On the Agenda Finally in 2018, Health to be in Focus

A senior public health specialist on his first visit to India a few years ago asked in all earnestness: “Why isn’t health a political issue and why don’t people demand better health facilities?” Well, 2018 changed this scenario. Not fully, but quite substantially. Health was finally big on the agenda last year. In his 2018-19 budget speech, finance minister Arun Jaitley said, “Only swasth Bharat can be a samriddha Bharat.” As truisms go, a healthy nation is certainly a prosperous one. The announcement of the Ayushman Bharat program, with its twin components of primary healthcare and insurance, in the Union budget did receive media attention. But what captured the headlines and grabbed eyeballs was the insurance component—the National Health Protection Scheme, touted as the world’s largest government funded healthcare program. The post-budget analysis with its usual focus on investment in infrastructure, agriculture and fiscal deficit and the like was suddenly focusing on health, for the first time ever. The scheme, renamed Pradhan Mantri Jan Arogya Yojana, aims at covering over 100 million poor and vulnerable families (approximately 500 million beneficiaries) providing coverage up to ₹5 lakh per family per year for secondary and tertiary care hospitalization.

Through the year, public health experts have debated the efficacy of the program, whether it would work or not and what the gaps in the scheme were. Much of the discussion centered around the size of the program and its funding and if it would pave the path for universalizing health coverage in the country. The positions bordered on being extreme—either you liked the Ayushman Bharat program, in particular Pradhan Mantri Jan Arogya Yojana, or you did not. Nuanced debate was the exception. But what was clear was that health had become center stage. It had become the discourse. While there had been various pronouncements earlier, for instance, the National Health Policy 2017 or the launch of Mission Indradhanush, never before had health been spoken of at this level or scale, and there seemed a clear vision that health could be the “agenda”—an issue that may resonate with the poor and the marginalized, and thus become the X factor in the 2019 elections. Pradhan Mantri Jan Arogya Yojana was duly leveraged by the government through the year, culminating in its high-profile launch by Prime Minister Narendra Modi in September 2018 in Ranchi, Jharkhand. That one eye was firmly fixed on political gains (read votes in the 2019 general elections) was evident as the government pushed hard to launch the scheme as soon as it could.

Without evidence that the scheme would be beneficial to the common man and indeed save him from catastrophic expenditure that healthcare entails, it could be a dud, and an expensive one at that. There’s lots that is riding on the success of Pradhan Mantri Jan Arogya Yojana. The government has clearly gone out on a limb on this. It has invested huge political capital, not to forget the financial resources. No wonder, looking ahead at the elections, Jaitley has called Ayushman Bharat a game changer in healthcare. In his Facebook post on the 1 January 2019, he shared that 685,000 poor patients have availed of free hospital treatment in the first 100 days of the scheme, which translates to an average of 5000 claims per day in the first 100 days. In contrast to the buzz that Pradhan Mantri Jan Arogya Yojana made, the component of strengthening primary healthcare—health and wellness centers—hasn’t made much news even though it had an equally high-profile launch by the prime minister earlier in April 2018 in Bijapur district of Chhattisgarh. Is it that only big is beautiful? Perhaps size does matter and that’s why it has not received much attention in the public discourse. Or is it that there is a feeling that the returns on health and wellness centers will not be commensurate and, therefore, the decision to prioritize Pradhan Mantri Jan Arogya Yojana (PMJAY)? After the launch of PMJAY in September 2018, there was a bit of a lull about health on the political landscape.

Surprisingly, it wasn’t much of a talking point in the recent assembly elections in the five states. Political pundits say that health and PMJAY was not much of a factor in these elections and a footnote at best. The picture will be different in the 2019 general elections. By calling PMJAY a game changer, the finance minister has fired the first salvo. It will only get more intense as we get closer to the elections. The prime minister is likely to expend political capital on this scheme hoping that it may swing votes his way much like the Mahatma Gandhi National Rural Employment Guarantee Act did for the first United Progressive Alliance government and also portray him as pro-poor. A slightly jarring note is that the opposition parties haven’t said much on health in the recent past though some states ruled by them have excellent health schemes. The mohalla clinics in Delhi are a case in point. The coming weeks will see an intensification of pushing the health card. Will it translate into votes for PM Modi? Only time will tell. If it does, health as an agenda on India’s political landscape would have truly arrived.

The writer Rajeev Varma is a former senior communications officer with WHO India. – Livemint