India's Janani Suraksha Yojana: Global Health's Transformations of a National Program and Dissipating the Right to Health (original) (raw)
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Health governance in India: Citizenship as situated practice
Global Public Health, 2014
Despite the impressive growth of the Indian economy over the past decades, the country struggles to deal with multiple and overlapping forms of inequality. One of the Indian government's main policy responses to this situation has been an increasing engagement with the 'rights regime', witnessed by the formulation of a plethora of rights-based laws as policy instruments. Important among these are the National Rural Health Mission (NRHM). Grounded in ethnographic research in Rajasthan focused on the management of maternal and child health under NRHM, this paper demonstrates how women, as mothers and health workers, organise themselves in relation to rights and identities. I argue that the rights of citizenship are not solely contingent upon the existence of legally guaranteed rights but also significantly on the social conditions that make their effective exercise possible. This implies that while citizenship is in one sense a membership status that entails a package of rights, duties, and obligations as well as equality, justice, and autonomy, its development and nature can only be understood through a careful consideration and analysis of contextually specific social conditions.
This article examines the changing dynamics of development in India, focusing on partnerships between civil society organisations (CSOs) 1 and the state in the area of rural health. Drawing on ethnographic perspectives of CSO work, we examine the shifting meaning of these partnerships for the institutions involved and how they function given their differing institutional cultures and values. We argue that the adoption by the state of a global language of rights and its efforts to integrate civil society language, practices and representatives in the policy and implementation of health programmes point to collaborationist models which support the creation of an 'activist' state, as they simultaneously strengthen as well as weaken the role of CSOs as mediators in development.
Lumping and splitting: the health policy agenda in India
Health Policy and Planning, 2003
India's health system was designed in a different era, when expectations of the public and private sectors were quite different. India's population is also undergoing transitions in the demographic, epidemiologic and social aspects of health. Disparities in life expectancy, disease, access to health care and protection from financial risks have increased. These factors are challenging the health system to respond in new ways. The old approach to national health policies and programmes is increasingly inappropriate. By analyzing interand intra-state differences in contexts and processes, we argue that the content of national health policy needs to be more diverse and accommodating to specific states and districts. More 'splitting' of India's health policy at the state level would better address their health problems, and would open the way to innovation and local accountability. States further along the health transition would be able to develop policies to deal with the emerging epidemic of non-communicable diseases and more appropriate health financing systems. States early in the transition would need to focus on improving the quality and access of essential public health services, and empowering communities to take more ownership. Better 'lumping' of policy issues at the central level is also needed, but not in ways that have been done in the past. The central government needs to focus on overcoming the large inequalities in health outcomes across India, tackle growing challenges to health such as the HIV epidemic, and provide the much needed leadership on systemic issues such as the development of systems for quality assurance and regulation of the private sector. It also needs to support and facilitate states and districts to develop critical capacities rather than directly manage programmes. As India develops a more diverse set of state health policies, there will be more opportunities to learn what works in different policy environments.
Looking beyond the Universal Health Coverage: Health Inequality, Medicalism and Dehealthism in India
Scientific & Academic Publishing, 2012
Abstract India is world’s largest democracy having parliamentary form of government and federal structure. India is witnessing poor and differential achievements in increasing the life expectancy at birth and controlling infant mortality, maternal mortality and long and short term communicable and non-communicable morbidities among and within various states. The increasing hiatus in health achievements among groups in India amidst growing medicalisation and other policy reforms suggests prevalence of a deeper creeping malaise: health inequality. A new road map of Universal Health Coverage (UHC) for providing universal accessibility and affordability of healthcare is proposed. Taking a broad perspective on health and health care, this paper critically analyses the various provisions of proposed UHC in the context of unmet health needs and growing health inequality. It finds that the narrowing of health policies in post independence India is also responsible for perpetuation of inequalities in health. It also identifies specific hurdles in the path of achieving universal health, which are: poor primary health care, limited reach of public health, denial of basic health goods, out of pocket health expenditure and the growth of a vicious circle of ‘medicalism’ and ‘dehealthism’.
Non State Actors And Global Health Governance A Political Economy View from India
Indian Foreign Policy & Contemporary Global Issues, 2019
Global health is a paradigm of health that transgresses national borders, focusing instead on improving health and achieving equity in health for all people worldwide. Despite the evidence supporting links between the Social Determinants of Health (SDH) and health outcomes, very little action has been taken to address these determinants of health on a global scale. The impact of action on the SDH on health outcomes is also less directly quantifiable when compared to the impact of curative interventions on reducing disease burden. Therefore, these determinants have been of less interest to global health funders such as the Bill and Melinda Gates Foundation (BMGF), who seem to be largely driven by clear targets, quick results, and quantifiable impact through evidence based approaches that biomedical and clinical interventions promise. Given the difficulty of changing fundamental socio-economic relationships, it is not surprising that ‘top-down’ clinical interventions - targeted at reducing mortality induced through very specific and well understood disease pathways - have been of greater interest to such non state actors as the BMGF. Under the influence of such non state actors, the Indian state has been receding from its duty of provision of primary healthcare services, while pursuing health sector reforms comprising of the privatisation of a range of health services, the introduction of user fees, and the removal of government subsidies. Health sector reforms have also brought about significant implications for the health of populations within India- particularly the poorest sections. The introduction of user fees alongside the privatisation of healthcare affects access to services and also increases the risks of poverty as household resources are increasingly diverted away from basic needs towards the purchase of vital healthcare and treatment. In focusing on this evolving policy scenario, with an increased involvement of non-state actors, this paper attempts to delineate the role of non-state actors and the resultant highly unequal health outcomes which continue to exclude vast sections of Indian society.
