Universalising Healthcare in India: From Care to Coverage Universalising Healthcare in India: From Care to Coverage Editors Imrana Qadeer K.B. Saxena P.M. Arathi Universalising Healthcare in India: From Care to Coverage Edited by Imrana Qadeer, K.B. Saxena, P.M. Arathi © Council for Social Development, New Delhi First Published 2019 ISBN 978-93-5002-588-8 All rights reserved. No part of this book may be reproduced or transmitted, in any form or by any means, without the prior permission of the Publisher. Published by AAKAR BOOKS 28 E Pocket IV, Mayur Vihar Phase I Delhi 110 091 India [email protected] Laser Typeset at Arpit Printographers, Delhi Printed at D.K. Fine Art Press, Delhi This collective work is dedicated to Pushpa M. Bhargava, A scientist with a social vision Contents List of Abbreviations 11 List of Figures 19 List of Tables 21 Acknowledgements 23 Foreword by Muchkund Dubey 25 Introduction: The Idea of Universal Healthcare: Its Passage Through Time 31 Part I Ideas, Concepts, History and Practice of UHC in India 1. Universal Health Coverage: The Trojan Horse of Neoliberal Policies 55 Imrana Qadeer 2. Universal Healthcare and Health Assurance Through Healthcare Industry and Market Mechanisms: Evidence Versus Ideology 74 Indira Chakravarthi 3. National Health Policy 2015: Growth Fundamentalism Driving Universal Health Coverage Agenda? 98 Indranil Mukhopadhyay 4. Interrogating the Proposed Universal Healthcare in India Through a ‘Quality’ Lens 117 Prachinkumar Ghodajkar 5. Growth of Private Medical Colleges in Maharashtra and Its Implications for Universal Healthcare 146 Archana Diwate Part II Evidences and Experiences of Public Private Partnerships and Health Insurance Schemes 6. A Critical Look at Public Private Partnership for Health Services in Karnataka 171 Sylvia Karpagam, Akhila Vasan, Elangovan Gajraj, Bijoya Roy and Imrana Qadeer 8 Universalising Healthcare in India 7. Role of Public Private Partnerships in Ensuring Universal Healthcare for India 187 Bijoya Roy 8. Unaccountable Deaths and Damages: An Analysis of Socio-Legal Implications of Sterilisation Camp Deaths in Bilaspur, Chhattisgarh 211 P.M. Arathi 9. Universal Healthcare and Universalising Health Insurance: Examining the Binary Through the RSBY/MSBY in Chhattisgarh 228 Rajib Dasgupta, Sulakshana Nandi, Kanica Kanungo, Madhurima Nundy, Ganapathy Murugan, Samir Garg, Dipa Sinha, Sangeeta Sahu and Reeti Mahobe 10. Aarogyasri Scheme in Andhra Pradesh, India: Some Critical Reflections 246 Sunita Reddy and Immaculate Mary Part III Drugs and Pharmaceuticals: Critique of Policies and Practices 11. Developments in India’s Domestic Pharmaceutical Sector and Implications for Universal Healthcare in India 271 Biswajit Dhar and Reji K. Joseph 12. Vaccine Policy of the Government of India: Driven and Controlled by Vested Interests? 287 Jacob Puliyel 13. Availability and Access to Medicines: Some Issues in Pricing 311 S. Srinivasan and Malini Aisola 14. Vaccines and Vaccine Policy for Universal Healthcare 334 Y. Madhavi 15. Drugs and Vaccines in Healthcare: Problems and Possibilities 366 Pushpa M. Bhargava Part IV Missing Links in the Debate 16. The Elusive Development: Poverty, Inequality and Vulnerability 377 K.B. Saxena 17. Water Governance and Supply in Urban Areas 404 Dunu Roy, Vasudha Akshintala and Ruchika Sharma Contents 9 18. Challenges of Reclaiming the Public Health System: Experiences of Community-Based Monitoring and Planning in Maharashtra 422 Abhay Shukla and P.M. Arathi 19. Constrained by Purchasing Power: The Story of Calorie Intake in India Post-Liberalisation 440 Sourindra Mohan Ghosh Postscript 457 List of Contributors 473 List of Abbreviations ACCP Alliance for Cervical Cancer Prevention ACE Angiotensin-Converting Enzyme ACIP Advisory Committee on Immunisation Practices ADB Asian Development Bank ADIP Accelerated Development and Introduction Plans AEFI Adverse Events Following Immunisation AHEL Apollo Health Enterprises Ltd AIDAN All-India Drug Action Network AIMA All India Management Association AIIMS All India Institute of Medical Sciences AMC Advance Market Commitments AMRUT Atal Mission for Rejuvenation and Urban Transformation ANM Auxiliary Nurse Midwife APL Above Poverty Line ART Antiretroviral Therapy ASHA Accredited Social Health Activists AWW Anganwadi Worker BCG Bacillus Calmette–Guérin BCSIA Belfer Center for Science and International Affairs BD Becton Dickinson BIS Bureau of Indian Standards BJP Bharatiya Janata Party BMGF Bill and Melinda Gates Foundation BOOT Build, Own, Operate, and Transfer BOT Build Operate and Transfer BPL Below Poverty Line BVP Bessemer Venture Partners CAG Comptroller and Auditor General of India CAGR Compound Annual Growth Rate CBMP Community Based Monitoring and Planning CCEA Cabinet