New Delhi: To widen scope of the government’s flagship scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Union Budget on Saturday proposed to set up a viability gap funding to allow empanelment of hospitals through a public-private-partnership (PPP) model.
Presenting the Union Budget for 2020-21 in the Lok Sabha, Finance Minister Nirmala Sitharaman announced an allocation of ₹69,000 crore for the health sector, which includes ₹6,400 Crore for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
“Presently, under AB-PMJAY, there are more than 20,000 empanelled hospitals. We need more in Tier-2 and Tier-3 cities for poorer people under this scheme. It is proposed to set up Viability Gap funding window for setting up hospitals in the PPP mode. In the first phase, those Aspirational Districts will be covered, where presently there are no Ayushman empanelled hospitals,” the finance minister said. Aspirational districts are those which are affected by poor socio-economic indicators and require overall improvement in human development. In order to achieve twin objectives of giving impetus to the domestic industry and also to generate resources for health services, the union budget has proposed to impose a nominal health cess, by way of a customs duty, on the imports of medical equipment keeping in view that these goods are now being made significantly in India. Proceeds from this cess shall be used for creating infrastructure for health services in the aspirational districts.
Further, a health cess at the rate of 5% has been proposed to be imposed on the import of medical devices. This cess shall be a duty of Customs. The proceeds of health cess shall also be used for financing the health infrastructure and services.
“This would also provide large scale employment opportunities to youth. Proceeds from taxes on medical devices would be used to support this vital health infrastructure. Using machine learning and AI, in the Ayushman Bharat scheme, health authorities and the medical fraternity can target disease with an appropriately designed Preventive regime,” Sitharaman said.
Billed as the world’s largest health assurance scheme, AB-PMJAY, dubbed Modicare, aims to provide free health insurance of ₹5 lakh per family to nearly 40% of the country’s population — more than 100 million poor and vulnerable families.
The government also proposed to expand Jan Aushadhi Kendra Scheme to all districts offering 2,000 medicines and 300 surgical items by 2024. In a bid to address the shortage of qualified medical doctors, both general practitioners and specialists, the government also proposed to attach a medical college to an existing district hospital under PPP mode. “Those states that fully allow the facilities of the hospital to the medical college and wish to provide land at a concession would be able to receive Viability Gap Funding. Details of the scheme would be worked out,” the finance minister said.
Stating that the government has a holistic vision of healthcare, Sitharaman maintained more needs to be done towards liquid and grey water management after achieving Open Defecation Free India. “Focus would also be on Solid waste collection, source segregation and processing. Total allocation for Swachh Bharat Mission is about ₹12,300 crore in 2020-21,” she said.
Reacting to the health budget allocations, Harsh Vardhan, union minister of health and family welfare said, “The budget estimates for the Department for Health and Family Welfare show an appreciable increase of 3.75%, while there has been a 10% hike in the allocation for the Department for Health Research. The focus in Budget 2020 is on medical infrastructure, human resources in the health sector, and holistic health and wellness. In addition, 6,500 projects under National Infrastructure Pipeline (NIP) include projects of healthcare for all. Also, “TB Harega Desh Jeetega” campaign has received a boost in the Budget. This shall strengthen our resolve and commitment to end tuberculosis by 2025,” he said.
Current health infrastructure in India paints a dismal picture of healthcare delivery system in the country. Health Infrastructure has been described as the basic support for the delivery of public health activities. According to the National Health Profile 2018, there are 23,582 government hospitals having 710,761 beds in the country. 19,810 hospitals are in rural area with 279,588 beds and 3,772 hospitals are in urban area with 431,173 beds.
Over 70% of population of India lives in rural areas and to cater their need there are 156,231 Sub Centres, 25,650 Primary Health Centres and 5,624 Community Health Centres in India as on 31st March 2017. According to the latest government data, as on March 2018, the country has total of 2903 blood banks which means less than 3 blood banks for every 10 lakh population.
Public health experts have said that the health budget of India continues to be low to achieve the universal health coverage. “The budget promotes health at the population level through allocations to sanitation, clean water, nutrition and air pollution control programmes. The overall annual increase in health budget by 10% compared to last year is low when adjusted for inflation. This will not create the momentum needed for a public financing goal of 2.5% of GDP by 2025, which requires a near doubling by then,” Professor K. Srinath Reddy, President, Public Health Foundation of India, said.
Sharing the same sentiments, Poonam Muttreja, Executive Director, Population Foundation of India said that the Union budget 2020-21 is way below expectations, especially when there is a huge unmet need for health care services in the country.
“The budgets allocated for health and family welfare, Rs. 65,012 crores this year, is a mere 3.8% increase over the previous budget. This is insufficient considering the current rate of inflation (7.3% as per the Economic Survey 2019-20),” said Muttreja.-Livemint