India and universal healthcare : public engagement needed

Too thin to spot : There's scant public discussion on India's plan for universal healthcare

Two articles I read recently brought home, once more, the absolute lack of a cohesive national debate on “healthcare for all Indians” which is currently a hot topic in New Delhi.

One of the articles observed that the Maharashtra state government had yet to deliver on its very dated promise  to provide free medicines to those who suffer from blood disorder haemophilia.  Currently, even those availing care in public sector hospitals pay an average Rs 9000 per injection of clotting factor without which patients might bleed fatally, it said. Patients are demanding that the promise be fulfilled.

The other reported on the intense debate in the Capital around the method by which India should move towards universal healthcare.  Should it work in partnership with the private sector? Should it make the public and private sectors compete? Should it be a healthcare provider? Should it be a financier?

It’s great that there is discussion around healthcare – that Indian patients are demanding more and that the government is interested to do more after doing so little for so long . But somehow it’s not achieved anywhere near the noise levels that such a vital issue should.

On the one hand, the discussion is so “micro” that it fails to connect or make any impact with a larger audience. Think of the haemophilia group, for one moment. This patient group is actually part of something bigger – the debate on healthcare for all which is currently playing out in the corridors of power. But do they know it? Do they know how to make the most of it? Is their voice reaching there? In the meantime, in a country where virtually everyone pays for healthcare out-of-pocket does their plight cause any meaningful outrage?

On the other, there are intense discussions ongoing among bureaucrats and the intelligentsia that the larger world is not privy to.  Parts of the discussion that reach the public at large are often served half-baked and without adequate context in the media (which was the case with this article).

I’m sure some of my readers know more about Obamacare and its problems than they know of our own universal healthcare debate.

This blog had earlier drawn attention – in a different context – to the Srinath Reddy report on Universal Healthcare that provides a directional roadmap which forms the basis of much of the discussions in Delhi. To its credit, the report has been drafted after extensive consultation with various stakeholders.

But while the Reddy report has answered the “what” question convincingly, the “how” is still being debated. At this point, shouldn’t the larger community get more involved and vocal?

The debate has to flow out into the open. Healthcare should be an issue discussed not just in seminars, conferences, and committee meetings but on college campuses, and around dining tables. And what the public wants has to go back to law and policy makers.

For a benchmark, consider this. Corruption – of all hues and shades – is an issue that has managed to achieve ubiquity in public discussion.  And the government has been forced to take notice. Is healthcare any less important? I should think not.

I decided to ask Prasanna Shirol of the Lysosomal Storage Disorders Support Society of India  or LSDSS (made up of patients affected by rare life-threatening enzyme deficiencies)whether he would like to be included in the debate on universal healthcare.  Shirol has been canvassing the government for support for better diagnostics and free medication for LSD patients. So far LSDSS has made little progress.

Here’s what he wrote to me : “There can be a lot of value addition to the model by the public who are ultimate beneficiaries. This can be encouraged by involving social groups, NGOs, support groups, to discuss, debate and submit their feedback on the model. A team may be nominated state-wise (for) national engagement.” Shirol points to the Disability Act of 2011  where he says a consultative process has been followed.

It’s about time every one -including mainstream media- took more interest in the high-stakes issue of universal healthcare.  Taking ownership of your health also means owning your country’s healthcare agenda.


4 thoughts on “India and universal healthcare : public engagement needed

  1. Maybe we need an Anna Hazare equivalent for universal healthcare. Someone like Devi Shetty should fit the bill


  2. You are right Gauri, I have followed the Obamacare model because we seem to ape the west blindly and it scares me to even think that we may end up emulating US. The medicare bill however makes sense to me. We need to have universal healthcare. In Thailand every single person is insured and everybody pays a small insurance premium or government pays for it. It is the same in Africa because healthcare is just so expensive. We do need to think it through but i know from rural health insurance examples of Dr Devi Shetty and Dr Prathap Reddy that rural health insurance is possible and it is hugely successful. We keep looking at the world without looking within for successful examples. Maybe its time we focused on showcasing them.


    1. Gina, absolutely. It’s also a sad commentary on our country’s priorities when smaller or poorer nations end up caring better for their citizens’ healthcare than we do.


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