Committee on Economic Affairs CES Consumption Expenditure Survey 12 Universalising Healthcare in India CGHS Central Government Health Scheme CHC Community Health Centres CHOICE Choosing Interventions that are Cost Effective CHW Community Health Worker CII Confederation of Indian Industry CIMS Chhattisgarh Institute of Medical Sciences CIOMS The Council for International Organisations of Medical Sciences CL Compulsory License CMIE Centre for Monitoring Indian Economy CMRF Chief Minister’s Relief Fund COPRA Consumer Protection Act CPHC Comprehensive Primary Healthcare CPI Consumer Price Indices CRAM Contract Research and Manufacturing CRM Common Review Mission CSO Civil Society Organisation CSSM Child Survival and Safe Motherhood CT Compute Tomography CTRD Centre for Tribal and Rural Development CVI Child Vaccine Initiative CY Chiranjeevi Yojana DBFOT Design, Build, Finance, Operate, and Transfer DCGI Drug Controller General of India DEG Deutsche Investitions-und Entwicklungsgesellschaft DISPRUDDelhi Society for Promotion of Rational Use of Drugs DLHS District Level Household Survey DOTS Directly Observed Chemotherapy, Short Course DP Drug Policy DPCO Drugs Price Control Order DPT Diphtheria, Pertussis and Tetanus EHP Essential Health Package EMRI Emergency Management and Referral Institute EPI Extended Programme on Immunisation EWS Economically Weaker Sections FDC Fixed Dose Combination FDI Foreign Direct Investment FERA Foreign Exchange Regulation Act FICCI Federation of Indian Chambers of Commerce and Industry FPP Family Planning Programme FTA Free Trade Agreements FYP Five Year Plan List of Abbreviations 13 GATS General Agrument on Trade in Services GAVI Global Alliance for Vaccines and Immunisation GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GIS Geographical Information Systems GMP Good Manufacturing Practices GNP Gross National Product GP General Practitioner GRADE Grades of Recommendation Assessment, Development and Evaluation GSK Glaxo Smith Kline HA Health Assistants HFA Health for All Hib Hepatitis B, H Influenza B HLEG High Level Expert Group HMIS Health Management and Information System HMOs Health Maintenance Organisations HMRI Health Management Research Institute HPV Human Papilloma Virus HRLN Human Right Law Network HSR Health Sector Reforms IANS Indo-Asian News Service IARC International Agency for Research on Cancer IAVI International AIDS Vaccination Initiative IBIS Invasive Bacterial Infections Surveillance ICD International Classification of Disease ICGEB International Centre for Genetic Engineering and Bio- Technology ICMR Indian Council of Medical Research ICPD International Conference on Population and Development ICRA Information and Credit Rating Agency IDD Infrastructure Development Department IDFC Infrastructure Development Finance Company IDMA Indian Drug Manufacturers’ Association IDPL Indian Drugs and Pharmaceuticals Ltd IFC International Finance Corporation IFFI International Finance Facility for Immunisation IFPMA International Federation of Pharmaceutical Manufacturers’ Associations IFRI International Forestry Resource Institute IHH India’s Healthcare Industry IJMR Indian Journal of Medical Research IMNCI Integrated Management of Neonatal and Childhood Illnesses 14 Universalising Healthcare in India IMPACT International Medical Products Anti-Counterfeiting Taskforce IMR Infant Mortality Rate INSAL Indian Association for Study of the Liver IOM Institute of Medicine IPHS Indian Public Health Standards IPR Intellectual Property Rights IPV Injectable Polio Vaccine IRDA Insurance Regulatory Development Authority ISID International Society for Infectious Diseases ISO International Standards Organisation ISQ International Society for Quality ITSU Immunisation Technical Support Unit IVCOL Indian Vaccine Corporation Limited JCAHO Joint Commission on Accreditation of Healthcare Organisations JCI Joint Commission International JNNURM Jawaharlal Nehru National Urban Renewal Mission JRM Joint Review Mission JSA Jan Swasthya Abhiyan JSSK Janani- Shishu Suraksha Karyakram JSY Janani Suraksha Yojana KHSDRP Karnataka Health Systems Development and Reforms Project KMPG Klynveld Peat Marwick Goerdeler KPMCH Kali Prasad Chowdhury Medical College and Hospital KSHSRC Karnataka State Health System Resource Centre LAC Local Audit Circle LIC Low Income Countries LIG Low Income Group LMICs Low Middle Income Countries LOCOST Low Cost Standard Therapeutics MARCH Medically Aware and Responsible Citizens of Hyderabad MCH Maternal and Child Health MCI Medical Council of India MDG Millennium Development Goal MLA Member of Legislative Assembly MLC Member of Legislative Council MMMHRV Mahila Mattu Makkala Hakkugala Samrakshana Vedike MMWR Morbidity and Mortality Weekly Report MNREGS Mahatma Gandhi National