Home / Opinion / India’s tightrope walk at the WHO

At a time when the Narendra Modi government is claiming success on several fronts after a year of governance, his health minister is busy showing off the gains from yoga and Indian traditional medicine at the 68th World Health Assembly in Geneva.

Like his leader, who is more at ease with the international power elite, New Delhi’s health policy chief J.P. Nadda is happily working with his counterparts from 194 countries in finalizing the global health agenda. This is, of course, a stupendous task in the face of the devastating earthquakes in Nepal, the ebola virus outbreak in West Africa, and the ever-rising disease burden across the world, more so in India.

Also, India has to indicate where it stands on some new but controversial issues being pushed by the powerful Group of 7 (G7) countries led by Germany. The Global Action Plan (GAP) for tackling anti-microbial resistance (AMR), air pollution and its impact on health, alternative research and development models for providing new medicines at affordable prices, and the framework of engagement between the World Health Organization (WHO) and non-state actors, are some of the issues on which Nadda has had to do a balancing act as the chair of the conference.

Significantly, the WHO, whose policies the health ministers are tasked with framing during the meeting, needs fresh orientation and direction owing to its botched response to disease outbreaks such as the ebola virus calamity, which has claimed more than 10,000 lives in West Africa.

Under the leadership of Margaret Chan, WHO was found wanting in several areas and faced widespread criticism. In the recent past, the WHO’s policy advice to governments for stocking Tamiflu to counter the swine flu pandemic threat was characterized as a pro-industry measure in some quarters. The world’s “directing and coordinating" health agency also faces turmoil from within, over issues of staffing and retrenchment policies.

For an organization founded in 1948 to ensure the highest possible level of health, this is not a propitious time. The WHO’s current budget of over $4 billion is financed mostly from voluntary sources, with the Bill & Melinda Gates Foundation being the second largest donor. Nearly 75% of funds come from the US and the Bill & Melinda Gates Foundation, with conditions attached—they are to be used for specific programmes and not for addressing global public health challenges.

“I am establishing a $100 million contingency fund, financed by flexible voluntary contributions, to ensure that we have the necessary resources available to immediately mount an initial response," Chan told the health ministers. She proposed a “unified WHO programme for health emergencies" and a “global health emergency workforce".

“I am strengthening our core and surge capacity of trained emergency response staff," she said. Chan also proposed other reforms, including changes in the International Health Regulations (IHR).

But the WHO chief’s concerted push for a GAP for tackling AMR and the Framework of Engagement with Non-State Actors (Fensa) has raised several questions.

Fensa is aimed at insulating the global public health policy decision-making from undue influences. The stand adopted by rich countries against putting any restrictions on corporate funding to WHO, transparency in funding, and restrictions on secondment to the private sector, raised serious ethical issues about the Fensa initiative. India suggested that the WHO exercise caution in dealing with food, beverage, alcohol and infant formula industries. “WHO’s engagement should be strictly limited to assisting such industries to comply with its norms and standards or guidelines or policy," New Delhi argued.

However, Canada, Denmark, Norway and the US disagreed with developing countries and managed to weaken the language on Fensa, particularly on the issue of funding from influential non-governmental organizations (NGOs). Therefore, the WHO’s engagement with non-state actors in setting the global policy agenda is bound to come under the scanner in the coming years.

On the issue of a GAP for tackling AMR, there is a general recognition about the emerging problem and the need to tackle it on a war footing. But whether there will be unimpeded access to new antibiotics and the funds for implementing AMR-related initiatives in developing and poor countries are not clearly spelt out. There is also the danger that AMR could be used as a potential sanitary and phytosanitary barrier as well as a name-and-shame excuse for grading health systems in developing countries.

While India continues to champion the cause of the underdog in the negotiations for setting the global health agenda, the government’s policies back home in the health sector remain a source of grave concern. India continues to perform poorly in the health sector, as per indicators such as life expectancy and mortality, cause-specific mortality and morbidity, selected infectious diseases such as leprosy and tuberculosis, health services coverage, health systems, and health expenditure, according to World Health Statistics 2015.

More disturbingly, India made uneven progress in meeting Millennium Development Goals such as tackling malnutrition or the proportion of people who suffer from hunger, child (under five years of age) mortality, maternal mortality ratio (the number of maternal deaths per 100,000 live births), universal access to reproductive health, the proportion of the population without sustainable access to safe drinking water and basic sanitation.

In comparison with China, which has made significant strides in providing state-funded health systems, successive governments in India, particularly the current one, chose to starve the health sector.

At a time when massive investments are needed for improving its crumbling public hospitals and primary health care centres, the government provided an outlay of around $4.81 billion ( 29,700 crore) for the health sector.

Such a meagre outlay for the health sector came in sharp contrast with what it paid for the purchase of new Rafale aircraft—$6 billion.

Financial conservatism, Amartya Sen, the Nobel Prize winner in Economics, told health ministers at the 52nd World Health Assembly in 1999, “should be the nightmare of the militarist, not of the doctor, or the school teacher, or the hospital nurse". But not in India!

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