Arima Mishra and Sandesh Kotte: Where does the healthcare of Indian people figure in political parties’ election manifestos?






In their recent book, Uncertain Glory: India and its contradictions, Sen and Dreze lament the fact that despite India’s consistent economic growth, the country falters on basic social indicators like health, nutrition, and education. This is partly because these issues have never figured prominently in the political and public spaces. The 2014 general elections provide an opportune moment to examine the political space where political parties articulate what they perceive as priority issues in the country. Where do issues of health and the healthcare of the people in India figure in political parties’ election manifestos?

Processing manifestos: Public opinion matters?  
Manifestos are a major instrument for fighting elections for all political parties in India. These ideally convey political parties’ vision of the future road map of the country and the specific plans they wish to put in place to operationalize this map, if elected. Considering the indirect nature of Indian democracy, political manifestos become an important communicative medium with the electorate to facilitate well informed choices to vote for specific parties.

Two interesting features mark the drafting of manifestos in the 2014 general elections. The first is the effort of the political parties to draft manifestos not only for the public but with the public. The process thus seeks to convey that public opinion matters. With the slogan “Your voice, we pledge,” political parties rope in the public in eliciting suggestions and opinions on public concerns to draft party manifestos. This perhaps began with the Aam Aadmi Party (AAP) when they sought to draft manifestos by taking suggestions from people. Other parties followed suit as nothing is more politically appropriate than to be pro-people.

The second, is the Election Commission of India’s recent guidelines on the model code of conduct. The guidelines say “In the interest of transparency, level playing field and credibility of promises, it is expected that manifestos also reflect the rationale for the promises and broadly indicate the ways and means to meet the financial requirements for it. The trust of voters should be sought only on those promises which are possible to be fulfilled” (emphasis added). Thus manifestos cannot afford to be a mere wish list, but should be operational.

The three major political parties, namely, the Indian National Congress (INC), the Bharatiya Janata Party (BJP), and the Aam Aadmi Party (AAP) subscribed to the “interactive” process of drafting manifestos, very much like the reality television shows in India. Let’s look at what these manifestos have to say about ensuring the health of the population. The congress party’s announcement to ensure the “right to health” led to swift reactions in media and academic circles. Supporters argue that it is the right time to raise this issue whereas critics argue that there is much more to do in the area of health and healthcare before talking about the right to health. The congress promises to increase public health expenditure, creating medical jobs, addressing issues of sanitation, malnutrition, and the effective implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) act to redress gender imbalance.

The newly established Aam Aadmi Party mentions the comprehensive “Right to Health Care” legislation. AAP also addresses the issue of the right to healthcare from the vantage point of access to services and their quality. One of the important issues mentioned by this party is that of fixing the accountability problem in the health sector. Poor governance of the health sector is a well-known bottleneck for health and nutritional failures including high out of pocket expenditure. In their manifesto, the BJP paid attention to the increasing out of pocket expenditures on healthcare. Other promises include initiating a new health policy and National Health Assurance Mission. Further the manifesto continues to say that their party will create a framework for healthcare delivery by using mobile phones and telemedicine in rural areas to address problems of access and a shortage of manpower.

Righting healthcare or right to health?
It is heartening to see that all political parties seem to be serious about health issues by drawing attention to some of the salient problems plaguing the state of healthcare in the country. These include problems of human resources, out of pocket expenditure, poor governance and other barriers to access quality health services.  But would these be enough to ensure the right of every citizen to health?

The UN Committee on Economic Social and Cultural Rights, adopted a general comment (no. 14) on the right to health also known as right to the highest attainable standard of health in 2000. This right encompasses medical care, access to safe drinking water, adequate sanitation, education, health related information, and other underlying determinants of health. It also includes freedoms, such as the right to be free from discrimination and involuntary medical treatment, and entitlements, such as the right to essential primary healthcare. The Indian constitution does not explicitly mention the right to health as such. But there is a mention of this in Article 47 under Directive Principles of State Policy, which says: “The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavor to bring about prohibition of the consumption except for medicinal purpose of intoxicating drinks and of drugs which are injurious to health.” The Supreme Court has however brought the right to health under the preview of Article 21.  Thus, the right to health, along with numerous other civil, political, and economic rights, is notionally offered protection under the Indian Constitution.

Where do the manifestos stand in such an overarching framework of rights to health? The right to health is certainly more than accessing quality healthcare. While speaking the language of rights, we plea that political parties do not conceive it narrowly in terms of provision of healthcare alone. They need to seriously address the winder determinants of health including access to safe water, sanitation, hygiene, education, gender, and an efficient health system to address health inequities and to ensure that hundreds of children and pregnant mothers in select pockets in India are not at risk of dying of malnutrition and pregnancy related complications. We also plea that manifestos do not become mere election gimmicks and political parties sincerely and responsibly carry out the promises made to citizens when elected to power.

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Declaration of interest: “All authors declare that that we have read and understood the BMJ Group policy on declaration of interests and we have no relevant interests to declare.”

Arima Mishra is an associate professor at the Azim Premji University, Bangalore, India.

Sandesh Kotte is research associate at the Azim Premji University, Bangalore, India.