Global Health Governance and Commercialisation of Public Health in India by Anuj Kapilashrami Rama V. Baru

Author:Anuj Kapilashrami, Rama V. Baru [Anuj Kapilashrami, Rama V. Baru]
Language: eng
Format: epub
ISBN: 9780367587208
Barnesnoble:
Publisher: Taylor & Francis
Published: 2020-06-30T00:00:00+00:00

Part II

The commercialisation of public health

5  Commercialisation in health services in India since 1980

A biographical approach

Roger Jeffery

Introduction

In the late 1970s, debate and innovation around India’s health services was intense. In the case of rural (and implicitly, slum) health programmes, Indian activities contributed to the attempts of the WHO/UNICEF to embed the notion of ‘Health for All’. By the 2010s, however, such idealism has become almost invisible. The receding tide of support for comprehensive solutions to India’s health problems within the public sector is most obvious in the debate over universal healthcare. Should this be access to health services that are publicly provided with low or no fees payable at the point of care, or should it be through some kind of universal health insurance (Nambiar 2013)? The latter is seen by some commentators as inevitably preventing the former (see, for example, Mukhopadhyay 2013; Qadeer 2013). By 2012, most of India’s states had ‘(i) insufficient state funding for health; (ii) a regulatory environment that enables the private sector to deliver social services without an appropriate regulatory framework; and (iii) lack of transparency in governance’ (Nishtar 2010: 74).

How did the Indian health system find itself in this position? It is possible to provide explanations in terms of global structures, and these are of course relevant factors in understanding processes of social change. Here, however, I want to look at the situation through the lens of the lives of Indian entrepreneurs who have embodied – through their own actions – these global processes. In the 1970s, medical entrepreneurs saw India’s health problems very differently from the views of dominant health policy specialists and public health planners. One group set in train the creation of corporate hospitals; another group pushed forward with establishing India’s pharmaceuticals industry. In this chapter, I illustrate the changes brought about since the 1980s through considering the lives of some key individuals. Their lives illuminate how commercialisation developed in different aspects of India’s health services between the 1980s and the 2010s.

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