutional deliveries through the hand of skilled birth attendants. This scheme has shown rapid growth with approximately 1.1 crore beneficiaries in the year 2010-11. As a result of the efforts put in JSSK, the MMR for India has been reduced by 28 per cent to 200 since 2005.
Another example of the government's innovative and inclusive healthcare delivery to the common man is the Rashtriya Swasthya Bima Yojana (RSBY). RSBY is a government-run health insurance scheme for below poverty line (BPL) workers and their family. The objective of RSBY is to protect BPL households from major health expenses that could wipe out their life's savings. Since its inception in 2008, this scheme has expanded its ambit and enrolled approximately 30 million BPL families. For its unique business model and growth potential, RSBY scheme was praised by the leaders of G20.
To empower the adolescent girls between the age group of 11-18, the government has introduced Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG)-SABLA in November, 2010. Through this scheme, the government aspires to empower adolescent girls by improving their health and nutritional status. Around 11 million adolescent girls are expected to be covered under the scheme every year as the government increased its budget outlay on the health and nutrition component of this scheme from Rs 296 crore to Rs 491 crore.
Finally, an initiative for universalisation of the Integrated Child Development Scheme (ICDS), the world's largest child development programme, has been taken up by Dr Singh's government. As part of this effort, 42,000 Anganwadi centres have been operationalised, taking the total number of such centres to 1.3 million. In 2011-12, ICDS expenditure has increased by 46 per cent to Rs 14272 crore with 9.7 million beneficiaries.
All these ambitious healthcare schemes have touched the lives of millions of common man but have not been hyped. India is poised to be most populous country in the world. It will need an effective healthcare programme and delivery mechanism for its citizens, thus making healthcare undoubtedly a fundamental issue for its citizens. Perhaps PM Manmohan Singh will be remembered then for reforming the healthcare sector, the same way he is credited now for liberalising the Indian economy.
(The author is a social healthcare analyst and has worked with the health welfare programmes of various countries. This article was published in The Hindu on July 22, 2012.)
More about Anurodh Jain
The author is a social healthcare analyst.