By Arif Azad
In the run-up to polls, political parties are polishing their policy preferences and slogans into manifesto commitments — concrete and vague. Though detailed manifestos for the 2018 elections are yet to be launched, the PTI has already given a preview in its first 100 days programme. Going by the trend of the 2013 manifestos however, one can confidently predict what is going to be included in those that are going to be rolled out and what is set to be excluded in so far as health is concerned.
With health spending stubbornly stuck at between 0.6 per cent to 0.7pc of GDP over the years, all major political parties have pledged to increase health funding. This commitment varies between 2pc to 6pc of GDP. While both the PTI and PML-N pledged a funding increase of between 2pc to 2.5pc, the MQM and ANP pledged 5pc and 6pc respectively.
One perennial problem with such funding commitments is that they are invariably uncosted and go largely unmonitored. As to how much of the pledged increase was implemented, no one is the wiser going into the 2018 election. The result is that it is more likely that the new manifestos will begin with the same baseline figure of health spending. Again, all major political parties are likelier to pledge an increase ranging from 2pc to 5pc in the new manifestos.
In 2013, there was across-the-board consensus among all party manifestos on extending health coverage. And the consensual way to do it is through health insurance schemes. Both the PTI and PML-N governments have introduced some version of health insurance schemes. This is commendable at a time when out-of-pocket expenses are sky-high, causing medical impoverishment, and chronic underfunding is a perennial issue. Curiously, of all the major parties, only the JUI-F’s manifesto did not contain any reference to health spending or national insurance schemes or any other significant health-related commitment.
Immunisation was also an integral part of the 2013 manifestos. Yet this life-saving health intervention was glaringly missing from the manifestos of the JUI-F and ANP in 2013. Why? One can only conjecture that extremist objections to vaccination might have caused this omission. Other common features have been mother and child health programmes, investment in tertiary care, family planning, etc.
Primary healthcare — an all-encompassing health component — has been missing, with only the PTI and ANP nodding feebly in this direction. PHC was incorporated as part of the mother and child health intervention in all manifestos. Overall, the previous manifestos tended towards the curative side of health rather than the preventive side that can not only prevent and control disease but can also save money spent on cure.
Though population control has not featured in all the manifestos, the PTI and PML-N made manifesto commitments to tackle the population. Mercifully, commitments to safe and clean drinking water were enshrined in the 2013 manifestos of all parties. The PTI’s previous manifesto committed to tackle health as an emergency issue. However, whether health was taken head-on with the promised urgency is another question.
The 2018 manifestos have yet to be unveiled, but one thing can be said with some degree of certainty: we are going to see more of the same in the new manifestos. We are going to see the same analysis of the issue in the manifestos, with the same emphasis on highly visible spending on eye-catching and vote-winning health programmes and hospital buildings.
Even though health-related manifesto commitments do address genuine and urgent medical and curative needs, the larger and integrated health vision that binds together both the curative and preventive sides has been notably absent from the parties’ electoral promises.
Unless they do not engage in a broader conversation about a well-integrated health vision underpinned by regular funding that is progressively increased, the manifestos are set to rehash old platitudes about health challenges and repetitive strategies of throwing money at vote-winning health challenges. They should instead focus on tackling underlying wider determinants of health such as nutrition, housing, environment and population.
My wish list for the 2018 manifestos is for primary healthcare, universal health coverage, access to affordable healthcare and medicine, public health and regulation of private healthcare, eye health and non-communicable diseases to be included in the 2018 election manifestos.
This is an ideal opportunity for political parties across the spectrum to demonstrate a bold vision for an integrated, well-funded, affordable health sector that addresses both the curative and preventive aspects of health. With more of the same no longer a sustainable option, the need for a new outlook on health is urgent.
Published in Dawn, June 10th, 2018