A.K. SHIVA KUMAR4
Some Considerations in the Formulation of India's Health Policy: A Note on Equity
The World Development Report 1993 (WDR 1993) contains three prescriptions for low-income countries' like India. First, it urges them to pursue macroeconomic policies that promote overall economic growth— particularly poverty-reducing growth—and basic education as means to good health. Second, it underscores the importance of stepping up and redirecting public spending to meet the needs of public health and a minimum package of essential clinical services. It also advocates phasing out of public subsidies for tertiary care, especially when they benefit the wealthy. Third, it urges governments to foster competition and diversity in the supply of health services and inputs in order to improve quality and lower costs. At the same time, it calls upon governments to regulate privately delivered health services (in order to ensure safety and quality), and also private insurance (in order to ensure universal access and coverage, and discourage malpractice and abuse of the system).
These general prescriptions need to be examined in the light of what we know about the health status of Indians, their health-seeking behaviour, the provisioning of health services by both the public and private sectors, and the effectiveness of government policy interventions. To begin with, there is considerable evidence to show that income enhancement per se does not lead to better health outcomes. To cite an example, whereas in both India and Pakistan, GNP per capita grew at an annual average rate of 3.1 per cent between 1980-92, the average annual rate of reduction in under-five mortality over this period was 0.7 per cent in Pakistan and 2.9 per cent in India.1 Again, whereas GNP per capita in Costa Rica grew at an annual rate of only 0.8 per cent between 1980-92, its annual rate of reduction in under-five child mortality, 4.5 per cent over the period, was considerably higher than India's.2 Even more impressive was Jamaica which, des-
Social Scientist, Vol. 22, Nos. 9-12, September-December 1994