Those of us who work in the health sector were delighted when Harsh Vardhan was appointed the health minister in Narendra Modi’s first cabinet in May 2014. The doctor had a formidable reputation, had done good work as Delhi’s health minister in the 1990s, was primarily responsible for the polio immunisation programme in Delhi, and responsible for the passage of the Act prohibiting smoking in public spaces. He was well-known among health activists across the world, was familiar with the best practices, and had worked closely with the World Health Organisation.
As was expected, the health and family welfare ministry took off at a hectic pace soon after. There was a buzz in the air as discussions started being held on immunisation, drug research, epidemiological studies, clinical standards, and the health workforce. Expectations were already high, and the initial frenzy led us all to believe that finally, health was getting its due. Then came the dampener. Sanjiv Chaturvedi, an Indian Forest Service officer and chief vigilance officer at AIIMS, had levelled serious allegations of corruption. An RTI report had revealed that Narendra Modi had called up Harsh Vardhan, who was in the eye of the storm, to discuss whistleblower Chaturvedi’s removal. Harsh Vardhan was also courting trouble because of his harsh steps against tobacco firms, including an increase in taxes on cigarettes to reduce consumption.
Matters came to a head and in November, less than six months after being in the position, Harsh Vardhan was moved to the science and technology ministry where he quietly served out the remainder of his term. The AIIMS story is now long forgotten. The tobacco industry is fighting a losing battle against tight regulations and high taxes, though they won a respite on Harsh Vardhan’s initiative in banning sale of loose cigarettes when the Modi government distanced itself from the health minister’s “activism” and put the decision on hold. Now, Harsh Vardhan is back in the seat he richly deserved even then.
What will he do now? He comes in when Prime Minister Narendra Modi’s pet project is all set to take off. Ayushman Bharat and the Pradhan Mantri Jan Arogya Yojana were the biggest announcements made last year. What the health ministry needs is a powerful minister who will negotiate hard with the finance minister to get huge outlays earmarked for the schemes. In the interim budget, Arun Jaitley had earmarked a miserly Rs 6,400 crore, when conservative estimates suggest that the sum required is at least three times the amount. The health minister will also have to tread a difficult path ahead – will the programme go on to take on a private sector insurance led structure or a become a public trust based universal coverage model?
Harsh Vardhan’s second challenge will be to take forward his fight against the Medical Council of India. Not only has he earlier tried fighting the corruption that is alleged to be the hallmark of the council, he also must balance the stakeholders involved. Doctors and surgeons do not want the body to be run by the bureaucracy, while the government wants it to be a truly third body adjudicator and supplier of skilled medical staff. The Indian Medical Council (Amendment) Act could not be passed last time and has stayed through a special ordinance. Will Harsh Vardhan be able to place it again and get it passed, and retain the MCI’s autonomy while cleaning up its Act? He will have to work quickly as the surest to derail Ayushman Bharat is by keeping the Indian health care sector understaffed.
Finally, among various other problems that the good doctor will hopefully tackle, is the simmering discontent on steps being taken to tackle air pollution. According to Greenpeace, Delhi has become the most polluted capital in the world. The Health Effects Institute has estimated that 1.2 million people were killed in India in 2017 due to air pollution. Harsh Vardhan as environment minister had rubbished these studies and kept up a brave front. As health minister, will he rise up to the responsibility and stop the astonishing increase in air pollution related deaths in the country’s capital?
While he does all this and at a brisk pace, we will all hope Harsh Vardhan stays on as the health minister for the full term.
The author is the Director of Research, Aequitas, formerly with the Bill and Melinda Gates Foundation. He is visiting faculty of economic policy at the Indian School of Business. Views are personal.