India’s healthcare received a huge jolt in 2015 with substantial budget cuts in the BJP-led government’s first full budget, In 2016, healthcare spending was marginally increased Rs 31,965 crores to Rs 33,282 crores. However, this rise, experts felt, was notional and that the allocation was actually lower than 2014-15 budget for health. India’s health budget stands at 1.3% of the Gross Domestic Product, lower than Nepal.
Not unexpectedly, the Rajya Sabha Standing Committee that put out a series of scathing reports on the running of the health sector, on budgetary allocations for the National Health Mission, for Ayush and for medical research. One of the most critical reports relates to Medical Council of India, which said that the council had failed in its mandate to provide quality medical education, and instill ethics among doctors in the country. The Niti Aayog considered the recommendations and released a draft replacing Medical Council of India Act, which also has its set of problems.
In June, the union government’s decision to allow up to 74% foreign direct investment in pharmaceutical companies through the automatic route. This move, some felt, could threaten competition and cripple an industry that supplies low-cost, generic drugs in the country. The government’s new and more felxible guidelines for clinical trials is, int he meanwhile, being percieved as a pro-industry move that does not adequately safeguard the subjects of trials.
Year of legislations
It was also a year of health legislations and possibly more health-related laws were passed in Parliament than any other year. In August, the Rajya Sabha passed amendments to the Maternity Benefit Act, 1961, increasing the period of maternity leave from 12 weeks to 26 weeks or more than six months. The amended law also mandates that a company have a creche if they have more than 50 women employees. However, the law was only applicable to organised sector, leaving out nearly 96% of the women in the unorganised sector, experts opined. In the same session, the Rajya Sabha also passed the Mental Health Care Bill, 2013, that recognised the rights of mentally ill people to affordable and quality healthcare. The bill provides a detailed and extensive definition of mental illness than the present law. Both the Maternity Benefit Act and the Mental Health care bill are yet to be passed by the Lok Sabha.
In August, the Union Cabinet also cleared the Surrogacy (Regulation) Bill, 2016 which banned all commerical surrogacy to couples, and only permitted surrogacy to infertile Indian couples who could find a surrogate among their relatives. This legislation evoked very strong reactions from the public health community. The industry is exploitative but what about the rights of women who earn their livelihood becoming a surrogate mother, some asked.
In October, the cabinet also cleared amendments to the HIV and AIDS (Prevention and Control) Bill, 2014. While looking to address issues related to discrimination of HIV positive people, the Bill puts the onus on the government to provide treatment only “as far as possible”, a term that has worried the 21 lakhs HIV positive people in the country who depend on the government to provide free treatment for them for life. The bill is yet to be cleared by the Parliament.
The only Bill that was cleared by both houses of Parliament was the amendment to the Disability Act, 1995. The amendments to Act expanded the definition of disability to include 19 more conditions, increased the reservations in governemnt employment for disabled people from 3% to 4%.
Also, early this year, despite much opposition from tobacco farmers lobby and the industry lobby, the government successfully enforced 85% of graphic health warnings on tobacco packs. With this, India has jumped in global rankings on size of tobacco pictorial warnings to the third position, having previously been at 136.
Policies still in limbo
Despite these legislations, it is not clear why the National Health Policy, framed in 2015, still remains a draft. The policy has to be cleared by the cabinet and has been pending for two years. The document, experts opine, is an improvement on the previous policy document of 2002. It speaks of universal healthcare and aims to provide health services to people as an entitlement.
There are other pro-industry moves made by the government, which may increase price of healthcare significantly. The government plans to overhaul the National Pharmaceutical Pricing Authority that fixes the price for essential medicines.
So, while the year has seen many legislations that could help improve lives of some, there is no sign of a health policy that will increase access to all Indians.