Re-instating a 'public health' system under universal health care in India
Journal of public health policy, 2015
I examine possibilities for strengthening essential public health functions in the context of India's drive to implement universal health care. In a country where population health outcomes are rooted in social, political, economic, cultural, and ecological conditions, it is important to have a state mediated public health system that can modify the causes of the major public health problems. This calls for strengthening the social epidemiological approach in public health by demarcating public health functions distinct from medical care. This will be a prerequisite for the growth of the public health profession in the country, because it can offer avenues for newly trained professionals within the country to work in 'core' public health.
Negotiating Power over Human Bodies: Populism, People and the Politics of Health in Delhi
Urbanities , 2022
Legitimacy of the Ruler The present right-wing regime of the Bhartiya Janata Party (hereby referred to as the BJP) came to power professing to model itself on ancient Hindu traditions and glory, as a religious nationalism (Thapar 2002: 21). The Hindutva movement shows ideological affinity to populism in that it showed 'hostility to the status quo, mistrust of traditional politicians, appeal to the people and not to classes and anti-intellectualism' (Laclau 1977: 147). It would, however, be wrong to presume that its legitimacy draws on religious identity alone. It actually derives from a combination of various factors that include disillusionment with the dynastical rule of the family of Indira Gandhi, widespread corruption in the public sphere and the lack of fit of the modern secular model followed by the Indian constitution with the majority of Indians, who are still steeped in feudal and parochial values. But no political regime in India can claim itself to represent the majority on religious/cultural grounds. The only goals and values that can actually cut across Indian society are those based on instrumental and immediate needs, including food, water, clean environment and health. Being well aware of these conditions, the central government floated a number of projects to support the 'liberal' and universal image of the regime, and especially that of the popular Prime Minister. Health and well-being were identified as goals that would appeal to practically everyone. Among the various catchy slogans distributed for consumption to the general public, one was, Sab ka Saath, Sabka Vikasmeaning, 'we want everyone to work together for everyone's development'; another was, Banega Swasth Indiameaning 'India will become healthy'. A strongly projected slogan-Swatch Bharat Abhiyan ('The Clean India Campaign')-was launched with great intensity but the actual policies and their implementation fell short of such intensity. The main spanners in the implementation were inequality and poverty, lack of infrastructural facilities and poor distribution. At the beginning of the pandemic, in February 2020, India was among those nations that quickly announced a lockdown, even before the cases had crossed into three figures. However, no attention was paid to the marginal, the poor, the daily wage workers, the cab drivers, the pavement-sellers, the migrant labour and those employed informally in the places that were shut down, like shops and restaurants, malls and gyms. The first phase was marked more by the sufferings caused by the lockdown than by the disease itself (Channa 2020). Globally, the visuals of hundreds of people walking on foot in the heat and dust of the Indian summer, trying to get back home, went viral in all media. At that time, the migrant issue was the real issuemuch more serious than the virus. It is reported that more than 8,000 migrant workers, desperate to get home were mowed down by trains, as they walked along the train tracks so as not to lose their way during the hundred-of-miles trek to their villages. These were workers who had come to Delhi to earn a living from far flung less prosperous, areas with very little resources as compared to the city. Elsewhere (Channa 2019), I have discussed under what conditions, the poor and the marginal are forced to leave their villages and small towns and migrate to the cities. The fate of these workers during the pandemic highlighted a blind spot in the vision of the state Special Issue-Edited by Italo Pardo and Giuliana B. Prato
2016
The health sector must play a paramount role in development policy, a priority clearly documented in the Millennium Development Goals. This article summarises health policies in India. Overall, these are characterised by an increasing role of the private sector, often at the expense of services to less powerful sections of the population and the neglect of crucial and populous regions. The core stakeholders in the health sector in India, at both national and state level, are described. These include the national- and state-level ministries and their line agencies at the sub-state and local levels, also private stakeholders, including pharmaceutical industry. The article also provides a selection of voices critical of the policy reforms, and the most crucial arguments are put forward. The article concludes by briefly sketching some potential areas for further research.
Globalization and Health, 2012
National and transnational health care systems are rapidly evolving with current processes of globalisation. What is the contribution of the social sciences to an understanding of this field? A structured scoping exercise was conducted to identify relevant literature using the lens of Indiaa 'rising power' with a rapidly expanding healthcare economy. A five step search and analysis method was employed in order to capture as wide a range of material as possible. Documents published in English that met criteria for a social science contribution were included for review. Via electronic bibliographic databases, websites and hand searches conducted in India, 113 relevant articles, books and reports were identified. These were classified according to topic area, publication date, disciplinary perspective, genre, and theoretical and methodological approaches. Topic areas were identified initially through an inductive approach, then rationalised into seven broad themes. Transnational consumption of health services; the transnational healthcare workforce; the production, consumption and trade in specific health-related commodities, and transnational diffusion of ideas and knowledge have all received attention from social scientists in work related to India. Other themes with smaller volumes of work include new global health governance issues and structures; transnational delivery of health services and the transnational movement of capital. Thirteen disciplines were found represented in our review, with social policy being a clear leader, followed by economics and management studies. Overall this survey of India-related work suggests a young and expanding literature, although hampered by inadequacies in global comparative data, and by difficulties in accessing commercially sensitive information. The field would benefit from further cross-fertilisation between disciplines and greater application of explanatory theory. Literatures around stem cell research and health related commodities provide some excellent examples of illuminating social science. Future research agendas on health systems issues need to include innovative empirical work that captures the dynamics of transnational processes and that links macro-level change to fine-grained observations of social life.