Editorial. A robust, publicly funded health system needed

Three years after the Wuhan outbreak, yet another wave of the Covid-19 pandemic has spread from its epicenter in China. The consensus among Indian health experts is that hybrid immunity, through exposure to the virus as well as vaccination, will insulate India from severe infections. This sense of comfort arises from the success of India’s Covid-19 vaccination programme, wherein over 88 per cent of the eligible population has received both doses of the vaccine.

It is a pointer to what a well-funded, strategic intervention can achieve in healthcare. India’s competence in dealing with Covid should be replicated with respect to other endemic diseases such as tuberculosis, malaria, cholera and heart disease. It was heartening to see the Economic Survey 2020-21 recommend an increase in public spending on healthcare services from a measly 1 per cent to 2.5-3 per cent of the GDP as envisaged in the National Health Policy, 2017. Such expansion can combat health emergencies while reducing the staggering Out-of-Pocket Expenditure (OOPE) which is close to 65 per cent of the overall healthcare spend in India. While the Pradhan Mantri Jan Arogya Yojana (PMJAY) covered the treatment of over eight lakh Covid patients over two years, according to a Rajya Sabha statement last November, this does seem a small proportion of the numbers hospitalised. PMJAY has been a game-changer, but it cannot replace public health systems.

As for health allocations by the Centre and States, while expenditure on health jumped from ₹2.43 lakh crore in 2017-18 to a budgeted ₹4.72 lakh crore in 2021-22, this increase was largely Covid-driven. Expenditure on health by the Centre increased from about ₹53,000 crore in 2017-18 to nearly ₹86,000 crore in 2021-22, a rise of 62 per cent. The proportion of Central and State health spending to GDP has risen from 1.4 per cent to 2.1 per cent over this period. If the learnings of the pandemic in terms of public spending outcomes are to be taken seriously, the Centre should show the way in stepping up health spending by 0.5-1 percentage point of GDP. Meanwhile, only a handful of provinces including Delhi, Assam and other north-eastern States have progressed towards better provisioning of the sector. The increased outlays should go towards reducing mortality in tuberculosis, malaria and heart disease, which kill in the thousands daily, without being noticed.

Globally, publicly-funded, robust public healthcare systems fared better in the face of the Covid crisis. The Indian success in vaccination was mostly owing to the public healthcare stepping up and providing free vaccination to all even as the private sector lagged. The Delta wave last year overwhelmed India’s crumbling health infrastructure, in the northern States in particular. A creaky system cannot be ramped up overnight to deal with emergencies. All the more reason, then, to improve the infrastructure and human resources base, instead of relying wholly on fire-fighting to deal with crises.

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