Lecture: Health Planning in India: Some Lessons from the Past, by Imran Qadeer, 2008
Keywords: Health and Government, Health Policy, Health Policy of India, India, Policy Research, Privatization, Privatization of Health
University of Delhi Bachelor of Arts Sociology of Health and Medicine
Reading to be Covered: Health Planning in India: Some Lessons from the Past, by Imran Qadeer, Social Scientist, Vol. 36, No. 5/6 (May-Jun, 2008, pp. 51-75
Course Structure
Important points to be kept in mind while studying the article
Expected outcome
Lecture in detail with comment and clarification
Introduction
Health Planning in India
Lessons from the Early Years
Integrated Planning
Inter-Sectoral Planning Strategies
The Role of Private Sector in Mixed Provisioning of Services
The Shift After the Sixth Plan
Distortion of Lessons
Reasons for the Shift
Distortion of Lessons
Reasons for the Shift
Social Responsibility (?)
Inevitability of Change
Conclusion
Important Points to be Kept in Mind While Studying the Article
How Indian health policy was shifted from a part of the welfare state to the part of the market. Which forces were involved for this policy shifting? This is not stated in this article but think that how political parties were ignored the right to the good health of the citizen under the pressure of global institutional and multinational companies pressure. Not only by Congress and BJP but also by those who are the self-claimed party of social justice.
Expected Outcome
In the end, students will be able to understand the role and importance of the health policy. Why we need health policy and how they affect the common people of India or any nation. Students will also be able to understand the policy shift in the health sector and which forces were involved in this process.
Lecture in detail with comment and clarification
Introduction
Pg. 221. India has a rich history of health discourse but in recent days this is not functioning well because of unplanned decentralization and privatization.
Pg. 222. Health is not a single-dimensional thing. It involves many things which are affecting the good health, for example for good health we need good food, hygiene, environment, etc, for which health department is not responsible. Hence, we cannot say that the health department is solely responsible for public health.
Therefore, the health service team, can at best demand for these but can make only limited interventions.
The health department itself has multi-functions.
Hence, we need better integrity between the related services, which is directly related to the health department and other services and facilities which is related or needed for good health.
In 2000s Indian has adopted the two new national policies, (1) one for national health and, (2) another for population control. Despite all these measures, the health condition of India is still worse and still, the population is no under control. However, we can say the health facilities have slightly increased and the population growth ration has also declined.
Pg. 223. Some among these three are the Population Commission, the Indian Commission on Macroeconomics and Health, The Rural Health Mission, and the National Advisory Council. Apart from these several international bodies are also working in the field of public health in India.
World Bank produces a document on ‘Financing for India’s Health Sector; in 1992, and Better Health Systems for India’s Poor, in 1992, and 2001 which heavily affect the Indian medical sector.
They advise India for the privatization of health, population control, and other services.
Health Planning in India
Pg. 224. Health planning in India has a long history. It was stated from the Nehru. The main goal of all health planning is to prevent the disease, give treatment and give them nutritious food.
Pg. 225. Before and after Independent many presented their health model proposal.
The Gandhian plan was based on public participation and shared a common faith in science and technology.
The health and economic plan were taken as complementary to each other. We cannot have a good economy without having good health and at the same time, we can have good health without a good economy. Thus both were treated as necessary for equal attention.
They also focus on the common minimum health and hygiene facility like drinking faculty, sanitation, primary health with child care facility etc.
Pg. 226. The second plan emphasized developing an integrated health service with a focused effort at building a network of peripheral instituting along with training manpower.
The plan places the highest priority on building the infrastructure, manpower, control of communicable debases and environment hygiene.
The poverty-disease link was realized and the broader planning strategies were evolved for addressing the basic malady (=problem) of poverty, the health sector planning took the removal of poverty for granted. Hence, while lying out-terms plans, seen the Bhore Committee Report did not take into account alternative projection, food production and availability drinking water, roads and transport, etc.
The third five-year plan focused on increasing the pace of growth of urban services especially the especially hospitals and raining facilities.
It emphasizes was on technological growth and expansion and acquiring bigger standards of technical competence.
Pg. 227. Indian also wanted a law act like National Insurance Act, 1911, in India. But arguments were given that that has evolved in Britain after a long experience and infrastructure. If India were to have national health insurance, then it could only be, ‘through a system of levy of fee except for the truly indigent,’ for whom service rules need to be evolved and implemented.
