Political Culture of Health in India: A Historical Perspective
This article from the Economic and Political Weekly, a peer-reviewed journal, examines the political motivations that have historically shaped India’s public health services. It says that while the state was committed to providing healthcare, there were contradictions in its approach, which explain its ineffectiveness. For instance, its ambition could not be matched with its infrastructure and resources, so it relied heavily on foreign aid, which supported mostly techno-centric – and not people-centric – programmes like malaria eradication. It says that the failure of this programme left a huge dent in the India’s commitment to public health.
The Bhore Committee, set up in 1943, made recommendations about how India’s health services can be remodelled. In its 1946 report, it suggested setting up a national health service with a network of district health centres that would be linked to specialised medical centres in larger urban areas.
In the Constituent Assembly debate of August 20, 1947, K. Santhanam, member of the assembly from Madras, had pointed out that the provisions for funding public health in the proposed Constitution were inadequate. He reiterated what the Bhore Committee report had said, that public health requires Rs. 300 crores.
In 1948, Renuka Ray, a member of the assembly from West Bengal, argued for a constitutionally guaranteed minimum for the funding of public health and education, somewhere between 15 and 30 per cent of overall expenditure.
Santhanam’s and Ray’s voices were in the minority, and the consensus in the Constituent Assembly was that public health should be a directive “principle of governance” rather than a fundamental right. (Over time, starting from the 1980s,, the Supreme Court has interpreted the right to life as including the right to healthcare.)
Between 1959 and 1963, the national malaria eradication programme took up nearly 70 per cent of India’s budget for communicable disease control. This accounted for almost 30 per cent of the overall health budget under the Second Five-Year Plan. The U.S. contributed more than 50 per cent of the cost of the malaria eradication programme between 1952 and 1958, and nearly 40 per cent of its cost between 1959 and 1961.
Focus and Factoids by Vedika Inamdar.
Economic and Political Weekly
13 Jan, 2007