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India’s Ambitious Health Care Plan Sparks Hope, Questions

“I am scared about how I will repay the money I have borrowed. What can a man working on daily wages do? It is in God’s hands,”

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Shavan Kumar has travelled to New Delhi with his wife from his village to get her treated for a heart condition at a government hospital, where treatment is free. VOA
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From a small village in Uttar Pradesh, laborer Shavan Kumar has brought his 38-year-old wife to a government-run hospital New Delhi to be treated for a heart condition. But he worries that the $500 loan he has taken will not cover the cost of her medical care; although the treatment is free, he has to pay for medicines, tests and their stay in the city.

“I am scared about how I will repay the money I have borrowed. What can a man working on daily wages do? It is in God’s hands,” Kumar said.

The Indian government has announced it will implement what it calls the world’s largest public health insurance plan, offering coverages of about $8,000 to poor and low-income families. That could be a game-changer for the 63 million people like Shavan Kumar who are driven into poverty every year by “catastrophic” expenses on health care, according to the Health Ministry.

ALSO READ: How govt can provide better healthcare system to more than 125 crore people in India

Dubbed ‘Modicare’ in a reference of Prime Minister Narendra Modi, the hugely ambitious scale of the project – which proposes to ensure 500 million people – has caused a wave of optimism in a country where improving access to health services has never been a political priority.

However, in a nation where many government initiatives are hobbled with poor implementation, there are concerns about how it will work and how it will be funded.

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Quality public hospitals such as the All India Institute of Medical Sciences in New Delhi where Shavan Kumar brought his wife, are few in number, confined to the big cities and hugely overburdened. VOA

Priya Balasubramaniam, a health specialist at the Public Health Foundation in New Delhi questions whether the $300 million earmarked this year will get the project off the ground. “While this has definitely come with a bang, I think for those of us who want to move to the next level, it is really about the fiscal space that the government has allocated for a scheme as ambitious as this,” she says.

ALSO READ: “Dual-Disease Burden”? India’s Great Healthcare Challenge and Opportunity

Officials say the vast scale of the project will drive down insurance premiums to as little as $18 per year. That adds up to $1.7 billion – an outlay that the government plans to make with funds pooled by both the federal and state governments.

Closing rich and poor gap

Health experts also hope the insurance cover will improve the quality of care by opening the doors of India’s expensive private hospitals to the poor.

A massive gap exists between private and public hospitals. The former have state-of-the-art medical facilities but only the upper-income groups can afford their steep costs. On the other hand, quality public hospitals such as the All India Institute of Medical Sciences where Shavan Kumar brought his wife offer free treatment, but are few in number, confined to the big cities and hugely overburdened.

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Private hospitals in India offer state-of-the-art facilities but only people in upper-income groups can afford them. VOA

That is the dilemma that Hari Singh, a New Delhi resident, faced when he broke his knee in a road accident three months ago. Having no savings, he first went to a government hospital, but left quickly and headed to a private hospital.

“The conditions were so miserable, the toilets were filthy, two patients were put on one stretcher and there was no system at all. I got very scared,” he says.

ALSO READ: Diseased, Ignored and Suffering Silently: A look into the Health Status of Adivasi Women in Jharkhand

But to pay for his care he had to borrow $5,000 at a crippling interest rate of 5 percent a month. Now he does not know when he can return to his job as a driver or how to support his two young children.

Ashok Agarwal, founder of the Indian Institute of Health Management Research, hopes the new government project will change that. “For the first time poor people would have a choice to go to a center where they feel comfortable,” he says. “Once you have insurance which is willing to pay, then the load of the patients can go to the private sector also.”

He says it will also incentivize private hospitals to improve facilities to attract patients. “Imagine you can have 500 million customers at your doorstep. Which company would not like that to happen?”

Health professionals underline that the insurance initiative needs to go hand-in-hand with improved primary health services and point out that poor people often land up in hospitals because they cannot afford day-to-day medical care and medicines.

