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Rich State Among Poorest Performers on Public Health

The BJP government in the state spent the last four years announcing social sector schemes — each more ambitious than the other — at a rapid pace, but the public reaction has been far from uniform. In other words, the government’s social sector sops have been a mixed bag. Its blood on call scheme earned bouquets, but its announcement to provide premix food as children’s meal got widespread flak for being unimaginative. Its decision to introduce direct benefit transfers in the public distribution scheme was trashed, but beneficiaries of the Mahatma Jyotiba Phule insurance scheme have been ecstatic to get angioplasty costing lakhs for free.

The budget also reveals a worrisome trend: allocations for schemes have been slashed or the private sector has been roped in areas that have traditionally been the domain of the government sector. An analysis of state budgets from 2015-16 to 2017-18 by Jaganyachya Hakkache Andolan showed consistent failure of Maharashtra’s government to allocate adequate funds for social sector, despite a deep agrarian crisis and people’s undeniable need for social services. “There is continued and deliberate massive underspending of allocated funds,” said health economist Dr Ravi Duggal. “Only 40 percent of allocated funds were spent by February 14, 2018, a few days from the close of the financial year.” Here’s a performance report:

Village Child Development Center (VCDC) Scheme

The women and child development department launched a ₹100-crore scheme to fight malnourishment after the Center stopped funds three years ago. The scheme envisaged giving children in villages premix food thrice a day — an idea health expert felt would not be popular. This was the third time in as many years that the ministry was caught in a storm. In June 2015, minister Pankaja Munde courted controversy for clearing purchase of chikki, mats and books for ₹206 crore without floating tenders. The next year it emerged that the department’s ‘Take Home Ration’ scheme distributed packets of sheera or upma to women—far from a balanced diet. Dr Ashish Satav, who works in the tribal-dominated Melghat area, said the VCDC scheme should be scrapped. “It does not administer WHO-UNICEF recommended diet or micronutrients,” said Dr Satav. “Unless we know the real figure of malnutrition, appropriate measures cannot be planned to reduce child deaths.”

Direct Benefit Transfer (DBT) for PDS

The state decided to implement the DBT scheme as part of the public distribution system (PDS) in two ration shops in the city with 1400 Antyodaya and priority household ration cardholders as an experiment. The Food Security Act entitles the neediest families in the country to 35 kg of grain at heavily subsidized rates per month under the Antyodaya scheme, while each member of a priority household is entitled to 5 kg. Both have to pay ₹3 for a kg of rice and ₹2 for a kg of wheat. The social organization Anna Adhikar Manch slammed the scheme, alleging that it is a step towards dismantling the PDS system. “This is a ghoshnabaaj sarkar. The scheme has amounted to diluting food security, which was guaranteed to the poor after a long agitation. The cash transfer business is part of doing away with PDS and also do away with buying grains from farmers for FCI godowns by providing them a minimum support price,” said activist Ulka Mahajan.

DBT for Tribal Ashram Shalas

The state implemented DBT in tribal ashram schools. It was meant for the purchase of 17 essentials items like toiletries so that these reach them directly instead through a contractor. The state has started transferring cash to students’ bank accounts as food allowance or scholarship (for hostel students). The state said the scheme has 4.14 lakh beneficiaries, with ₹1474 crore spent till date. As of now, it is being implemented in only 120 out of 491 hostels, located in the jurisdiction of corporations and districts. Minister for tribal welfare Vishnu Savara claimed this was being done to put an end to the constant complaints of poor quality of items reaching tribal children. Rajendra Maraskolhe, president, Organization for Rights of Tribals, said the scheme is good, but needs awareness among tribals. “The tribal community is different. They still hesitate to mix with others; so, they are not aware about how to spend the money. The state should consider counselling them,” he said.

Public Health Schemes

The government flagged off many schemes, but the ‘blood on call’ program seems to be the most popular one, with experts and critics acknowledging that it fills a yawning gap in the public health system. “The government’s bike ambulances have also met with positive response, but these have a limited role and cannot do much in big crises,” said Dr Abhijit More of the NGO Jan Arogya Abhiyan. The free health insurance scheme Mahatma Jyotiba Phule Jan Arogya Yojana has been the government’s most visible scheme for the masses as it provides free access to 1000 surgeries that cost up to ₹1.5 lakh. This year, after the Center’s Ayushman Bharat scheme was launched, the benefit has climbed to ₹5 lakh. But some economists are not happy. “There have been complaints of patients still not getting proper access. Until a few months back, some hospitals made patients pay extra,” said one. The biggest criticism, according to Dr More, is that the scheme is only dedicated towards surgeries. “What about hospitalization due to chronic diseases? We get calls from people across the state to enquire if hospitalization could be covered under the scheme,” he said. “It’s time to revamp the scheme and make it more broad-based.” – TOI