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Flip-flop stance of political parties

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Rajeev Ahuja, a development economist, formerly with the Bill and Melinda Gates Foundation (BMGF) and the World Bank, compares the three political parties the Bharatiya Janta Party (BJP), the Congress and the Communist Party of India (CPI)) manifestos from a healthcare perspective

From the health sector perspective, the promises made by the three political parties (the BJP, the Congress and the Communist Party of India (CPI)) in their manifestos make for an interesting comparison.

The Congress party manifesto that begins with a quote from its party president, Rahul Gandhi, reads, “I’ve never broken a promise that I’ve made.” Yet, the promises made in the Congress manifesto are tall, almost to the point of appearing unrealistic. Whether it’s about enacting right to healthcare act or doubling the share of public health spending in GDP over the next five years, these promises are definitely a tall order. More so, when the party opposes the insurance based-model of care that leverages the private providers and instead supports public system for delivery of healthcare to achieve universal coverage. Those familiar with the Indian health sector would know that the insurance-based model for hospital care, RSBY, was in fact promoted by none other than the Congress and its allies when they were in power. This flip-flop stance of political parties, even if this remains confined only to promises, statements or conversations, doesn’t augur well for the health sector.

Here is another promise made by the Congress in its manifesto. It reads, “We will ensure that all vacancies at all levels in PHCs and in public hospitals are filled within a period of one year.” Those familiar with the reality of health workforce supply in the country would know how unrealistic this promise is.”

There is a lot in common between the manifestos of the Congress and the CPI. The CPI also promises to enact right to healthcare, to raise the share of public health spending to 3.5 per cent of GDP in a short-term, to scrap insurance-based model of healthcare, to implement clinical establishment act to bring accountability among providers of care, to make healthcare affordable, to strengthen medical education and training and so forth. Of course, there are other promises too made by each of these parties in their manifestos but nothing comes across as very striking.

Now, look at the health promises made by the BJP in its manifesto. There is nothing on health that its incumbent government hasn’t said during its tenure. There are no new promises or commitments and therefore no surprises. It promises continued support to Ayushman Bharat and reiterates its goal of establishing 150,000 Health and Wellness Centres (HWCs) by 2022. It also envisages providing tele-medicine and diagnostic laboratory facilities at HWCs. As is the case with manifestos of other political parties, BJP talks of continuation of reforms in the area of medical education and training and making healthcare affordable to the masses. It talks of coming up with an essential list of medical devices and a separate pricing policy to make medical devices accessible and affordable. Additionally, it talks of making national nutrition mission a mass movement, achieving full immunisation coverage of children and pregnant women by 2022, and eliminating TB by 2025 through a special mission.

None of the manifestos takes a holistic view of the challenges in the health sector. Among the three manifestos, BJP’s manifesto is leanest of all and has some striking omissions. For example, it doesn’t talk of healthcare regulation in the country. This could perhaps be due to the National Health Policy 2017 that explains government’s stance in dealing with various health sector challenges.

Regardless of what gets mentioned in manifestos of different political parties on the eve of the 2019 general elections, health in India has become a political priority. Manifestos of different political parties is not necessary the right place to gauge its importance. Why? One, it’s not clear to what extent voters’ behaviour get influenced by party manifestos in the midst of other, more visible, factors such as personality of local candidates, track record of serving candidates seeking re-election, local development issues and so forth. Two, non-fulfillment of promises made in manifestos provide ready ammunition to opposition parties against the party in power. Nevertheless, it is interesting to study and compare health sector promises made by different parties in their manifestos to see if they are setting the expectations right.

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