Electoral manifestos are invaluable for understanding a party’s vision. And health is a pivotal aspect of this vision. This scrutiny is particularly important amidst the lingering memories of the pandemic and the collapse of our health system.
How effectively do the manifestos of the two major national parties, the ruling BJP and the opposition Congress, address the pressing health challenges facing our nation?
Here’s an analysis:
Increasing burden of NCDs
A recent study has painted a troubling portrait of declining health nationwide. According to findings from the Indian multinational healthcare group, Apollo Hospitals, India has earned the dubious title of “the cancer capital of the world” due to the escalating cases of cancer and other non-communicable diseases (NCDs). One out of every three Indians is pre-diabetic, two out of every three are pre-hypertensive, and one out of every ten battles with depression.
Limited awareness about symptoms and early detection results in the increase in the burden of these diseases. Despite this alarming trend, neither electoral manifesto acknowledges these developments or offers any solutions, although Congress passingly mentions the phrase “free palliative care” in its manifesto.
One out of every three Indians is pre-diabetic, two out of every three are pre-hypertensive, and one out of every ten battles with depression. Manifestos provide little insight into preventive healthcare and early detection
Out-of-pocket expenditure and inadequate health budget allocation
Out-of-pocket spending continues to dominate healthcare expenses in India, with nearly half of all health expenditures being borne directly by patients at the point of treatment. However, there has been a notable increase in the government’s share of health spending since 2013-14, according to the Economic Survey 2022-23.
In the fiscal year 2013-14, government health expenditure accounted for only 28.6% of total health expenditure, but by 2018-19, this figure had risen significantly to 40.6%. Correspondingly, out-of-pocket expenditure as a percentage of total health expenditure decreased from 64.2% in 2013-14 to 48.2% in 2018-19. Nonetheless, out-of-pocket health expenditure remains a significant driver of impoverishment in India, where government healthcare spending amounts to just 1.28% of GDP (Source: Lancet), a figure that has been countered by the government. As per National Health Policy, 2017, public investment in health is envisioned to reach 2.5% of GDP by 2025.
Both political parties have proposed insurance as a means of alleviating out-of-pocket expenses. The BJP advocates for a coverage limit of 5 lakh rupees, while the Congress party proposes a higher coverage of 25 lakh rupees, inspired by the Rajasthan model. Additionally, the Congress party pledges to gradually increase the health budget to 4% of total expenditure, whereas the BJP has not explicitly addressed this commitment.
Out-of-pocket health expenditure remains a significant driver of impoverishment in India. Both parties promise insurance cover to address this.
Congress talks about gradually increasing health budget to 4 per cent of total expenditure. BJP hasn’t committed any numbers.
Air pollution and its health impact
Air pollution in India has resulted in 1.67 million deaths in 2019, marking the highest pollution-related death toll globally, and has incurred economic losses of $36.8 billion, according to a recent study led by researchers from the Global Observatory on Pollution and Health at Boston College, the Indian Council of Medical Research, and the Public Health Foundation of India. A Lancet study in 2022 also highlighted the increased risk of Chronic Obstructive Pulmonary Diseases (COPD) due to long-term exposure to air pollution, especially among those with a high genetic risk and unhealthy lifestyles.
Despite these alarming findings, both electoral manifestos fail to acknowledge air pollution as a significant health threat and offer adequate measures to address it, merely mentioning vague efforts to improve air quality.
Air pollution in India has resulted in 1.67 million deaths in 2019, marking the highest pollution-related death toll globally. Yet, there is a refusal to look at the crisis through the prism of health among political parties
Malnutrition and hunger
According to the UN’s Food and Agricultural Organisation (FAO) ‘The State of Food Security and Nutrition in the World, 2022 Report’, 224.3 million people in India, accounting for 16 per cent of the population, are undernourished, with 53 per cent of reproductive-age women experiencing anemia. India’s position in the 2023 Global Hunger Index, ranking 111th out of 125 countries with sufficient data, highlights the seriousness of the issue, with a score of 28.7 indicating significant hunger levels.
