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Healthcare at ICU doors as government spend drops, again

INDRANIL MUKHOPADHYAY | Updated on January 12, 2018

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Far from fulfilling the long-pending promise of upping healthcare spend, the Budget has brought in schemes not financially supported

Finance Minister Arun Jaitley may have received praise from various quarters on the increased allocation for the rural population and tax relief for the middle-class. But the healthcare sector is not pleased at all.

The Budget makes an additional ₹10,600 crore for health compared to the previous year. That still brings the Centre’s allocation on health as a share of GDP to 0.29 per cent, lower than what was spent in 2011-12 (0.31 per cent).

The small increase in allocation this year may not be enough to maintain existing programmes, yet that has not stopped the government from announcing new, ambitious ones, without Budgetary support.

Every year we have been seeing the allocation for health dropping. Funds are transferred from the Finance to the Health Ministry with considerable delays and cuts, as a result little gets spent on the ground.

Last month, the Health Minister expressed concern that his Ministry was not getting the money promised by the Finance Minister and as a result most Central programmes were facing severe cash crunch. An increased allocation is long overdue.

The most promising statement in the Budget document is on converting 1.5 lakh sub-centres into health and wellness centres.

If this is funded adequately and implemented appropriately to deliver a set of primary-level care, a lot of economically weak can benefit. Unfortunately, there is no allocation specified in the Budget for this programme. A mere statement does not mean much, unless it is backed by a financial commitment.

The Finance Minister has also promised to transfer ₹6,000 to the bank accounts of pregnant women who undergo institutional delivery and vaccinate their children. Global experience suggests that cash transfer schemes work only if complemented with good quality public services. Notwithstanding its limitations, the NHM (National Health Mission) has in the past increased institutional delivery and saved thousands of mothers and children — with a combination of cash transfer and improved services.

But a severe crunch in the NHM budget in the last few years has stalled the efforts to strengthen the rural public health system. Even if one in four mothers delivering in a year are covered by the scheme, around ₹5,000 crore will be required every year. Remove this from the NHM allocation of ₹27,153 crore and it means that the allocation for existing programmes will be squeezed further.

It is not clear from the Finance Minister’s statement whether the money will be given to women who deliver in government hospitals or to those in private hospitals too.

A minimum of ₹15,000 is spent by households for a normal delivery in a private hospital. If the scheme is open to private sector deliveries, mothers might end up spending a lot more by shifting to a private institution, misguided by the thought that their entire bill will be covered by the government.

The Finance Minister’s statement on tuberculosis too, is difficult to comprehend. Given the staggering number of TB patients in the country and the emergence of multi-drug resistance TB and as the government faces increasing difficulty in supplying medicines to patients, a proclamation to eliminate TB by 2025 does not only makes any public health sense, but also undermines the suffering of millions.

(The writer is a Research Scientist and Assistant Professor, Public Health Foundation of India. The views are personal.)

Published on February 05, 2017

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