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Much has been discussed and debated about the socio-economic and political significance of the ongoing national election on Indian democracy including the constitution. It is being reiterated that the outcomes of this election could shape the future of the Indian polity. The election manifestos of the Indian National Congress (INC) and the Bharatiya Janata Party (BJP) are rooted in distinct ideological underpinnings and aspirations. The BJP, driven by the personality politics of the Prime Minister, firmly commits itself to ‘inclusive growth and development’. While the INC also advances the idea of inclusive growth and development, there is a definite realisation that this cannot be achieved or sustained without ensuring social justice and equity. The urgent need to embrace social justice and equity flows from the devastation caused by the COVID-19 pandemic.
The encounter with the pandemic exposed the fragilities and challenges of the Indian public healthcare system. However, the fact that it remained the only resort for millions underlines its resilience. The significant contribution of public healthcare sector workers was lauded by the PM, and citizens enthusiastically clapped and banged thalis at his urging, even though we are yet to arrive at a consensus regarding the number of lives of healthcare workers lost to the pandemic. The unregulated private healthcare system remained largely dysfunctional and apathetic as wave after wave of the pandemic wreaked havoc.
Regrettably, the manifestos of both the leading contenders completely miss the impact of the pandemic on the healthcare systems and the people. However, this is not surprising, given the historical trajectory of policies leading to the systematic weakening of the public healthcare system and projecting the private healthcare sector as an alternative. Given this background, it is interesting to examine what the two manifestos have proposed for the healthcare system in India.
The dire need to increase the budgetary allocation for public health has been repeatedly emphasised for decades. Hence, it is promising that the INC manifesto has committed to achieving a stepwise enhancement of the health budget to 4% of total expenditure by 2028-29, while the silence of the BJP manifesto in this regard is puzzling.
Although both manifestos emphasise a commitment to strengthen the public healthcare system, the INC manifesto demonstrates a pronounced focus on the continuum of care, starting from basic determinants like nutrition to primary healthcare networks and secondary and tertiary care. The INC’s promise of universal and free healthcare in the public sector covering a spectrum of services reflects their stated belief in citizens’ Right to Health. However, the focus of the BJP on the provision of healthcare services remains fragmented, with higher priority on secondary and tertiary care and negligible emphasis on primary healthcare. For instance, it has promised ‘free and high quality’ healthcare services through Ayushman Bharat for poor citizens, and ‘high-quality’ healthcare services for the middle class by expanding the AIIMS and Ayushman Arogya Mandir network.
Both manifestos also propose health insurance as a “magic bullet” for healthcare access. This despite the fact that the inadequacy of health insurance schemes in a country with a fragile public healthcare system and grossly unregulated private healthcare sector in ensuring healthcare access has been amply documented.
The two manifestos espouse medical pluralism in healthcare, which is a welcome step. However, it is important to understand how each of the five different systems of medicine under AYUSH functions and interacts with human health. Such critical examination is also necessary to prevent misappropriations and misuse of these systems of medicine, as recently demonstrated by the Patanjali controversy. The focus on mental health through yoga and meditation in the BJP manifesto is well appreciated. However, it is also crucial to recognise that privileging one system, such as Ayurveda or Yoga, over the others for political gains is unjustified.
Challenges posed by the understaffed public healthcare sector and inadequate remuneration of healthcare workers have been discussed for decades. While these have been considered in the INC manifesto, what is more commendable is their position on protecting health professionals against violence. On the other hand, the BJP manifesto restricts itself to increasing the capacity of different healthcare cadres.
The pandemic made the dire state of the Indian healthcare system apparent, yet the heated conversations around the election campaign totally invisibilised this as a relevant poll agenda. One would anticipate that in the aftermath of the pandemic, citizens would demand active conversations around the health agenda. But the deafening silence proves the disappointing pattern that health, including healthcare, can never gain or lose votes in India, giving free rein to politicians to remain indifferent to the health of the citizens.
Sapna Mishra is an Assistant Professor, Easwari School of Liberal Arts, SRM University, AP; Malu Mohan is an Independent Public Health Researcher.