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The burden of disease rises among poor people because they cannot afford to buy needed medicines. VOA

But most government-run medical centers “are dysfunctional, lacking equipment, medicines and even qualified staff,” says Balasubramaniam, the health specialist at the Public Health Foundation in New Delhi. “You are focusing on the top of the pyramid while the foundations are still very shaky.” For example, Shavan Kumar may never have needed to head to a hospital in New Delhi if his wife’s condition had been diagnosed earlier.

But in a country where government spending on health care is among the lowest in the world – just 1 percent of the GDP – the project has sparked hope. “What the government has done in one stroke is to look at 500 million at the same time. I have no doubt it will take a few years to come on the ground and be stabilized, but the intent is very good,” says Agarwal. (VOA)

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Waves of black as Modi visits Chennai

Tamil Nadu has been in turmoil since the six-week period for setting up the Board expired, with opposition parties and a host of fringe Tamil groups attacking the Centre

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Narendra Modi App
Prime Minister Narendra Modi (FILE PHOTO)

Black flags and balloons and activists in black shirts and trousers greeted Prime Minister Narendra Modi as he paid a whirlwind visit to Chennai with helicopter as the chosen mode of transport in the wake of statewide agitation demanding constitution of the Cauvery Management Board (CMB).

Protests were also held with black flags and placards throughout Tamil Nadu in cities like Tiruchi, Thanjavur, Coimbatore and Tuticorin against the Prime Minister’s brief visit to the state and the Centre’s failure to constitute the CMB despite a Supreme Court order. Black flags were hoisted on homes and business establishments across the state.

Prime Minister, Narendra Modi stressed on the importance of service to others in his last Mann Ki Baat edition for 2017.
Narendra Modi welcomed with black flags in chennai.

In a bid to avoid protesters, Modi, who arrived here by a special aircraft in the morning, chose a helicopter to reach Tiruvidanthai, in neighbouring Kanchipuram district where he opened the 10th DefExpo organised by the Defence Ministry. From there he took another chopper to come to IIT Madras, in the heart of the city. From there, he took a one-kilometre ride by car to the neighbouring Adyar Cancer Institute for an event.

The Prime Minister walked a few steps from the helicopter to the car that ferried him to the Cancer Institute. As he did so, he encountered some 30 students from IIT Madras who stood silently but held posters demanding a Cauvery Management Board as ordered by the Supreme Court — an issue which has whipped up emotions in Tamil Nadu. Modi then left by helicopter to the airport before returning to Delhi.

Also Read: Modi is anti-Dalit, will defeat BJP in 2019: Rahul Gandhi

#Go back Modi trended on top as netizens took to the cyberspace to register their protest against the Central government’s failure to set up the CMB as directed by the Supreme Court to ensure proper sharing of Cauvery waters between Tamil Nadu and Karnataka and other states.

DMK leader M.K. Stalin, who was on a padayatra of the Cauvery delta areas, wore black shirt and trousers as he protested along with state Congress President Thirunavukkarasar and CPI-M state unit chief Mutharasan. “The Prime Minister may be flying in the air today but he has to come down when the elections come,” he said taking a dig at Modi.

A black flag was hoisted at DMK chief M. Karunanidhi’s residence. The ailing leader wore a black shirt. DMK MP Tiruchi Siva and leaders of DMK allies wore black dress and marched on the road near the Chennai airport.

In the morning outside the Chennai airport, activists of the Federation for protection of Tamil Art and Culture, led by noted film director Bharatiraja and other film personalities like Amir, Gautaman and Vetrimaran protested against Modi’s visit. They were arrested.

will also hold a meeting there with the Indian community. Wikimedia Commons
Cauvery River Dispute is going on for a while now. Wikimedia Commons

While MDMK chief Vaiko held a black flag protest in Velachery, Naam Thamizhar Katch convenor Seeman, a film director, was arrested elsewhere. Vaiko called Modi a “coward” for choosing to fly. Political leaders Velmurugan and P. Nedumaran were arrested from Alandur metro station in Chennai for holding black flag protests.

Tamil Nadu has been in turmoil since the six-week period for setting up the Board expired, with opposition parties and a host of fringe Tamil groups attacking the Centre, saying the BJP was interested only in winning the Assembly elections in Karnataka. Even the hugely-popular IPL cricket matches have been shifted out of Chennai to Pune in view of the disturbances on Tuesday. IANS