Suravi Sharma Kumar
Political parties pay least attention to real issues like health during elections, manifestos show
The Covid-19 pandemic has exposed cracks in failing healthcare systems, making us reflect on the role of government in ensuring healthcare for all in the country. Surprisingly, India’s election manifestos from all political parties make no mention of health issues. Curiously, Indian voters also seem less interested in giving enough weight to the topic of health in electoral decision-making.
In the Bihar Assembly elections held from October to November 2020, the post-poll survey found that only around 0.3% of voters considered health a priority despite the state surrendering at the polls during the COVID-19 pandemic. Economic factors and general development issues weighed more heavily on the electorate.
It’s an irony since the country’s people account for the highest out-of-pocket expenditure in the world, at 78% for health care, with the situation not having changed in decades. The reasons for the low prioritization of health in elections appear to be complex and rooted in people’s psychological imprints. People surprisingly seem to have non-existent expectations of the government for health care. This could be because the healthcare system has been unresponsive and irresponsible for too long.
An expectation is the emotional anticipation or belief of an event that may take place in reality in the future. Also, the lack of attention on the part of political parties for health care in their electoral manifestos could also explain the loss of expectations of citizens vis-à-vis the government. Political leaders, meanwhile, avoid promising improved health care, either because they don’t have the answers or because they find the subject too complex. However, we find that where political leaders have managed health care well, such as in Kerala, it has created an expectation on the part of citizens that compels political leaders to pay attention to the issue of health.
The ruling Center party is seen as benefiting from maintaining a series of welfare schemes since 2014, adding several such schemes and actively promoting them in elections. Various factors/reasons are at play for the lack of electoral focus on the health care agenda. It is indeed a fact that reforms in the health sector are more difficult to execute and they are much slower to produce tangible results for voters to take notice. Therefore, investments in the health sector by political parties were seen as politically more risky than other results-oriented programmes/programmes. For example, improvements in the distribution of food grains or gas cylinders (Ujjwala) are more visible and tangible/measurable to the general public than enabling an effective medical care policy/programme, which is a much more difficult task. difficult and long to undertake. Social protection schemes based on the “delivery” of a product are much simpler and more tangible than improving services like health and education, which are much more complex.
Health care depends on a system that includes high infrastructure, human resources, protocols and medical resources, accountability and capacity. For this reason, perhaps, the main
Election commitments in the health sector in recent years have focused on health insurance and a few offers of free treatment rather than comprehensive infrastructural reforms under which this product can be used effectively.
The social determinants of health that are high priority in the United Nations livelihood goals must find a place in any discussion about improving health infrastructure. These are important contributing factors to overall health status and receive varying degrees of priority within governments. But a more targeted coordination is necessary to ensure an optimal allocation of resources between the different sectors affecting the subjects of drinking water, sanitation, hygiene and nutrition. Their contribution to good health is undeniably important, but they must be recognized, measured and valued appropriately.
There is also a need to establish a coordinating body in the highest offices of the country to connect the dots on health and other social determinants of health and coordinate the work of the various agencies contributing to improved health. in order to improve them and make better use of them for the general good.
Experts would agree that rebuilding India’s healthcare system first and foremost requires better financial allocation and policy work around clarifying the roles of national and state governments. The other area is to create self-sustaining institutions with evidence-based health care governance and administration. The motivation for these will emerge from creating (or highlighting) Indian voters’ demands for better health. Welfare groups and nongovernmental organizations should work on voter awareness, their perception of health plans, and even the politics behind them.
Finally, the responsibility rests with the leaders of the ruling party. Political will is needed to overcome resistance from various groups to carry out these major reforms. It is high time that elections were fought over issues like health and education rather than palliatives and placebos like loan waivers, grants and freebies.
The author is Consultant Physician at Moolchand Medcity, New Delhi