Public health policies

Abstract

Health and nutrition had always been at the core of welfare that anchored Indian democracy. However, the government’s approach of limiting the assured services and the notion of affordability in establishing universal health coverage indicates that the state’s commitment is shrinking. Political commitments may change in intensity and spheres over time within a given framework, but when the value framework itself changes then fissures of discontinuity appear. India is under one such shift and the present redefining of the health policy objective is reflective of the country’s attempt to get integrated into a fast expanding neo-liberal global market through structural reforms, where health like many other services is a driver of revenue and wealth. Interestingly, despite drastic cuts in financial allocations in welfare, promotion of markets, and rejection of participatory planning at all levels – for political reasons – the language of universality, inclusion and assurance for the disadvantaged, especially the very poor, continues and promotes targeting in official programmes. This chapter examines the shift in policy perspective through a review of four aspects of the Indian experience of health planning: (a) the intensification of health sector reforms in India and its gradual consolidation in the 21st century, (b) medical industry’s perspective regarding the health sector, (c) the National Health Accounts estimation of expenditures for better planning and its official use and (d) contribution of the National Institute for Transformation of India (NITI Aayog) to the HSR. The directions emerging out of these are then analysed for their value for the less privileged and the wisdom of the present policy, and the implications are considered. The scope of this chapter is limited as it primarily addresses the growing shift towards individualised medical care away from the comprehensive approach of public health.