The Bharatiya Janata Party (BJP)-National Democratic Alliance (NDA) which has once again formed the government, will be presenting its budget of this new term on July 5. The last five years (2014-19) were marred with a number of health disasters in the country ranging from the sterilisation-deaths in Chhattisgarh to the child deaths in a Gorakhpur hospital in 2017.
Although there was no major immediate response, health was one of the major issues around which the BJP campaigned during the run up to the general elections, taking credit for launching the Ayushman Bharat, which is claimed to be the “world’s largest healthcare programme”. Continuing this agenda, the BJP’s election manifesto promised to provide sufficient budget for covering 10.74 crore families under the Pradhan Mantri Jan Arogya Yojana (PMJAY) and completing the task of setting up 1.5 lakh health and wellness (HWS) centres.
Apart from this there is mention of access to affordable medicines and strengthening health infrastructure through more medical colleges and reforms in the para-medical education sector. It is indeed welcome that there is some notice being paid to the problem of people’s access to healthcare in national politics. However, it is also unfortunate that despite the intensity of the situation, health is still not getting either the appropriate or adequate attention.
The recent deaths of children in Muzzarfurpur in Bihar (attributed largely to Acute Encephalitis Syndrome) have yet again highlighted the shambles in which the health sector in India is, especially for the poor. These instances also show that improving the health of the people requires comprehensive interventions addressing preventive, promotive and curative care at all levels along with paying attention to the social determinants of health, such as nutrition, sanitation etc.
The PMJAY is for aiding with out-of-pocket hospitalisation expenses, something that would not have helped the AES situation in Bihar even if it were fully functional. The main problem has been in access to timely medical care — with lack of functioning primary health centres (PHCs), the SK Medical College and Hospital is where all children are being brought to, making families travel long distances and also overburdening the hospital. According to the Rural Health Statistics, 2018, of the ministry of health and family welfare, the shortfall in the number of PHCs in Bihar is 39%, 47% for sub-centres and 81% for community health centres (CHCs) — all of this is in relation to the government’s own population norms. There are only 0.3 allopathic doctors per 100,000 population in Bihar compared to an all India average of 3.4.
In order to achieve comprehensive and universal health provision, a number of things need to be done, starting with strengthening the public healthcare system from the primary to the tertiary levels with adequate infrastructure, human resources, medicines and other facilities. This has to be done in a determined way with efforts towards winning back the trust of the people in the government health system. Among other things, one of the most important inputs that is required is much more resources be poured into the health sector. This is where the upcoming budget can show some vision and leadership.
The National Health Policy, 2017 aims to increase India’s health spending to at least 2.5% of GDP by 2025. The current public health expenditure is only 1.3% of GDP and has been hovering around this level for a very long time. If we are to reach the target of 2.5% in the next six years, then it has to be done progressively, starting immediately.
While the interim budget presented in February increased the allocation for the PMJAY to Rs 6,400 crore from an allocation of Rs 2,000 crore last year, there is a drop in the funding for the core areas of health, including the National Health Mission, components of maternal, child and reproductive health and communicable diseases. This was the indeed one of the fears expressed by many in shifting to an insurance-based strategy such as the PMJAY, that it would be expensive, divert funds to the private sector at the cost of the neglect of primary healthcare and strengthening public systems.
If the Modi-led central government is serious about doing something impactful for the health of the people, it must begin with this budget where it can lay the roadmap for the next five years by increasing the health allocation in the budget and also strengthen the public health system, especially at the primary level. Along with this, resource allocation for allied sectors such as nutrition, water and sanitation would also have to be enhanced. – Money Control