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Health For The Poor: WE NEED TO INVEST MORE, By Dr. Oishee Mukherjee, 10 March, 2018 Print E-mail


New Delhi, 10 March, 2018

Health For The Poor


By Dr. Oishee Mukherjee


The health sector is the big take-away from the recent Budget. Whereby, the Modi Government plans to provide health insurance to 100 million households for up to Rs 5 lakhs per annum under the National Health Protection Scheme (NHPS) which replaces Rashtriya Swasthya Bima Yojana (RSBY). For a country with a per capita income of around Rs 1800 and where most people do not have any health insurance, this measure might have raised expectations but only time will tell whether the poor and the EWS will benefit.     


Notably, the amount earmarked for (NHPS) this fiscal year is meagre, a mere Rs 2000 crores of which States have to bear 40% cost. Critics aver the insurance premium would be many times the Niti Aayog’s estimate of Rs 1000-Rs 1200 per family. Alongside, around Rs 10,000 crores would be needed for paying the premium.


Shockingly, as the World Bank reveals India’s public spending is just 1.4% of GDP compared with China’s 3.1%, Sri Lanka’s 3% and Ethiopia’s 2.9% in 2014. It goes without saying that there is an imperative need to invest more resources in improving public health and sanitation.  


True, the Government has increased cess by 1% to 4%, yet the allocations for health has not been hiked significantly. Allegations abound, and not without reason, that implementing all the plans announced in the Budget would require enhanced resources which have not been allocated. This stands at Rs 9975 crores compared to Rs 9500 crores (Budget estimate) of 2017-18. Thus, it remains to be seen how Finance Minister Jaitley’s promise of providing health facilities to the poor would be realized.


Besides, the proposal to set up 24 new Government medical colleges and hospitals might not meet the target of setting up one medical college for three Parliamentary constituencies. Undoubtedly, it would have been better instead of 24, the Sarkar had doubled the figure. Also, the wellness centres proposed for maternal and child health might help the rural sector and the budgetary provision of Rs 1200 crores appears satisfactory though more funds would be necessary.


Scandalously, State health facilities in villages are in a poor state, worse impoverished sections do not have the money to avail private sector treatment. Hence, it is necessary to upgrade health centres in blocks or sub-divisions, but unfortunately the Budget is silent on this.  


The deterioration in the state of health is manifest from the fact that some of the country’s best performing States including Kerala have slipped from their earlier scores, according to the latest national health report card. Gujarat, Haryana, Karnataka, Himachal Pradesh and Uttarakhand have also shown a decline in their health indices from 2014-15 and 2015-16.


Pertinently, the health index assessed States on the proportions of newborns low birth weight,  their immunisation, success rate of tuberculosis treatment, personal and out-of-pocket expenses families pay for deliveries in Government hospitals and vacancies in primary healthy centres.


Additionally, another report National Health Accounts (NHA) 2014-15 shows the average Government spend per citizen per year was a meagre Rs 1108 against almost Rs 6300 per Central Government employee. Even the most generous spending among States, Himachal Pradesh was just over Rs 2000 per capita. According to the NHA, India’s total health expenditure in 2014-15 worked out to Rs 3826 per person of which people had to spend Rs 2394 (63%) from their own pockets!


However, in 2014-15 the Union Government’s expenditure on National Health Mission (NHM) to boost the health care system was Rs 20,199 crores spread over a population of roughly 1.25 billion which came to a paltry Rs 162 per head. Thereby, clearly indicating that a majority of this population did not receive any medical treatment.


Though the poor suffer due to inadequate facilities and resources, the Government’s expenditure on its Central Government Health Scheme (CGHS) for retired and serving employees, current and ex MPs, judiciary etc. is quite high. As per information furnished to Parliament by the Union Health Minister, CGHS has 36.7 lakhs beneficiaries which translates to Rs 6300 per CGHS beneficiary. And if one adheres to the 2011 Planning Commission report CGHS spending was mostly driven by high-end tertiary care provided largely by big corporate hospitals.


Undeniably, the whole situation is alarming and needs the Centre and States’ urgent attention. Given that the pro-urban approach which is manifest in Indian planning over the decades has found expression in the health sector. Questionably, with meagre resource allocation in the health sector, how can one expect the present pitiable situation to improve?  


Importantly, the poor and economically weaker sections need immediate attention as the incidence of diseases like dengue, malaria and TB are still to be controlled. Even people in big cities like Kolkata, Delhi and Chennai suffered from dengue, chikengunea  and other forms of bacterial infection last year.


Add to this, heart and blood circulation related diseases and diabetes have become really big diseases though they are non-communicable like cancer which do not spread through external agents. Heart affects 5.5 crores people and diabetes some 6.5 crores. Death rates are much more in the case of heart diseases as they affect seniors more and treatments are expensive. When it comes to complicated diseases, the number of specialized hospitals are very few with the result doctors have very little time for the poor.


Even a 2017 Rashtriya Swasthya Bima Yojana (RSBY) study revealed that it has been ineffective in reducing the burden of out-of-pocket spending by poor households. Consequently, burdened with high medical treatment, the financial position of poor and economically weaker sections becomes bad to worse.


Indeed, the growing burden of diseases is a big challenge for the Government, both Central and States. Inter-related with this is the lack of water and sanitation which has contributed to increase in diseases. Though we talk of various measures aimed at preventing disease, it is becoming difficult for the poor and economically weaker sections.


Therefore, a plan has to be formulated at the highest level with doctors drawn from all over the country to prepare a future map for tackling diseases, specially in rural and semi-urban parts of the country. ---- INFA      


(Copyright, India News & Feature Alliance)

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