In his State of the Union address earlier this month, the US President Joe Biden said, “We finally beat Big Pharma”, outlining measures to bring down medicine prices, including insulin.

A reduction in drug prices is welcome by patients/citizens anywhere in the world, but in an election year for the US, it is also being seen in some quarters as a campaign speech of sorts.

Back home, the last few weeks have seen a slew of activity involving healthcare and pharmaceuticals — and at the highest levels. There’s been the launch of several AIIMS (All India Institute of Medical Sciences) facilities, the inauguration of 40 drug and medical device manufacturing units and more recently, the updation of an ethical code defining the red line between doctors and drugmakers, to name a few recent developments.

But in an election year for India, will health feature on the manifestos of political parties and be a rallying point in campaign speeches, as seen in other developed countries?

There is a lot more attention on health, agrees Srinath Reddy, founder and former president, Public Health Foundation of India. However, what he looks for, is “greater emphasis on primary healthcare”, both infrastructure and workforce, as they play a pivotal role as the first line of defence.

The role of ASHA (Accredited Social Health Activists) and anganwadi workers and auxiliary nurse midwives (ANMs) cannot be emphasised enough — in the immensely successful child immunisation programmes and the more recent Covid-19-linked developments, to name a few. In fact, drugmakers working with State governments look to equip them with tools for screening, data capture etc. And yet, these footsoldiers are seen protesting for better salaries and recognition.

Reddy calls for strengthening the building blocks in delivering Universal Health Coverage (UHC) — be it frontline workers, primary health centres or district hospitals. They help capture and tackle common disorders before it escalates, requiring a tertiary hospital to treat — thereby reducing the healthcare cost to the government, he explains.

Health manifesto

As the country tackles non-communicable diseases and mental health concerns, Reddy calls for doubling this human resource, bringing back male ANMs and definitely ensuring better salaries for them.

In its Health Manifesto 2024, the Indian Medical Association (IMA) calls for a tax-based system of health financing. “Contributory health insurance offers incomplete coverage and restricted services,” it says.

The health allocation at 1.1-1.6 per cent of GDP is one of the world’s lowest it said, adding that expenditure incurred on health determinants like drinking water, sanitation should be provided separately. “The minimum allocation for Health alone should be around 2.5 percent of the GDP,” it said, calling for an increase in national health expenditure to 5 per cent of GDP.

Reddy agrees on increasing health-spends. But even the 2.5 percent projection would be well used, if prioritised and put into strengthening primary healthcare, he says. It’s on this, that digital measures and initiatives like the Ayushman Bharat health insurance coverage can further build. The health insurance programme (that is being reviewed) needs to be preventive in nature, rather than covering hospitalisation costs, he adds, further optimising cost for the government.

Citizen rights

Brinelle D’Souza, Co-Convenor, Jan Swasthya Abhiyan (Mumbai), says, health is likely to get lost in the noise and din of this time’s election campaigns. Political parties don’t seem to be centre-staging health, instead it is about competitive welfarism, she says, when they should be talking about a citizen’s right to health and education. Citing the UK and Canada, she said, they discuss funding and other health-related issues. Even a free-market country like the US, talks about healthcare and medicine costs and pharma and insurance companies are pushed to give value for citizens, says D’Souza, also Chairperson, Centre for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences.

The IMA manifesto also calls for revival of the Indian Medical Services, which was discontinued in 1948. Covid-19 exposed the vulnerability of the healthcare system and brought to fore the grave paucity of professionalism in health management, it observed.

Public health experts want the elected political representatives to address critical issues, including the shortage of healthcare practitioners and quality of medicines, for example. Just days ago, a fake cancer drug racket was busted in Delhi, a worrying thought of how many fly below the radar.

D’Souza says, “access to healthcare and affordability should be part of election campaigns (here), but it’s not. The middle class should make it a campaign issue, involving the community, otherwise it will not make a difference.”

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