A health manifesto released by the Indian Medical Association ahead of this year’s Lok Sabha election has raised concerns about the present state of the country’s drug regulatory system, inadequate government spending on health and high out-of-pocket expenditure that is pushing more people into poverty.

The manifesto, released on February 8, also flagged rising antimicrobial resistance and gaps in the functioning of the government-funded Pradhan Mantri Jan Arogya Yojana.

The Indian Medical Association, an umbrella body of 3.6 lakh allopathic doctors, has submitted the manifesto to all major political parties, including the Bharatiya Janata Party, Indian National Congress, Trinamool Congress, Aam Aadmi Party, Nationalist Congress Party, and Samajwadi Party with the aim to push healthcare concerns higher on political parties’ agendas.

The manifesto noted that India’s overall health spending (public and private) – estimated to be 3.8% of the country’s gross domestic product – is lower than most low and middle income countries, where the average share of health spending is around 5.2% of the gross domestic product.

“India’s health system is overwhelmingly financed by out-of-pocket [OOP] expenditures incurred by households,” the manifesto said. “…Government funding, provided by both the central and state governments, currently constitutes approximately one-third of all health spending, with states accounting for nearly two-thirds of total government health expenditure.”

Urging political parties to focus more on healthcare and increase spending on it, the Indian Medical Association also drew their attention towards the country’s weak drug control infrastructure.

In the last two years, India has come under the spotlight due to allegations of spurious or adulterated drugs causing deaths in other countries. In 2022, over 70 children died in The Gambia allegedly because of toxic cough syrup made in India. Later that year, 18 children died in Uzbekistan after consuming cough syrup made by an Indian firm, while in 2023, multiple people in Sri Lanka lost their vision allegedly due to Indian-made eye drops.

The Indian Medical Association said India currently faces a shortage of drug testing facilities and drug inspectors, lacks uniformity in drug enforcement, and lacks adequate monitoring of manufacturers and their compliance with good manufacturing practices.

Also read: India’s cough syrup testing regime has a deadly blind spot

Expand health insurance scheme in private sector, says IMA

The Pradhan Mantri Jan Arogya Yojana, a government-funded insurance scheme that was launched by Prime Minister Narendra Modi in 2018, provides a cover of Rs 5 lakh for treatment in empanelled hospitals. So far, 31 crore people have been issued cards under the scheme, and six crore out of them have benefited from it.

The scheme has 29,607 empanelled hospitals, of which 12,572 are private-run ones and 17,035 are government-run ones.

The Indian Medical Association said that the government is diverting more funds under the scheme to government hospitals, which already provide free treatment to patients. It suggested that the scheme should instead be expanded in private hospitals, which cater to a larger population and can provide more beds for treatment.

“PMJAY should be exclusively used for strategic purchase from private sector,” the medical association said. “Pricing of services should be based on independent scientific costing in district level basis.”

The organisation also said there was a need to revisit the prices paid to hospitals under the current insurance scheme.

Medical colleges

Data from the Indian Medical Association indicates that 1,08,915 students enrolled in 706 medical colleges get MBBS degrees each year in the country. “This is posing a huge challenge for quality maintenance in our medical colleges,” its manifesto said.

Scroll had previously reported on how the BJP-led government is on a spree to construct new medical colleges without ensuring adequate teaching staff. The Indian Medical Association has raised concerns on similar lines, and said that the National Medical Commission Act, 2019, needs “to be amended to incorporate a provision to support medical education through accruable developmental funds by the government”.

Also read: Maharashtra proves race to build new medical colleges is no fix for Indian healthcare

Needs of senior citizens

By 2050, the number of people aged 60 years or more is expected to rise to almost 20% of the total population, according to the Indian Medical Association. “This change is likely to result in a rise in the prevalence of conditions like dementia,” the organisation noted. “At present, approximately 8.8 million Indians aged 60 years or older are living with dementia, which is considered an emerging epidemic.”

The Indian Medical Association has urged political parties to create specialised units for geriatric care in tertiary hospitals and to integrate geriatric medicine into the medical curriculum. It has also called for a strong policy to treat non-communicable diseases among senior citizens.

The focus of the government’s non-communicable diseases programme – that deals with cancer, heart ailments and diabetes – is currently on young adults, not older citizens.