The Time magazine has dubbed Manmohan Singh “underachiever” stating his unwillingness “to stick his neck out” on reforms has put India off the growth track. It says people are losing confidence in his government and advised him to bring populist measures and win back voters’ trust. It is ironical that the criterion of populist reform changes as one travels between the opposite time zones of the U.S. and India.
In the U.S. presidential elections, healthcare reform has been a momentous campaign issue and will continue to remain so in the future. In 2008, Barack Obama promised universal health coverage and, soon after his election, announced Healthcare for America Plan vis-à-vis Obamacare. His plan went through major twists and turns, and after three years of a roller-coaster ride was upheld by the U.S. Supreme Court as constitutional. Despite little progress on his healthcare promise till date, President Obama will be looking to capitalise on this ruling and seek re-election on the issue considered a hot button for the Americans.
On the other side of the globe, the Manmohan Singh government introduced innovative and inclusive healthcare schemes like NRHM, RSBY and RGSEAG-SABLA to bring about a healthy change in the lives of the common man. Still he is given little credit for all his efforts at improving India’s healthcare indicators. Does it mean that if Dr. Singh were the President of the U.S., where healthcare is considered a significant campaign issue, or if Indian electorate considered healthcare an important issue the way American electorate does, he would be tagged as “moderate” if not “overachiever”?
A quick glance at India’s improved health indicators could concretise our theory of “Manmohan cares.” As per the Economic Survey, “the combined revenue and capital expenditure of the Centre and the States on medical and public health, water supply and sanitation and family welfare increased from $9.4 billion in 2006-07 to $17.3 billon in 2010-11.” In 2005, the Government of India initiated the National Rural Health Mission, known to be “the most ambitious rural health initiatives ever.” The NRHM aimed at providing effective healthcare to rural population, especially women and children. With an annual budget increased to $3.7 billion, the mission has been able to reduce infant mortality rate by 13 points to 49, total fertility rate from 2.8 to 2.6, and crude birth rate from 24.2 to 22.2.
Similarly, the government introduced the Janani-Shishu Suraksha Karyakram to lower the maternal mortality ratio (MMR) by facilitating institutional deliveries through the hand of skilled attendants. This scheme has shown rapid growth with approximately 11 million beneficiaries in 2010-11. As a result of the efforts, the MMR has reduced by 28% to 200 since 2005.
Another example of the government’s innovative and inclusive healthcare delivery to the common man is the Rashtriya Swasthya Bima Yojana. It is a government-run health insurance scheme for below the poverty line (BPL) workers and their family. Its objective is to protect the BPL households from major health expenses that could wipe out their life savings. Since its inception in 2008, this scheme has expanded its ambit and enrolled 30 million BPL families. For its unique business model and growth potential, the RSBY was praised by the World Bank as a “model of good design and implementation,” recommending it for the rest of the world.
To empower adolescent girls in the age group 11-18, the Centre introduced the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls in November 2010. Through this scheme, the government aspires to empower adolescent girls by improving their health and nutritional status. Around 11 million adolescent girls per annum are expected to be covered as the government has raised its budget outlay on the health and nutrition component of this scheme from $530 million to $879 million.
Finally, an initiative for universalisation of the Integrated Child Development Scheme (ICDS), the world’s largest child development programme, has been taken up by Dr. Singh’s administration. As part of this effort, 42,000 anganwadi centres have been operationalised taking the total number of operational centres to 1.3 million. In 2011-12, ICDS expenditure increased by 46% to $2.5 billion with a total of 9.7 million beneficiaries.
All these ambitious healthcare schemes have touched the lives of millions of common men, yet have not been hyped as Indians are still getting past bijli (electricity), sadak (road) and pani (water). India is poised to be most populous country in the world. We will need an effective healthcare programme and delivery mechanism for our citizens, thus making healthcare an elementary issue for the coming generations. Perhaps, Dr. Singh will be remembered then for reforming the healthcare sector the way he is credited now with liberalising the Indian economy.
(The writer is a social healthcare analyst and has worked with health welfare programmes of various countries. His e-mail is anurodhj@gmail.com)
