March 30, 2004
Press Release
Both Vajpayee and Advani are claiming that `India’ has arrived in the world scene with a bang under the NDA stewardship of the union government. It is on this basis that they are trying to trump up `nationalism’! We also want India to emerge strong, but an India — whose strength will be built by each and every billion plus countrymen and women which will equally benefit all. The status of their `health’ is, therefore, the subject of our eleventh study in the "Lies, damned lies and statistics" series.
Is India Really Shining?
Lies, Damned Lies and Statistics
Ill Health of the Health Sector under NDA Rule
While the NDA government has been suffering from a hallucination of late that India is poised to become a developed country within the next two decades, its health indicators compared to other developing countries bring out the true picture. The Human Development Report 2003 ranked India 127 out of a total of 175 countries. India’s Human Development Index (HDI) rank was 124 in 2002 and 115 in 2001. Thus the celebration of a ‘Shining India’ is taking place at a time when we have been gradually sliding behind other countries in terms of basic indicators of development. If we compare India’s performance with some selected developing countries in terms of some basic social sector indicators, our backwardness appear starkly.
|
COUNTRY
|
BRAZIL
|
MALAYSIA
|
SRILANKA
|
CHINA
|
INDIA
|
|
HDI rank
|
65
|
58
|
99
|
104
|
127
|
|
Life expectancy
at birth
|
68.1
|
73.1
|
72.6
|
71
|
63.9
|
|
Maternal Mortality
(per 1,00,000 live births)
|
160
|
41
|
90
|
55
|
540
|
|
Infant mortality
(per 1000 live births)
|
31
|
8
|
17
|
31
|
67
|
|
Population with
access to affordable
drugs
|
0-49%
|
50-79%
|
95-100%
|
80-94%
|
0-49%
|
Source: Human Development Report 2003
The pathetic state of affairs as far as life expectancy, infant or maternal mortality and people’s accessibility to drugs are concerned, as brought out by the above table, is easily explained by the chart below which shows that India lags behind all the other countries mentioned above in terms of both public health expenditure as a proportion of GDP as well as per capita health expenditure.
Source: Human Development Report 2003
The proportion of public expenditure on health to GDP in India is only 0.9% of GDP while the average public spending of Less Developed Countries is 2.8% of GDP. Only 17% of all health expenditure in India is borne by the government, the rest being borne privately by the people, making it one of the most highly privatised healthcare system of the world.
Many people die of communicable diseases in India and the resurgence of some like Malaria and Tuberculosis have also been observed in the recent past. However, the allocations in the Health Budget for combating major communicable diseases have gone down during the NDA rule (AIDS being the only exception). Among the major communicable diseases, allocation for the control of Malaria as a proportion of total expenditure on combating communicable diseases has gone down from 16.34% in 1998-99 to 7.22% in 2003-04; in case of TB it has fallen from 7% to 4.37% in the same period.
While the government is keen on advertising its pious intentions of creating AIIMS like centres of excellence across the country, expenditure budgets show that capital expenditure in the health budgets of the Central government actually declined from Rs. 45.09 crores in 1996-97 to only Rs. 7.3 crores in 2001-02.
The National Health Policy (NHP), which was announced by the NDA government in 2002, had abandoned the concept of “comprehensive and universal health care”, which India was committed to as a signatory to the Alma-Ata Declaration on Primary Health Care of 1978. While remaining silent on the need to review the ill-conceived population control programme, which has proved to be a massive failure causing a huge drain on primary health care, the NHP 2002 instead argues for the virtual dismantling of the latter. The NHP also remains silent on drug prices and manufacturing with the Ministry of Industries taking over the decisions about Drug Policy. Glossing over the burning issues concerning basic healthcare, the NHP instead argues for greater privatisation — privatisation of existing public hospitals, creating new private hospitals and subcontracting public health to NGOs, besides emphasising on the creation of health facilities to attract foreign exchange and promoting health tourism. The National Health Policy document actually exposes the insensitivity of the NDA government towards the dire need to strengthen and expand the public health system in India and its lop sided priorities in promoting health tourism while millions of Indians die of preventable communicable diseases.
The NDA government has claimed that its policies have brought down the prices essential drugs. This claim is indeed a shameless one. The fact of the matter is that the pharmaceutical industry has been deregulated to a great extent, the number of drugs under price control coming down steadily over the years and stood at 73 in 2003. The Drug Policy announced by the NDA government in 2002 recommends that the number of drugs under price control be further reduced to 25.
Number of Drugs under Price Control
|
1970
|
1979
|
1987
|
1995
|
2003
|
Proposed in the Drug Policy, 2002
|
|
All drugs
|
347
|
163
|
76
|
73
|
25
|
Source: Policy Brief, National Coordination Committee for Jana Swasthya Sabha, 2004
As a result of the policies of decontrol, prices of drugs have increased several times, many drugs being sold at 200 to 500 % profit margins, with only 20% of the population being able to access all essential drugs they require (National Coordination Committee for Jana Swasthya Sabha, 2004). Prices of many commonly used antibiotics, anti-diabetics and analgesics have increased substantially hugely. An article by Wishvas Rane (‘Have Drug Prices Fallen?’, published in EPW, 1-7 November 2003) show that out of the 253 formulations (sold by the 73 top selling brands in 2000), 169 (67%) show a price rise, while only 49 (19%) show price declines and 35 (14%) unchanged prices.
The worsening of the child sex ratio in the country from 945 in 1991 to 927 as revealed by the Census 2001, points to the growing incidence of female foeticide and infanticide in the country. It is ironical that some of the more prosperous states of India like Punjab, Haryana, Gujarat and Delhi have registered the sharpest fall in the child sex ratio between 1991 and 2001.
|
States
|
Sex Ratio
(Females per 1000 Males)
|
Child Sex Ratio
(0-6age group)
|
||
|
|
1991
|
2001
|
1991
|
2001
|
|
India
|
927
|
933
|
945
|
927
|
|
Punjab
|
882
|
874
|
875
|
793
|
|
Haryana
|
865
|
861
|
879
|
820
|
|
Gujarat
|
934
|
921
|
928
|
878
|
|
Delhi
|
827
|
821
|
915
|
865
|
|
Rajasthan
|
910
|
922
|
916
|
909
|
|
Himachal
Pradesh
|
976
|
970
|
951
|
857
|
Source: Census 2001 and UNFPA