Imrana Qadeer’s comment reflects a misunderstanding of the contents of both the HLEG report and my article. The HLEG is neither drafting (or redrafting) the health chapter of the 12th Plan, nor are its members who included public health experts, practising community health providers, senior government officers, and civil society activists, particularly enamoured of technological fixes. In fact one of the central arguments of my piece was that “consistent public underinvestment in health …is a major reason why health care is so unaffordable for so many people” and this is a major indicator of the fact that the system is broken. Moreover the HLEG made a strong case for tax-based financing rather than health insurance. The HLEG report and my own article make it clear that we believe “the public sector should be the bedrock of reform” and we agree with the Health Ministry on this as a matter of record.

It is not obvious in any case why Qadeer attaches the term “merely” to lack of drugs and equipment or disrespectful treatment. Few people at the receiving end would agree that these are trivial. She attaches another even more mystifying “merely” to the need for regulation of the private sector and ad hoc public-private partnerships. She then proceeds to call citizen participation and accountability “buzzwords.”

Her main argument appears to be that health is a result of much more than health services. Few would disagree. What makes her criticism bewildering is the fact that the HLEG report has a full chapter on these larger determinants and another on community monitoring, contrary to Qadeer’s assertion.

(Gita Sen is Professor at the Centre for Public Policy, Indian Institute of Management, Bangalore.)

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