India Confronts AIDS

Article excerpt

NEW DELHI, INDIA -- The new government in India, led by a center-left formation called the United Progressive Alliance, says it is serious about health.

It has recently announced plans that include:

* Increasing public spending on health from the current 0.9 percent of Gross Domestic Product to 2-3 percent over the next five years;

* A focus on primary health care;

* Stepping up public investments in programs to control all communicable diseases and providing "leadership to the national AIDS effort"; and

* Making life-saving antiretroviral (ARV) drugs available at reason able prices.

But critics say much more than promises are needed if decent health care is to be delivered to all Indians, some 80 percent of whom live on two dollars or less a day.

The Jan Swasthya Abhiyan (JSA, or People's Health Movement), a campaign led by a group of health professionals, says that healthy living conditions and access to quality health care for all citizens are not only basic human rights but also essential prerequisites for social and economic development.

At present, the government's health statistics make for dismal reading.

Infant and child mortality claims the lives of 2.2 million lives every year (a 1983 target to reduce the infant mortality rate to less than 60 per 1,000 live births remains unrealized). The rate of decline in infant mortality, which was significant in the 1970s and 1980s, slowed down in the 1990s.

Maternal mortality has jumped from 424 deaths per 100,000 live births in the 1990s to 540 per 100,000. Nearly half a million Indians die of tuberculosis every year as the nation witnesses a disturbing resurgence of communicable diseases such as Kala Azar, dengue, encephalitis and malaria.

Environmental and social dislocations combined with weakening public health systems have contributed to this resurgence, the JSA says.

The public health infrastructure has been unable to keep up with this situation. While healthcare facilities have grown substantially since the 1990s, they are mostly in the private sector--often beyond the reach of the poor. According to the Central Bureau of Health Intelligence at the Ministry of Health and Family Welfare, the private sector accounted for 57 percent of the 11,174 hospitals that existed in 1991. In 2000, however, the proportion of privately run hospitals grew to 75 percent of a total of 13,218 hospitals.

Only 17 percent of all health expenditure is borne by the government, which makes India's health sector one of the most privatized in the world. The World Health Organization standard for expenditure on public health is 5 percent of GDP. India's 0.9 percent expenditure of GDP is less than the average for poor countries--2.8 percent.

Some critics say India's health took a knock in the 1990s--the era of economic liberalization, when stagnant public health budgets and decreasing government expenditure in public health facilities were worsened by the introduction of user fees at various levels of public health facilities.

Now, a new initiative by the WHO and UNAIDS--the United Nations agency on HIV/AIDS--to increase access to ARV drugs to three million HIV/AIDS patients around the world by 2005 has galvanized the government and public opinion.

The so-called Three by Five initiative, launched in September 2003, has led to what the government's National AIDS Control Organization (NACO) calls a "paradigm shift." Until 2003, India's AIDS policy did not support the provision of ARV treatment through the public health delivery system.

After the Three by Five initiative, then-Health Minister Sushma Swaraj declared a strong policy commitment to provide free ARV treatment to 100,000 AIDS patients. This began in April 2004. Government hospitals were to provide treatment in six high-prevalence states, and within them to three vulnerable groups: HIV-positive mothers; HIV-positive children below the age of 15 years; and AIDS patients who seek treatment in government hospitals. …