Although the Budget did not fulfil our healthcare expectations, there are good reasons to be optimistic. One, the UPA government failed to increase public spending on health. Under-spending on health has been a major cause for the growing inequities, insufficient access and poor quality of healthcare services. In fact India’s health spend is among the lowest in the world. The extremely high private out-of-pocket expenditure on health — close to 70 per cent — has also emerged as a major cause of impoverishment: it drives close to 50 million people into debt and poverty every year.

Sadly, public spending on health by India has stagnated at around 1 per cent of GDP for close to a decade now. The draft health policy put out by the NDA government does talk about increasing public spending to 2.5 per cent of GDP which is a welcome sign though there is no indication of the timeline by which this target will be met.

Assuring health Two, the political leadership of the UPA government had only reluctantly bought into the idea of universal health coverage, though some of the recommendations of the high level expert group on universal health coverage were incorporated into the Twelfth Five Year Plan document. The NDA government breathed new life by talking about universal health assurance — very different from universal health insurance.

To many of us, health assurance has three dimensions. The first is access to affordable good quality healthcare for all, similar to the notion of universal health coverage which is being pursued by over 75 countries today. The NDA government has talked about free medicines and free diagnostics. Global evidence suggests that a tax-funded single payer system is the best option.

The second dimension is to recognise upfront that health outcomes are determined not just by investments in the health sector but equally significantly by investments in non-health sectors. This is the reason why the draft health policy talks about setting up seven task forces to specifically deal with many of the social determinants of health. These include the Swachh Bharat Abhiyan; the promotion of balanced and healthy diets; addressing tobacco, alcohol and substance abuse (Nasha Mukti Abhiyan); increasing road safety (Yatri Suraksha); advancing women’s safety and security (Nirbhaya Nari); reducing stress and improving safety in the workplace; and reducing indoor and outdoor air pollution.

The third dimension has to do with accountability.

Refreshing analysis Some of the discussion in this year’s Economic Survey is insightful. The discussion on health and family planning admits that India’s population policy seems overly preoccupied with extending family planning measures, mainly contraceptives for women, leaving them with little reproductive choice or autonomy. For the first time, the survey draws attention to the dangers of pushing female sterilisation as part of the family planning programme. It argues that there may be a case for the government to undo as much as to do, for example, by not setting targets, withdrawing incentives for female sterilisation and for mass camps. Further, it calls upon the government to reorient the family planning programme such that it is aligned with the reproductive health rights of women; increase budgets for quality services, static family planning clinics, and quality monitoring and supervision; and address youth needs, induct more counsellors for sexual health, more youth-friendly services, and adequate supply of spacing methods.

Such evidence-based policy analysis is refreshing and much wanted. It raises hopes of new policy thinking and action. Bold steps are needed to fulfil the promise of a healthy India by 2022.

It is not beyond a government that believes in good governance to do away with targets and cash incentives for sterilisation, stop mass sterilisation camps, and focus instead on spacing methods of family planning that are more appropriate for young people. It is not beyond the acumen of a finance minister who has promised to raise over ₹70,000 crore for Indian Railways to mobilise a similar amount for investing in people’s health — undoubtedly an equally important national priority.

The writer is the executive director of the Population Foundation of India, New Delhi

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