New Delhi, Jan. 28: A group of independent global leaders has written to Prime Minister Narendra Modi urging him to implement universal health coverage in India, pointing out that tens of millions of Indians are pushed into poverty each year through healthcare expenses.
The 13-member group of "Elders" chaired by former United Nations secretary-general Kofi Annan and campaigning for human rights, justice and peace has recommended guaranteed free essential medicines and diagnostic services, promises that the Modi government had made two years ago.
The Elders, in their letter also sent to Delhi chief minister Arvind Kejriwal and Bihar chief minister Nitish Kumar, have cited Delhi's mohalla (neighbourhood) clinics and Bihar's initiative to provide frontline health workers and essential medicines as models for the rest of India.
The letter comes over two years after the Modi government unveiled a draft health policy proposing a health cess to fund free healthcare services and about five years since an expert panel appointed by the Manmohan Singh-led government similarly proposed universal healthcare funded by tax revenues.
Both proposals would have needed the government to increase funds for health, but India's healthcare expenditure remains stagnant at about 1 per cent of the gross domestic product.
The Elders, whose deputy chair is Gro Harlem Bruntdland, former director-general of the World Health Organisation, have now recommended an increase in public health spending to 2.5 per cent by 2019, the level that the expert panel had recommended in its report submitted in 2012. Since 2016, the Elders have written similar letters urging improved healthcare services to the heads of states of Indonesia and several African countries.
Their letter points out that India has one of the largest populations in the world without effective healthcare and around one billion Indians are at risk of financial hardship due to healthcare costs.
"It is unfortunate - most people in India do not view healthcare as a fundamental right, something that they can demand from their government," said Priya Balasubramaniam, who leads the universal health coverage research initiative at the New Delhi-based Public Health Foundation of India, a research and education centre. "In this environment, health remains a low political priority, although we've seen changes in some states."
While the Centre has not taken any major policy or funding initiative towards universal health coverage, several states such as Tamil Nadu, Kerala, Rajasthan and Himachal Pradesh have taken initiatives to provide free medicines and diagnostic services to their populations.
The proposals appear stuck amid a debate over the source of healthcare expenditure - some health economists have asserted that money for healthcare should come directly from tax revenues, but others have argued for expanding and improving existing health insurance schemes.
"No health system in the world is perfect or has satisfied all users," said Rajendra Badwe, director of the Tata Memorial Centre Hospital, Mumbai. "No single model is likely to work for all health issues, so we'll need to distil features from different models," he said.
The TMC today started hosting a three-day conference of health experts from India, Brazil, Thailand, Iran, France and Cuba, among other countries, to discuss the challenges a country faces in efforts to introduce universal health coverage.
The other members of the Elders are Maarti Ahtisaari, former president of Finland and Nobel peace prize winner, Lakhdar Brahimi, former Algerian foreign minister and UN diplomat, and Hina Jilani, a lawyer and human rights activist in Pakistan, among others.