All is surely
not well with the Health Administration of the country. The other day two
shocking revelations were made in the press. One of them related to detection
of serious irregularities by the Parliamentary Standing Committee on health and
family welfare in respect of advices and letters of recommendations from some
experts submitted to the Drug Controller General of India (DCGI) regarding
several drugs. These recommendations, apparently, read the same, word-for-word,
as those submitted by the drug companies concerned. Experts’ endorsements are crucial
testimony for country’s Central Drugs Standard Control Organisation for
allowing launch of drugs in the market.
The disclosure
revealed a nexus between some experts and a few drug companies enabling
unquestioned endorsement of the scientific recommendations of their own
products for onward transmission to DGCI. These are required to be submitted by
the experts after due consideration of the drugs’ content and their efficacy.
Evidence, however, has been unearthed indicating that the experts merely
affixed their signatures to the recommendations submitted by the companies
concerned. Worse, some were submitted on the day of their receipt by the
experts, obviously without according to them due consideration. More alarming
was the fact that the experts are from a few iconic medical institutions of the
country and some of them happen to be working as professors in these
institutions.
The innocent,
ignorant and unwary patients will be at the receiving end if drugs are pushed in
such a manner by the drug companies in collusion with highly placed medical
experts without being evaluated in regard to their therapeutic potential. Suspect
efficacy of drugs will hit all classes of people across the board and with high
drug prices it would be a sort of double whammy for them. Already, people are
suffering under the weight of their medical bills. A recent report said that
the “out-of-pocket” expenditure – the percentage of expenditure incurred by
households on medicines – has increased by 75% during the past couple of years.
High medical costs, along with rising prices of essentials, are biting the
common man. According to 2011 World Health Organisation estimates about 70%
Indians spend their entire income on healthcare and purchase of drugs. With the
prices of drugs for common ailments like cardiac disease, hypertension,
diabetes creeping up northwards, market watchers are asking for State
intervention. Poor are simply unable to afford many drugs. Decrying the ineffectiveness
of the National Pharmaceutical Pricing Policy even ruling party politicians are
concerned about common man’s woes.
Such improperly
evaluated medicines can also adversely impact exports once they fail to live up
to their claims. India is considered the pharmacy of the world. While the
domestic retail market in 2008 was estimated to be valued at more than Rs. 55000
crores ($10 billion app.), exports were worth around Rs. 38000 crores ($6 billion
app). Unless checked, corrupt practices at the stage of approving and launching
a drug in the market would amount to shooting oneself in the foot.
The health
sector is somehow saturated with corruption, whether at the Centre or in the
states. A former central minister of Health & Family Welfare was involved
in several scandals during his tenure, including what is known as the “vaccines
scam”. He ordered the public sector units to discontinue manufacture of various
essential vaccines only to throw open the entire market to one of his cronies
for easy pickings. Ultimately, the other day he was charged by the Central
Bureau of Investigations in a Delhi court for abusing his authority and
permitting a medical college to admit students without having necessary faculty
and clinical facilities. Establishment of medical colleges has become a very
paying proposition. Politicians, in collusion with money bags, bribe their way
into acquiring prime lands for establishing such colleges, the approval and
later recognition for which is easily obtained by pulling strings and money
changing hands. The President of the Indian Medical Council, Dr. Ketan Desai,
and two others were arrested last year for taking hefty bribes for granting
recognition to a medical college. No wonder, the quality of medical education
leaves much to be desired. Barring a few reputed hospitals, medical
institutions and (elderly) private physicians, the general quality of medical
attention to the patients is poor, more so to those belonging to the
economically weaker sections.
The
National Rural Health Mission (NRHM) appears to have become a goldmine for
corrupt politicians, doctors and administrations. The ambitious goal of the Mission
is to “improve the
availability of and access to quality healthcare by people, especially for those
residing in rural areas, the poor, women and children”. The second news report
was about the sleaze detected NRHM in Madhya Pradesh where, one after the other,
two directors of health services have been caught with huge amounts of liquid
and fixed assets - all disproportionate to their respective incomes. In the
earlier case even the minister in-charge was involved along with the principal
secretary of the department of health, an IAS officer, who, mercifully, is being
prosecuted. The minister resigned but escaped prosecution. In the recent case,
the director was found to be in possession of assets worth more than Rs. 100
crores (Rs.1 billion app). Serious irregularities were detected in the process
of tendering and procurement of medicines, mosquito-nets, etc. During the raid
at the director’s residence his wife reportedly advised the Lokayukta (Ombudsman)
officials to raid the houses of ministers to whom a crore (Rs. 10 million) of
rupees was required to be delivered every month.
One can imagine the astronomical
sums that have been poured into the Mission from the fact that in Uttar Pradesh
alone Rs 10000/- crores are believed to have been siphoned off. Two chief
medical officers and three other officials were murdered and scores of
engineers, doctors, administrators and ministers have been charge-sheeted by
the CBI.
Conscious of the abysmal level of public expenditure on health (1.4% of
GDP) the government has been allocating huge amounts of tax-payers’ money to
the states in an effort to achieve universal health coverage, including
cashless treatment. The Centre’s resolve to boost
government spending can potentially make high-quality care accessible to all.
It has not shied away from making necessary allocations as can be imagined by
the way the system has been milked by the powers-that-be at the Centre and in the
states, especially, in MP and UP. No wonder, despite the (now waning) growth
story India ranks below the Sub-Saharan Africa in many international health-related
indices. While the corrupt, cannibalistic predators do not allow the benefits
of outlays to reach the needy, high drug prices and raging inflation prevent millions
from buying essential medicines because of pervasive poverty – a significant facet
of the Indian growth story.
Clearly, the corrupt hordes in the government
wouldn’t allow it to achieve its own “goal” of building a healthy and strong
India.
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