People’s Health Manifesto Demands A Common Health System and Commitment of Much Higher Resources | Bharat Dogra

While several concessions and isolated commitments are frequently announced before elections, what is often missing is a more comprehensive approach to the many-sided reform of various important development sectors. A recent attempt for making more comprehensive health sector reform the talking point at the start of the election season should therefore be welcomed.

On March 21, the Jan Swasthya Abhiyan (JSA) a coalition of health activists, experts, and organizations committed to the advancement of public health in India, announced the launch of its People’s Health Manifesto 2024 in the run up to the general elections starting from 19 April. Under the theme ‘Our Health, Our Right’, the manifesto outlines key policy recommendations aimed at ensuring universal access to quality healthcare services for all residents of India. The 18-point People’s Health Manifesto, developed through extensive consultation and collaboration with various constituents of JSA, emphasizes the urgent need for transformative reforms in the healthcare sector to address the existing challenges and disparities.

According to the JSA, India’s public spending on health is among the lowest in the world. Per capita government spending is USD 25 in India, while Thailand spends USD 256 (10 times), China spends USD 363 (15 times), and Sri Lanka spends USD 77 (3 times). After the Covid-19 experience, it was expected, the JSA says, that the government will prioritize health and increase spending in the sector. However, this hope still remains to be fulfilled, as reflected in the continuing low government expenditure on health.
India also fares badly in terms of out-of-pocket expenditure, JSA adds. More than half the money spent on health comes from patients and their families. In this context, JSA’s manifesto makes concrete policy proposals that will improve access to free and quality healthcare by all.

Among the prominent features of the manifesto are:

Right to Healthcare Legislation: JSA calls for the enactment of Right to Healthcare legislation at State level, supported by making Healthcare a fundamental right at National level to guarantee the availability of free quality treatment for all conditions in close proximity to individuals’ residences. The manifesto stresses the importance of preventing denial, delay, and incomplete treatment.

Increase Budgetary Allocation for Health: JSA demands increasing health spending to 3.5% of GDP, with a special emphasis on raising the central government’s allocation to 1% of GDP. States must receive special financial envelopes from Central government to enhance health expenditure.

Major Reduction of Out-of-Pocket Spending: JSA’s proposal aims to reduce Out-of- Pocket (OOP) spending on health to less than 25% of total health expenditure, to alleviate financial hardships faced by individuals seeking healthcare services.
 Justice to Health Workers: The manifesto emphasizes the importance of filling vacant posts in health facilities and ensuring justice for health workers by regularizing all scheme-based and contractual staff. It calls for adequate wages and protection under labor laws. The National Policy on Safety, Health, and Environment at Work should be properly implemented and ESI system to protect workers’ health needs to be strengthened.

Devolution of Administrative and Financial Powers: JSA advocates for devolving administrative and financial powers to local bodies and state governments to enable them to manage health systems effectively in their jurisdictions.

Availability of Essential Drugs and Diagnostics: The importance of ensuring affordable and quality essential drugs and diagnostics is very evident. This can be achieved through effective implementation of rational price control measures. Many states in India already provide a good model to do so and that should be scaled up to the entire country with active support from the central government.

Government’s Responsibility in Healthcare, need to reverse privatization: JSA advocates for phasing out government-funded health insurance schemes including PMJAY and public- private partnerships, emphasizing the primary responsibility of the government in healthcare provision. These privatization oriented measures should be replaced by a public-centered system for universal healthcare, ensuring healthcare services for all residents of India.

Regulation of Private Healthcare Sector: JSA calls for effective implementation of an improved Clinical Establishment Act and regulation of rates and grievance redress systems for patients in the private healthcare sector. Similarly, commercialization of medical education should be reversed. The manifesto proposes reviewing and reforming the National Medical Commission and National Eligibility cum Entrance Test (NEET) to prevent the commercialization of medical education.

Speaking on the launch of the Health Manifesto, Richa Chintan, national co-convener of JSA remarked, “Our Health Manifesto embodies our collective vision for a healthier and more equitable India. We urge political parties and policymakers to give adequate priority to these recommendations to ensure the right to health for every individual.”

Highlighting the importance of gender equality, Sarojini N. of JSA said, “Government should regularize ASHA, ANM and anganwadi workers and provide them proper wages. Maternity and benefits across populations should be ensured.”
 Emphasizing the importance of access to quality medicines, Harishankar Singh of Delhi Network of Positive People (DNP+) said, “Access to affordable and quality essential drugs and diagnostics is non-negotiable. Implementing effective price control measures, returning to cost-based pricing, and ensuring availability of medicines as per the NLEM 2022 are critical steps towards achieving equitable healthcare for all.”

Indranil from JSA said, "Healthcare is fundamentally the responsibility of the government. We call for the phase-out of government-funded health insurance schemes and public-private partnerships. Resources should be redirected towards strengthening public healthcare systems and ensuring universal access to quality care. To start with, Union Government should increase its spending from 0.29% of GDP to 1% of GDP."

“What we need is devolution of financial and administrative powers to state governments and local bodies. This should be done in the spirit of 73rd Constitutional Amendment and promoting people’s health in people’s hands,” said Dr. Narendra from JSA.

Ravi Duggal, public health researcher and activist said, “A public-centered system for universal healthcare is the cornerstone of a just society. We envision a future where healthcare is a common system that provides for the health needs of all residents of India, irrespective of their socio-economic status.”

Clearly this is a very important manifesto in terms of the real health needs of India, and in fact this manifesto has a higher relevance for many other countries as well. The health sector of several countries like India is troubled by the allocation of less than adequate resources for public health as well as by the increasing private profit domination, leading to several distortions and malpractices. Some reforms emphasis the former aspect, while some emphasize the latter. In this manifesto, however, we find the coming together of both important aspects. This is why political parties should give the due attention to these. One hopes that the JSA will send these to as many political parties as possible and ask them to respond to the important issues raised here.

(Author: Bharat Dogra has commented extensively on health and development issues)