In addressing this challenge, the BJP manifesto focuses on tackling malnutrition among the tribal population, aiming to eradicate undernourishment in this vulnerable group. Conversely, the Congress party proposes extending the provision of mid-day meals up to class 12, expanding beyond the current coverage up to class 8, as a strategy to combat hunger.
16 per cent of the population, are undernourished, with 53 per cent of reproductive-age women experiencing anemia. BJP in its manifesto promises to eliminate sickle cell anemia, and malnutrition in tribal population.
Women’s health
The BJP’s approach to women’s health extends beyond maternity benefits, with a commitment to launching targeted programs addressing prevalent issues such as anaemia, breast cancer, cervical cancer, and osteoporosis. Of particular note is the pledge to eliminate cervical cancer, a leading cause of death for Indian women. However, notable gaps exist, particularly in addressing menstrual health issues, which significantly impact women’s productivity and overall well-being. Neither party recognizes symptoms associated with menstruation as a disability, representing a significant oversight. Nonetheless, the BJP’s promise to construct toilets holds significant importance for menstruating women, addressing a critical aspect of menstrual hygiene and sanitation.
Neither party recognizes symptoms associated with menstruation as a disability, representing a significant oversight.
Health of transgender community
The health needs of the transgender community are glaringly absent from both manifestos. Numerous studies have highlighted the pervasive stigma and discrimination faced by transgender individuals when accessing healthcare, leading to poorer health outcomes and increased morbidity within this community. However, neither political party acknowledges or addresses this critical issue in their manifestos.
Numerous studies have highlighted the pervasive stigma and discrimination faced by transgender individuals when accessing healthcare.Unfortunately, this issue has not received significant attention within the political agendas of either the BJP or Congress.
Perks for healthcare professionals
One of the notable aspects of the Congress manifesto lies in its support for healthcare professionals. It pledges to double the government’s contribution towards the wages of frontline health workers and increase the hardship allowance for doctors serving in rural areas.
Additionally, Congress vows to enact legislation to address the rising incidents of violence against doctors, providing a comprehensive approach to support and protect healthcare workers.
Mental health
In India, a staggering 60 to 70 million individuals grapple daily with the weight of common and severe mental disorders. Yet, the harsh reality persists: over 2.6 lakh cases are reported annually, a stark testament to the depth of this public health crisis. According to World Health Organization statistics, India’s average suicide rate stands at a chilling 10.9 per lakh people. Despite the magnitude of this crisis, both political parties fall short of grasping its enormity and offering visionary solutions fueled by genuine political will.
India’s average suicide rate stands at a chilling 10.9 per lakh people. Is Yoga and meditation enough to curb it?
In addressing the pressing issue of mental health, the BJP’s approach centers on Yoga and meditation, while also highlighting initiatives like Tele Mental Health Assistance and Networking Across States (Tele-MANAS) and Manodarpan—an initiative under the Ministry of Education aimed at providing psychosocial support to students for their mental health and well-being.
Training of frontline health workers:
Frontline workers, often untrained and under-resourced, play a crucial role in meeting the healthcare needs of our communities. ASHA workers, in particular, have been tirelessly advocating for improved employment terms and better compensation. Despite being frontline warriors during the COVID-19 pandemic, they have not received COVID incentives or non-MCTS allowances. Additionally, they are frequently deployed for various government health programs, elections, and other initiatives, yet continue to face inadequate working conditions.
The Congress party has pledged to address these concerns by promising to double the remuneration of frontline health workers, which includes ASHA workers, Anganwadi workers, and Mid-Day Meal cooks. BJP is largely silent on the issue.
Congress aims to double remuneration for rural doctors and frontline health workers, prioritizing healthcare access in underserved areas.
Alternate medicine
The BJP reiterates its commitment to Ayush, while the Congress pledges to promote all schools of medicine. However, neither party addresses the pressing issue of medical quackery and misinformation, which have tragically impacted countless lives. Moreover, the BJP introduces the notion of promoting tribal medicines, but the specifics of this proposal remain unclear.
Although both parties advocate for the promotion of alternative schools of medicine, their manifestos remain conspicuously silent on combating quackery and misinformation often propagated under the guise of traditional medicine.
