Many PHCs that I have visited around the small towns and villages, never open, many don’t have nurses or medicines, rues Sakuntala Narasimhan

(Deccan Herald, Bangalore, May 31, 2005)

Earlier this month, Delhi saw an outbreak of meningitis that caused a scare, with dozens of victims hospitalised. The electronic media quickly latched on to the event as news, but once something else came up as ‘newsworthy’, the deplorable state of health and sanitation even in the national capital quickly got shelved as an issue.In the next few weeks, once the rains play havoc with low lying areas, and gastroenteritis breaks out again (as it does year after year) it will once again become ‘news’ (to be superceded as soon as more gory or graphic stories become available).

The basic neglect of health issues, which causes such ‘newsy’ outbreaks of illnesses, doesn’t get tackled, and this leads to the loss of not only lives but also thousands of hours of man hours of productivity for the community and country. This is true in almost all developing countries where the trend is for resources to be apportioned for ‘prestige’ projects rather than for ensuring the availability of basic medicine for the citizenry.

Which is why six weeks from now, medical practitioners and activists from around the world will be gathering in Ecuador in south America for the second global People’s Health Assembly (PHA 2) to urge national governments to prioritise health issues and prevent millions of avoidable deaths that now take place annually, among children, men and women. PHA 1 took place in Bangladesh in December 2000, with 1,453 participants from 92 countries.

Life spans have risen in almost all countries over the last fifty years, but these statistics mask the fact that inequalities have been growing, leaving the poor poorer and the rich richer. While sophisticated, super-speciality hospitals come up in the metropolitan areas, thousands of slum dwellers living next to these hospitals have no access to even simple cures (or even to water and sanitation, for that matter).

Under the new economic policies of the last one decade, government health services that used to be free are now imposing ‘user fees’ so the poor are actual;ly worse off. Medical emphasis is also shifting towards fancy and expensive curative treatments rather than simple, inexpensive preventive measures (ensuring clean, potable water supply, sanitation, prevention of malnutrition, monitoring industrial developments that increase pollution and cause ill health).

The Voluntary Health Association of Karnataka recently brought to light the case of a woman who died at a primary health centre in Sasalu village near Doddballapur, because of medical negligence during an abortion procedure.

The teenaged daughter of a daily wage earner in the Ambedkarnagar slum of Koramangala in Bangalore, died following careless treatment at the local primary health centre, right in the middle of the ‘Electronics capital of India’. Many PHCs that I have visited around the small towns and villages, never open, many don’t have nurses or medicines, and there is a wide gap between the rhetoric of the state government’s boast about the number of PHCs set up , and the actual facilities available.

Even among the well-off , persistent afflictions like asthma, allergies and water-borne illnesses are on the rise, and yet money spent on health services is far less than the allocations for ‘prestige projects’ like flyovers and airports (which benefit only the affluent) or for political rallies. It is clearly not a question of lack of resources, but one of wrong priorities and a lack of political will.

How many of us would choose to go to a government clinic or primary health centre, if a private hospital were available as an alternative ? Even the poor, who cannot afford treatment at private hospitals, would rather incur a debt to pay for private medical care, than opt for treatment at a government clinic, because the latter is so woefully unsatisfactory.

The People’s Health Movement seeks to bring pressure on policy makers, to treat healthcare – and preventive care in particular -- as a human right (and the pursuit of economic-political policies that cause ill health as a violation of human rights). ‘Health for All’ was a slogan that many governments around the world, including ours, adopted after the Alma Ata declaration more than twenty five years ago, but precious little has been done to translate that slogan into reality. Debilitating illnesses like malaria, the WHO noted last month, have now in fact resurfaced widely, and health activists have pointed out that if it is a question of the relative importance of expanding exports or ensuring basic health of the population, the answer is obvious. Manipulations by transnational companies (especially pharmaceutical corporations) for profit rather than the people’s good, is another cause for concern in the context of public health.

Unless we as citizens demand better healthcare services as a right, this state of affairs is not going to change. Why do we assume that government health services cannot be improved, when other developing countries have shown that betterment is possible? Bolivia has fought against privatisation of water, for instance. Brazil and El Salvador have likewise notched up success stories in health. It is strategies like these that Indian participants at PHA 2 hope to bring back, for possible replication on our country.

Pinch of salt VAT is that again?!

Value Added Tax is supposed to increase transparency, reduce corrupt tax evasion, and even reduce prices for consumers. In reality – shops continue to avoid giving a bill or worse, use VAT to round off prices to higher amounts. Even the Janata Bazar (supposed to be for the common man) sells an item marked Rs 13, for Rs 15, claiming VAT. Tax is only 12.5%, but the final price of Rs 14.60 is rounded off to 15. What was that again, about consumers benefiting from VAT?