Universal healthcare plan caught in a turf war

Reddy panel’s suggestion that drug manufacturing be shifted from the domain of chemical and fertiliser ministry to health ministry to ensure fair pricing becomes a breaking point


Pankaj Kumar | June 17, 2012

Those who believe in dreams must be blamed for their credulity. The union government conjured up a dream of universal healthcare for ordinary people. Prime minister Manmohan Singh articulated it. The planning commission was assigned to work on it and incorporate in the 12th five-year plan.

But good intentions proved to be a chimera. A high-level expert committee constituted by the planning commission under the chairmanship of Dr Srinath Reddy came out with a wide range of suggestions. And none of these were acted upon.

But what has triggered a virtual turf war within the government is the pricing of drugs, the most critical element of the universal healthcare plan (UHP). In fact, the Reddy committee clearly suggested that the drug manufacturing be shifted from the domain of the chemical and fertiliser ministry to the health ministry in order to ensure fair pricing.

Obviously, this is an old suggestion repeated by the committee. But the fact that the chemical and fertiliser ministry has to cede its lucrative ground to the health ministry is patently unacceptable. This is the precise reason why the suggestions related to the UHP have virtually run against a wall without moving on inch on the avowed objective of providing universal healthcare to the average Indian.

The story of how the UHP and policies for providing essential medicines went awry could be traced to the proposal for the 12th five-year plan which suggested a new initiative to supply essential medicines free of cost to patients seeking healthcare in public health facilities. Officials in the health ministry say that the ‘free dugs for all’ policy will enable the poor to get access to healthcare in public facilities, an important index of reducing a sense of privation. Director general of health services Dr Jagdish Prasad while talking to Governance Now said, “Free drugs in public facilities will soon be a reality. The high-level expert committee report is with the planning commission.”

But his admission deftly conceals the fact that the planning commission has not been moving on the expert committee’s recommendation. For instance, the Reddy committee’s recommendation to enhance the expenditure on healthcare in terms of its share in the GDP is only a reflection of a good intention that means nothing. A noted social activist associated with the UHP said, “We know that all these suggestions would lead to nothing but still we are keeping our fingers crossed.”

That the chemical and fertiliser ministry and the health ministry are working at cross-purposes is evident by their approaches to the pricing of medicines. Though the government promised in the supreme court to regulate the prices of 348-odd essential drugs to make them accessible to the poor, the draft of national pharmaceutical policy 2011 clearly stipulated that an average of top three brands of medicines would be taken to fix the medicine price. “This is an absurd way of fixing price of essential drugs,” said Mira Shiva of All-India Drug Action Network (AIDAN), an independent network of several non government organizations working to increase access and improve the rational use of essential medicines.

The methodology of fixing price known as weighted average price (WAP) triggered a strong protest from AIDAN which has challenged it in the supreme court. According to Mira Shiva, the methodology was devised in a manner to give maximum advantage to pharmaceutical industry at the expense of patients. In AIDAN’s PIL, it was pointed out that while the WAP of a life-saving drug is thousand times higher than the manufacturing cost.

Apparently the government’s method of regulating price of medicines in the national list of essential medicines (NLEM) evoked strong reactions from the corporate sector. The Federation of Indian Chambers of Commerce (FICCI) led the protest by asserting that the regulation of drug price would militate against the spirit of liberalisation and prove to be a disincentive for the pharmaceutical industry to undertake research and development.

Even as the government is still grappling with intricacies of its popular dream, the facts sketch a scary scenario. The UNESCO report suggests that 42 percent of children below three years are undernourished and third largest number of measles-infected cases are found in India. There is a significant spurt in number of diabetics which may have crossed 60 million. A similar trend is discernible in the rise of cancer patients. There is no doubt that to deal with such a scenario, creation of capability is essential. But even more essential is to bring under regulation the highly unregulated pharmaceutical industry to contain essential drugs’ prices.

With millions of Indians regularly pushed into a vortex of poverty, the unaffordable healthcare cost is life-threatening. If they be relieved of the burden of unbearable health expenditures which accounts for a significant chunk of their earning, it will be a dream come true. But so far, it remains a distant dream.




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