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18 March 2017 Editorial

 

18 MARCH 2017

A road map for health

The National Health Policy 2017, which the Centre announced this week after a nudge from the Supreme Court last year, faces the challenging task of ensuring affordable, quality medical care to every citizen. With a fifth of the world’s disease burden, a growing incidence of non-communicable diseases such as diabetes, and poor financial arrangements to pay for care, India brings up the rear among the BRICS countries in health sector performance. Against such a laggardly record, the policy now offers an opportunity to systematically rectify well-known deficiencies through a stronger National Health Mission. Among the most glaring lacunae is the lack of capacity to use higher levels of public funding for health. Rectifying this in partnership with the States is crucial if the Central government is to make the best use of the targeted government spending of 2.5% of GDP by 2025, up from 1.15% now. Although a major capacity expansion to produce MBBS graduates took place between 2009 and 2015, and more initiatives were announced later, this is unlikely to meet policy goals since only 11.3%of registered allopathic doctors were working in the public sector as of 2014, and even among these, the number in rural areas was abysmally low. More health professionals need to be deployed for primary care in rural areas. Availability of trained doctors and nurses would help meet the new infant mortality and maternal mortality goals, and build on the gains from higher institutional deliveries, which exceeded 80% in recent years.

Contracting of health services from the private sector may be inevitable in the short term, given that about 70% of all outpatient care and 60% of inpatient treatments are provided by it. But this requires accountability, both on the quality and cost of care. No more time should be lost in forming regulatory and accreditation agencies for healthcare providers at the national and State levels as suggested by the expert group on universal health coverage of the Planning Commission more than five years ago. Without such oversight, unethical commercial entities would have easy backdoor access to public funds in the form of state-backed insurance. It should also be mandatory for all health institutions to be accredited, and to publish the approved cost of treatments, in order to remove the prevailing asymmetry of information. For the new policy to start on a firm footing, the Centre has to get robust health data. Currently this is fragmented because inputs from multiple sources and sample surveys are not reconciled, and the private sector is often not in the picture. To reduce high out-of-pocket spending, early deadlines should be set for public institutions to offer essential medicines and diagnostic tests free to everyone. This was estimated in 2011 to require a spending increase of only 0.4% of GDP, which is within the 2.5%that the Centre is talking about.

 

 

Beyond the vote

Fears that the tide of populism would sweep relentlessly across Europe have been somewhat belied by the result of the election in the Netherlands. Prime Minister Mark Rutte’s centre-right People’s Party for Freedom and Democracy (VVD) retained its primacy by winning 33 seats, ahead of Geert Wilders’s anti-European Union, anti-Islam and anti-migrant far right Party for Freedom (PVV). The proportional representation system, with 28 parties competing for 150 seats in the lower House of a bicameral legislature, means that a coalition government is inevitable. Until a week or so before the elections, Mr.Wilders was leading the opinion polls, slipping behind Mr. Rutte only in the very last stretch. The Prime Minister’s pre-election gains have now translated into an electoral victory. This is being attributed in part to his tough stand against the Turkish government’s attempts to campaign in the Netherlands for its President, Recep Tayyip Erdogan’s upcoming referendum to consolidate power. The spectacle of clashes between the police and people of Turkish origin in Rotterdam, following bans on Turkish ministers addressing crowds, could have also worked in favour of Mr. Wilders, who argues that migrants and Muslims do not it into Dutch society. Mr. Wilders, who wants to ban the Koran, ‘de-Islamise’ the Netherlands, and pull out of the EU, has indicated the country has not seen the last of him. His warning must be taken seriously: the PVV won 20 seats, five more than last time.

The most notable gains on 15 March 2017, however, were for pro-EU parties, the liberal D66 and the Green- Left, led by 30-year-old Jesse Klaver who is pro-refugee, opposes populism and speaks of tolerance and empathy. This may have cost the PvdA (Labour) party, which suffered a precipitous decline in seats from 38 to nine, losing voters to other parties on the left. Overall, the election results have, at least for now, stemmed the growth of populism and given the EU a much-needed shot in the arm. The first task for Mr. Rutte will be to stitch together a coalition, which is likely to consist of other centrist parties. The government will then have to navigate what is a turbulent period in Europe. This will involve protecting the rights of refugees and treating those displaced with compassion and respect, while at the same time addressing the legitimate concerns and needs of those who have been hit by austerity and are feeling left behind by globalisation. It will require having meaningful and fair conversations about immigrant integration and Dutch values without giving in to Islamophobia and the scapegoating of minorities. In this, Mr. Rutte and his partners will be assisted by the economy, which is growing at a respectable 2%, and by the fact that the far right in France and Germany—which go to the polls this year — will not find it easy to capitalise on Dutch populism, thanks to how people have voted.

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