Elections in India: Fight for a healthy future
It's time for promises - generous, sweeping and all-encompassing. Whenever elections are scheduled, politicians of all hues and affiliations come up with promises, of turning life for the common man into a rosy idyll. Looking through my file of political promises over the last fifteen, I have these samples chosen at random from a thick stack of clippings -
"Zero level poverty promised" says a Congress (I) manifesto of November 1994 released in preparation for state assembly elections. Five years was the time period for this promised eradication of poverty. Ten years after that deadline, what we have is another set of promises, reiterating the same ‘goals' and pledges that betray insensitivity to people's basic needs and entitlements.
Look at the ground realities - Bangalore, the IT capital of India, has 440 slums, according to official count (which leaves out countless small huddles of homeless migrants). Most of these have no proper water supply, no toilets or other sanitation facilities. Garbage clearance even in the non-slum neighbourhoods is woeful. No one dares to drink tap water, even in this state capital that spends thousands of crores on fancy flyovers. In theory a primary health centre is supposed to function in each area and village, but the reality is that the PHC in Sasalu village an hour outside Bangalore remains locked when I visit it (despite a National Rural Health Mission ad that boasts of "24 hour service") , the public hand pump at the entrance to the village is rusted, broken and dysfunctional, and the well is choked with weeds and dried up. A PHC in north Bangalore, within the city limits, is ‘open' only on paper, because the doctor in charge comes in the morning, signs the register, locks up and leaves, so indigent patients are forced to shell out money for treatment at private clinics. If they cannot afford it, they remain sick. No wonder then, that 60 years after independence, we still have the world's largest horde of malnourished children, high maternal and infant mortality rates, and the world's largest population of the blind.
Which is why the people's Health Movement (PHM) a global network of health activists, has issued a manifesto demanding that all political parties should promise to focus on people's right to basic healthcare, as part of their political agenda during the run-up to the 2009 elections. The PHM manifesto, released on 6 April, points out that if India is "poised to take its place as a leader in the community of nations" as claimed by our ruling elite, we need to first work on basic health as a pre-requisite for socio-economic progress - what use is progress in terms of higher incomes and foreign exchange reserves, if the socio-economic parameters trap millions of poor citizens in poor health ? If we build fancy high-tech hospitals with state-of-the-art sophistication to woo foreign tourists and earn dollars through "medical tourism", but cannot ensure safe drinking water to our own citizens, would that be progress in socio-economic terms?
India signed the Alma Ata Declaration thirty years ago, which promised "Health for All" by 2000. A decade later, we are in fact curtailing health services in government hospitals, in the name of privatisation, and "Health for All" is nowhere in sight as an attainable goal.
The PHM manifesto challenges all political parties to take effective measures to "tackle malnutrition" as a priority. Malnutrition stunts children and reduces their potential contribution as future citizens of India. Malnutrition among women leads to poor child health, high maternal mortality, and debilitating costs on the economy in terms of lost productivity. Much of malnutrition is caused by unsafe drinking water and poor sanitation, and these need to be tackled before we allocate resources to fancy, prestige projects like bigger airports or bullet trains (the super-fast Japanese trains that caught our railway minister's imagination after his recent visit to Japan) "Ensure 100 percent availability of safe water in each village and 100 access to sanitation (including in public places like markets, railway stations, bus stands)" the PHM manifesto urges.
The People's Health Movement also demands an increase in the national health budget from the current 1 per cent of GDP to at least 3 percent immediately (rising to 5 per cent in ten years)
However, promises are easy, implementation invariably lax. Less than six months ago the Karnataka chief minister announced a new Arogya Suraksha Yojana offering free medical insurance and health cover to 80 lakh BPL (Below the Poverty Line) families in the state. The reality is that. many thousands of poor families do not even have the documents necessary to qualify as BPL (because the officials in charge of issuing these documents demand bribes that the poor cannot afford). Ask the roadside cobbler sitting along a busy metropolitan intersection, whose three children are forever sick because he does not earn enough to seek medical care for their ailments. Ask the cleaning maid sweeping inside an air-conditioned bank every morning, whose husband is paralysed and bedridden but lacks access to the facilities he is entitled to under existing laws, because (again) he needs documents to prove that he is "incapacitated" and these come only at a price, after repeated visits to the relevant offices that mean the woman has to take time off from work, something she cannot afford.
On January 26, 2008 the Karnataka State government took a Republic Day pledge promising basic health facilities to all. A Suvarna Arogya Chaitanya scheme for check-ups for all school children was also announced. Ask the roadside vegetable vendor's daughter whether she had a check-up, and the answer is a predictable no. Nice sounding names do not a nation's health make. "Funds provided for essential drugs" an ad from the National Rural Health Mission declared, on March 9, 2009. A random check of PHCs however found medicines were "out of stock" so patients had buy them from private stores. If promises could cure our nation's health problems, we would be the world's healthiest. Alas, promises don't cure. Actions do. That, then, is the crux.
This article appeared in Grassroots, published by the Press Institute of India, issue dated May 15, 2009.
Sakuntala Narasimhana is a former Vice president of the Consumer Guidance Society of India, Mumbai, and a columnist specialising in consumer protection issues.
