Perhaps most worrisome is India’s gross inability to spend more on health, the starting point for any change.
Policymakers and thought leaders across the world have drawn much political capital by talking at first about “Health for All”, and then Universal Health Care. While the framing, terminology and timelines have changed over the years, the matter has remained a consistent topic of debate in almost every country. The reality of the ongoing pandemic—one with no parallel in recent history in terms of the disruption caused—has thrust this matter back to the forefront of all policy formulation. Add to this pandemic the grave reality of widening income disparities, and it’s easy to understand why expeditiously attaining broader health coverage has now become the topic of the hour.
To better understand the subject of universal health care, it is useful to start with the modern genesis of this desirable measure. Post the carnage of the Second World War, which saw over 55 million direct deaths and another 30 million casualties due to war related disease and famine, Fabianism-imbued welfare became the hallmark of most democratic governments, especially in Europe. The Conservative Premier Winston Churchill, who had led Great Britain to victory over the Nazis, was replaced by a pronounced Socialist in Clement Attlee. Just months after the war ended, Attlee emerged as the leader in national polls, promising a national health scheme and additional state-funded welfare. In fact, health care became a north-star of a new social orientation, as a series of nations ranging from the Nordic countries to Japan and Canada gradually rolled out their variations of universal health care.
Fast forward to 1977, and the General Assembly of the World Health Organization unanimously declared that the major social goal of governments should be the attainment of a level of health that would permit all people of the world to lead an economically and socially productive life. Perhaps too ambitiously, the date to reach this target was set for the year 2000. The following year, the Declaration of Alma-Ata was adopted by 134 member nations including India, identifying primary health care as the key to achieving “Health for All”.
The Declaration emphasised the role of the State in actively providing adequate health care and recommended that Third World countries use a decentralised approach based on setting up rural health units instead of city-hospitals and prioritise low-cost preventive care measures over high-cost curative ones. The reformulated approach based on a holistic concept of health and equitable redistribution of resources, was tantamount to the State taking responsibility for comprehensive health care provision.
India, an enthusiastic participant of the Declaration, announced its first National Health Policy in 1983 and echoed the WHO call for “Health for All” by laying down specific goals on various health…