The Fourth Plan raised the status of the family welfare programme to a level where its share of resources almost equalled that of total health escort resources. These planning were also promoted the private participation in the health sector. It was imitated by Mudaliar Committee.
Pg. 228. In 1960 malaria we resurge and the government failed to control, they failed to control most of the daises except small pos. Again in 1970 malaria and smallpox emerged as main daises in India.
For the government, all were rooted in the poverty of the nation.
The government had started Minimum Need Programme in 1874 for integration of nutrition, maternal and child health and family welfare services for this plan.
This provided the greatest learning experience in health panning and showed that without unity of purpose that sanction scarifies ad the use of political will within society no political forces can success.
Pg. 229. The income is very much related to health and hygiene if you earn more than you can expend on health and hygiene. However, during Sixth Pan and 1960s and 1970s decades, there was a marginal change in the economic upliftment. The assets of the lowest 10 per cent of the rural population remained there they were (at 0.1 per cent) while for the lowest 30 per cent population it, in fact, slid down from 2.5 to 2.0 per cent. The assets of the top 30 per cent moved from 79 per cent to 80 per cent of the total.
During the Sixth Year plan government also introduced Minimum Need Programme and Family Welfare Programme.
Lessons from the Early Years
Pg. 230. Health panning is very crucial for any country. Nehru insisted on and Mahalanobis (chief planner) to build into the planning process from the Second Plan itself. Non-performance was thus at least acknowledged and addressed. It was this process that has made it possible to extract and concretize some basic concept in health planning – those if integration, inter-sectoral planning, and of the mixed provision of health services through the private and public sector, where the former initially provided out-patient care.
Integrated Planning
The concept of integration of service was initially a mix of interventions for the control of disease at different stages (promotive, preventive, curative and rehabilitative). It also encompassed organizational integration. This is the integration of strategies, resources, technology, organizational and administration, and monitoring mechanism.
Pg. 231-32. Thus, integration emerged as a complex, conceptual exercise of prioritizing problem, recognizing linkages between them and consequently problem, recognizing linkage between them. The integration needs sound technological, material, and social science knowledge that brings in the need perceptions and priorities of the people into health service planning.
This Principle of planning was ‘well’ recognized as early 1962 when the National Tuberculosis Institute evolved India’s first integration disaster control programme, the National Tuberculosis Programme.
Inter-Sectoral Planning Strategies
Pg. 232. By principal, it was accepted to provide certain basic necessities of life to the greatest proportion of people, irrespective of their ability to purchase. Mahalanobis also argues that ‘conspicuous consumption’ by the more to-to-do classes must be checked, because we have limited resources.
PLEASE NOTE: ‘conspicuous consumption’ means is defined as expenditure on or consumption of luxuries on a lavish scale in an attempt to enhance one’s prestige.
The Role of Private Sector in Mixed Provisioning of Services
Pg. 234. The Bhore committee was clearly against the private sector in public health. The eminent participant in the national movement active in health planning in health debate like B.C. Roy, Col. S. Abdur Rehman and Hakim Abdul Latif was too argued for basic health care for all. The Madaliar Committee had already raised questions about the nature of the state and its ability to provide free care.
Pg. 235. Later on, the government accepted the need for banning the private practice. But efforts to ban the private practice in several states failed (Qadeer & Nayar et al 2005).
By the 1980s, the powerful private sector was able to join the pressure for ‘reform’ and ‘international standards in medical care’ and carve a space for itself in the government’s 1983 National Health Policy.
The Shift After the Sixth Plan
Pg. 236. The Sixth Plan can be called the last and weakest millstone in India’s experiment of establishing itself as an independent architect of its health sector services.
The Seventh Plan, under increasing pressure of neo-liberal policies, scaled-up investment in Family Planning and opened up to NGO and private sector partnership.
The Eight Plan talked of privatization of medical care and of targeting the underprivileged for providing Primary Health Care and national health programmes. The rationale was that the burgeoning middle-class count now pays for its medical expenses.
Pg. 237. Interestingly, while in the 1950s, even without much resources, the state had committed itself to free care for all, in the late 1990s, despite a flouring middle class and improved economic growth rates, it did not bother to ensure free services for the poor or provide for a national insurance system, health co-operative, or a health cess. The target of the poor was no indication of a better deal for them, as they become the focus of a very limited set of services.
