India ended 2016 hanging onto the words of Prime Minister Modi, as he made his second national address on the eve of 2017. His first national address on November 8 ended up demonetising 86 per cent of the nation’s currency and there were bets that he was due to make yet another big bang reform announcement.
Luckily, the PM had a bag of goodies for selected segments of India’s population. Timed perfectly a day after the 50-day deadline post-demonetisation he started by applauding the public for supporting his move. Then went on to make a series of announcements, which were almost Budget-like in tone and content. In fact, West Bengal Chief Minister Mamata Banerjee tweeted, “The PM just took over post of Finance Minister and made pre- Budget speech… The Nation Address became the Budget Address.”
But, the PM was clearly was in damage control mode, trying to counter the blow of demonetisation, at least for certain sections of society, like retired/ senior citizens, farmers, small entrepreneurs and yes, women.
Healthcare professionals will be particularly pleased with his intention to improve maternal mortality rates (MMR). He announced that a current pilot project running in 53 districts, under which pregnant women who underwent institutional delivery and vaccinated their children were given financial assistance of Rs 4000, would be expanded to cover the whole nation with the financial assistance increasing to Rs 6000.
This may seem a small step but for a woman living in the rural or even semi urban areas of India, this is further incentive to insist on having her baby in a healthcare facility. It means a chance of better care for both the mother as well as child, not just in terms of more cash in her bank account to buy better nutrition before and after delivery but also being tracked by health workers for immunisations. This scheme will help reduce MMR in a big way, said the PM , leaving no doubt in anyone’s mind that he knows the pain points of India’s healthcare infrastructure and its impact on the nation’s health.
This announcement may not sound like a ‘big bang’ reform like demonetisation, but PM Modi clearly has his eye on the long term. A healthier mother stands better chance of raising a healthier child and family. An empowered mother stands a better chance of educating her children and her family.
According to the NITI Aayog, while India’s total MMR reduced from 254 (deaths per per 100000 live births) in 2004-06 to 167 in 2011-13, some states are way below this benchmark. Kerala started out with 95 and ends with 61 in the same period whereas Assam remains burdened with the highest MMR, both in 2004-06 (480) and in 2011-13 (300). This data maybe dated but serves to illustrate the disparity between different states and regions.
An editorial in The Lancet, titled Universal Health Coverage—looking to the future’’, published on December 10 last year, is critical of governments, including the UK’s NHS, for being ‘complacent’ about taking responsibility for financing their health systems, and urges them not to pursue alternatives to public finance.
The Modi government has also come in for criticism, as it ‘has been disappointingly inactive in supporting UHC, and has reduced the funding of national health programmes’, though it says ‘regional initiatives are emerging and show great promise’. As an example, the same week’s World Report describes a network of local mohalla clinics run by Delhi’s Aam Aadmi Party government, that are successfully serving populations otherwise deprived of health services.
But in a classic tussle between centre and state, the centre, (led by PM Modi’s BJP) is reportedly stalling the expansion of the mohalla clinics initiative. Public health seems to have become a populist political tool, one of many such sops, that ruling and state parties will use to woo the electorate in the upcoming state elections as well as the all important 2019 general elections.
We hope to debate such concerns in February at the second edition of our public health focused leadership summit, Healthcare Sabha. Meanwhile, the January issue, our 17th anniversary issue and a public health special, highlights some of the efforts to address these challenges.
Viveka Roychowdhury
Editor
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