CLAIMS

One of the main claims of the government is that its scheme – the Pradhan Mantri Jan ArogyaYojana (PM-JAY) – has saved millions from becoming poor due to the costs of care.

Ayushman Bharat – Health and Wellness Centres (HWCs), now re-named Ayushman Arogya Mandirs will meet the health needs of people.

From 7 AIIMS the number has gone up to 21.

By 2025, ‘TB Harega, Desh Jeetega; (TB will lose, the nation will win)

By 2047, the National Sickle Cell Elimination Mission will eradicate this disease. 

TRUTH

Although over Rs 6,000 crore is spent on PM-JAY every year most of it goes to private hospitals who do not give free care giving to the card holders. The government projection is that 5 lakhs per family is to be paid per year, almost no family has been paid the full amount. In fact, poor families have seen health costs become unbearable. The card does not cover most of secondary and tertiary healthcare needs. Though the Central government claims full credit for this scheme, most states already had insurance schemes in place and the Central government agreed to pay only a part of the costs. The rest is paid by the states.

In the last 70 years, the Central and state governments established about 1.46 lakh health sub-centres and 26,000 primary health centres, with most of the funds coming from states. The Modi government has re-named and re-painted these and claimed that it has created 1.6 lakh Ayushman Arogya Mandirs. Not a single new facility has been created.

States that refuse to go along with this branding exercise are being denied even the central funds that were always available for these services. Similarly, earlier introduced Jan Aushadi Kendras have been re-branded as Pradhan Mantri-Bhartiya Janaushadhi Pariyojana (PM-BJP!)

Actually, the Modi government established 15 new AIIMS but many of them are functioning with limited services. Similarly new medical colleges lack doctors and other staff. Instead of a systematic strengthening of state medical colleges, announcements of more and more centrally administered AIIMS are being made.

Most of the increase in medical college and post-graduate seats have been in the private sector where fees are so high that only very few of graduates will be available for public service. Every year, over one lakh such medical graduates are being created but there is no corresponding expansion in the number of posts in the public sector. The end result is that patients will not get affordable health care.

The reality of the eradication of TB by 2025 is, that by the government’s own survey, as of 2021 over 60 per cent of those with TB and having clear symptoms of the disease had not even been identified, let alone brought under treatment.

As far as the claims of the National Sickle Cell Elimination Mission are concerned, currently most babies with the disease die before they are even recognized and most of those who survive have no access to treatment.

National Health Mission

Central funds have stagnated in real terms and therefore do not even cover the rising costs of medicines and services paid for earlier. The National Health Policy required that Central government expenditure rise to 1.5 per cent of the GDP but it is 0.3 per cent of the GDP and less than 2 per cent of the Union Budget. Within this, substantial transfer of funds to the private sector is taking place i.e. passive privatization.

The government has also tried active privatization. The National Health Authority has developed model contracts of how district hospitals and other government facilities could be outsourced to private medical colleges and has been pushing states to do so and has also been encouraging privatization of primary health care.

Despite the deliberately created scarcity of reliable evidence, it is known that India’s rank on nutritional status declined in the Global Hunger Index to 111^th out of 125 countries.

All indicators, whether it is wasting or stunting, have stagnated or worsened. The GHI index improved by only 0.5 points over the recent 8 years as compared to over 12 times that amount in the previous 8 years (Hindu Oct. 12, 2023).

Life expectancy has stagnated since 2017-18 and in 2021 it declined due to the pandemic. As per estimates of the WHO, India experienced excess mortality of 4.7 million deaths due to Covid 19, one of the highest in the world.

The government has either shut down or unreasonably delayed all the important scientific sources of information on health outcomes. The once-in-10-years census has not been held. Even the routine Civil Registration System data and the Sample Registration System data, which were available annually, have not been released after the data for 2020.

The periodic report on mortality based on CRS is last available for 2014. The National Sample Survey rounds on morbidity and the cost of care is not available after 2018 when the NSS 75^th round done in 2018 showed a huge increase in cost of care. Another important source of health information was the National Family Health Survey which was last done in 2019-21 and showed that health and nutritional outcomes were below expectations and claims.

In the last five years, the pharmaceutical industry expanded from a 46-billion-dollar turnover to more than 130-billion-dollar turnover. The hospital industry grew from $62 billion in 2017 to $132 billion in 2023. The digital healthcare market quadrupled to $485 billion. By 2023, there were more super rich in the pharmaceuticals industry (133) than in any other sector. It is interesting that pharmaceutical companies, many of them engaged in unethical practices, have been among the largest purchasers of electoral bonds.

Attacks on federalism will prove and are proving disastrous for public health.  While finances made available to the states are shrinking, Central control over the health sector is increasing.

Three new acts – the National Medical Commissions Act, The National Allied Health Workers Act and the National Nursing Commission Act – have been passed leading the  imposition of centralized national examinations for admission to the medical institutions and now centralization of exit examinations along with legalization of what was earlier called corruption by expanding the management quota and the fees that private institutions can charge along with lowering the threshold marks to enter in the management quota. Despite urgings by the Supreme Court, even the information on faculty and attendance is not been put up in the public domain.

The effect of BJP governments’ policies on public health and the health of women, adivasis, dalits have been disastrous.

FREE HEALTH FACILITIES FOR ALL!

STRENGTHEN PUBLIC HEALTH! DEFEAT BJP!

Published by Communist Party of India (Marxist)