The Structural Adjustment Programme (SAP( and Health Secord Reforms was formally accepted by then and the package it brought for the poor include population control through reproductive and child health (RCH) and disease control programme for tuberculosis, malaria and AIDA, based on technologies that were on the research agendas of the major Global Public-Private Partnership (GPPP).
Pg. 238. The Night and Tenth Five Year plan ignore the lesion learned regarding comprehensive and integrated approaches and handling of the private sector. (To know more please go to Page No, 238 to 242)
Distortion of Lessons
Pg. 241. This section is describing that without any research, organisation integration and lessons from the past the government integrated the services and services providers such as ANM, AWW, ASHA and AWW. The author argues that these integration worlds did not serve the purpose. This also compromises the inter-sectoral planning, integration and systematic resource and guidance of WHO.
Pg. 242. The government also starting promoted the private sector, the focus shifted from structural aspects of the system to patient satisfaction. This automatically excluded those who cannot use services and the social reasons for it.
Pg. 243. The National Health Policy 2002, focuses on privatisation and health tourism as a means of earning feign exchange.
Reasons for the Shift
India’s performance in the field of health is already very low.
Pg. 244. Communicable diseases continue to be India’s biggest killer than non-communicable diseases.
The previous emphasis on areas such as feeding programme, water supply and housing have acquired a backseat and their privatisation has reduces their accessibility to the poor.
The emergence of the middle class, its demands for advanced medical services that match class, its demands for advanced medical services that match the international standards and the proliferation (=propagation) of five-star hospitals in urban areas have influenced the general perception of the other classless about what is best for them. The medical bureaucracy, rooted in the middle class, has generously supported this trend.
The ruling political parties supported this move and made the health services as just another commodity, and shed the burden of responsibility for the services they were earlier committed to. Cutbacks, privatization, opening u of the public sector, casualization of health personnel and change in prioritising were introducing through the Health Sector Reform.
Social Responsibility (?)
This was the safest way to make profits but both the MNCs and the private care providers who become partners in implementing national programmes in the name of social responsibility.
Millennium Development Goal and Poverty Eradication!
Pg. 225. The service sector is the second most important sector of the U.S. and the European economy, and the transfer of technology in the name of Poverty Removal Structure of the Millennium Development Goals has an economic motive in turn with their national interests but not India’s poor.
The withdrawal of welfare and the emergence neo-liberal agency with its thrust on monetarism, market and centralized control by the global economy, have seriously impacted health sector planning.
Inevitability of Change
Shifting in planning to accommodate politics is a reality, but when distorts the very objective of that politics, then they become politically counterproductive. Global pressures are real.
246-47 In case of global pressure in India, these cannot become an excuse for the shoddy exercise that is passed off as health planning. They, in fact, threaten the very stability that the Indian ruling class seeks.
Health planning will have to regain some of its past reputations, as there is much that can be done even within the constraints of the present.
Please visit Page No. 246-47 to for suggestions for health planning.
Conclusion
(This is just copied from the article pg No. 247-48)
In health planning, neither the imperative of globalization nor the Paramount role of science and technology in bringing about change can be ignored.
However, the direction of change is debated.
Nehru envisioned the use of science and technology ‘to bring freedom and opportunity to the common man, to the peasants and workers of India, to fight poverty, ignorance and disease, and to build a prosperous, progressive and democratic nation which will ensure justice and fullness of life to every man and women’. He The National Health Policy 2002 that adjudges Bohra Committee’s dream as unrealistic in today’s context can only promote an attitude of dependence towards the rest of the worlds, something that Nehru’s internationalism negated. What did object to being not aid and mutual cooperation but selling out the interests of a people and the future generations? By falling into the trap of the short-term project-based strategy of the ‘Global Fund for Health,’ To achieve the ‘Millennium Development Goals’ set by the international financial institutions, the ruling political elite today is accepting the shift from a public health perspective of a comprehensive Primary Health Care approach to one which transforms illness into commodities. A World Bank study itself shows the importance of consistent overall development of infrastructure, nutrition and employment for health.
Our narrative then shows that to globalize with dignity and without aping others or giving up national priorities that made the cutting edge is to reform conditions where the less privileged could not only survive but, live with dignity.
Anil Kumar | Student of Life World
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