This year's Union Budget's essential focus on rural India and agriculture has received much appreciation. Increase in funding for MNREGA, a new irrigation scheme, crop insurance and increased budget for rural development are measures taken keeping in view the severe rural distress and upcoming state elections.
Being a diverse country with different income levels and aspirations among citizens, it is almost impossible to keep everyone happy with the Budget. However, the government’s failure to address the impending crisis in health comes as a shocker.
Surging healthcare expenses push 39 million people in India to poverty each year. In India, 682 out of every 100,000 people die from non-communicable diseases, as against the global of 539, according to the WHO. India accounts for the highest maternal deaths and still births in the world.
Every indicator is dismal.
Already, India’s per capita spending on healthcare is the lowest among BRICS countries.
Last year, The Lancet, a globally acclaimed medical journal, had slammed the Modi government for not doing enough to tackle the impending crisis. In a scathing critique, Lancet’s editor Richard Horton said “Since Modi has come in, health has completely vanished. India is on the edge. If PM Modi does not tackle health, India's economy combined with rising population is not sustainable. For India, health is an issue of national security. The government cannot protect the sovereignty of its nation, cannot ensure sustainability unless it has a healthy population. At present Modi has done nothing much to tackle the challenge”.
Horton also wrote about how India’s ambition to be a Security Council member should be a key motivation. “India wants to play a larger role in the world, wants to be in the security council of the United Nations, which are very legitimate objectives for India. I don't think it can claim to be a world leader when it allows so many of its children and mothers to die of abject poverty".
Though the Centre moved to devolution of funds as per the 14th Finance Commission recommendations, the poorer states face the brunt especially in funding the social sector schemes once funded by the Centre.
Given the circumstances, one expected a slew of radical health reforms, but clearly, the government’s Budget seems to have no clear vision of tackling the crisis. I outline three major focuses, which should have been prioritized in the Budget:
Increasing allocation for filling up vacant posts
The rural healthcare infrastructure is a three tier system – a sub-centre, primary health centre and community health centre. PHCs in India are short of more than 3000 doctors, with the shortage being 200% over the last 10 years, according to an analysis by IndiaSpend. Furthermore, there is an 83% shortage, of specialist medical professionals (Gynecologists, surgeons, physicians, etc) across CHCs in India, with many states having no specialists at all.
Lack of public medical professionals leads rural India to spend heavily on private healthcare systems, thereby, burdening their pockets.
Therefore, the government should have focused on increasing the allocation to fill up these vacant posts which will enable people to get treated in public hospitals and not rake up debts to access private healthcare.
Launch a National Program for Non Communicable Diseases
One in every four Indians stands the risk of dying from a non-communicable disease before the age of 70. About 60% of all deaths in India are due to non-communicable diseases (NCDs). India records the maximum number of tuberculosis deaths in the world.
These statistics portend the need to have a National Program for Non Communicable Diseases funded by the Centre on the lines of Swacch Bharat Abhiyan which will focus on reducing India’s NCD mortality rate. Though India was the first country to adapt the Global Monitoring Framework on NCD, lack of inadequate funding will be a hindrance to achieve the desired targets of reducing deaths due to NCDs by 25% by 2025.
Investment in health infrastructure
When it comes to providing adequate health infrastructure to its citizens, India’s performance is worse than most major economies.
Only 0.5 hospital-beds exist per 1000 population, as compared to 9.1 for Russia and 3 for China. Only 0.21% (Rs 938 Crore) of the total infrastructure investments in India is in the health sector, according to an analysis of government data by IndiaSpend. There was a shortage of 6,700 (23%) public health centres and 2,350 (33%) community health centres as of March 31, 2014, according to data tabled in the Rajya Sabha.
As data reveal, there is an imperative need to improve the health infrastructure, and therefore, there should have been initiatives focused on health, similar to the ones Jaitley announced for other sectors like rural infrastructure.
The only silver linings in the otherwise disappointing Budget in terms of healthcare were introduction of the National Dialysis Service Program (NDSP), extension of the Jan Aushadhi Yojana and the proposal to extend an insurance cover of Rs 1 lakh to economically weaker families.
However, both the NDSP and the insurance cover programs will be based on public private partnerships, which basically imply that the government is only willing to play the role of a facilitator rather than taking on a sheet anchor role, which is the need of the hour.
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