A PRESCRIPTION FOR HEALTH DISASTER 149
new global market economy which enriches a chosen few at the cost of pauperising the rest. It has also converted health into a marketable commodity to be sold at the greatest profit. This is especially reprehensible as it leads to a trade in human suffering when consumer resistance is at its lowest. Even the capitalist economies of Western Europe have, by and large, maintained health in the public domain;
and at 6 per cent of GDP have a much superior health status to that of the USA expending almost 14 per cent of its GDP on health. Despite spending over 1 trillion dollars on health, the USA provides no health care to over 10 per cent of its population representing over 33 million of her citizens. Even the British Medical Association, which opposed the National Health Service in 1947, now opposes its privatisation.
According to the World Bank*s own data, China spending 3.5 per cent its GDP on health, two thirds in the decentralized public sector, had an IMR of 38 in 1991 while India spending 6 per cent of its GDP, three quarters in the private sector, had an IMR of 90. Why then does the Bank advocate the privatisation of health care in India? Is it because the Westernised profession, especially in the private sector, will continue to advocate the US model in order to favour the Western multinational drug and instrument industry in which it has a major stake? Or is it also a means of inculcating the "superiority" of Western science and technology on these countries? Instead of supporting and strengthening the decentralised concept of integrated people based health care as advocated by the Bhore model and practised so effectively by China, why does the Bank advocate the policy of further promoting vertical programmes for Selective Primary Health Care (especially for family planning) which have not only failed in themselves, but have destroyed the entire PHC concept of Bhore and alienated the people from their PHC? This comes just when Panchayati Raj offers the ground reality for implementing such a people-based model which has demonstrated its high cost-effectiveness as compared to the present centralised over-bureaucratised and over-professionalised one.
Why does the World Bank lend further support and strengthen this centralised model based in Delhi which it feels will serve as a "lever" to implement its policies in the States? Is the Bank not aware of the Rockefeller report "Good Health at Low Cost' of 1985? Or the examples of China, Sri Lanka, Kerala, Cuba and a vast number of NGOs all of whom have demonstrated the far greater cost-effectiveness of the decentralised model, leave aside its far more humane approach? All such experiences reveal that at between Rs. 100 to Rs. 150 per capita per annum, remarkably effective health care can be achieved right from the village to the super-speciality level. This is done by employing specifically trained village health and paramedical workers who can best perform over 70 per cent of preventive, promotive and curative health functions when trained,