By Lamya Ibrahim:
Post-independent India has had its share of medical achievements to boast of: it witnessed milestones ranging from a doubling of life expectancy to the eradication of Polio. And it continues to churn out world-class health professionals every year. Yet, the UN reports that 70% of our public health expenditure is concentrated in the urban areas, where less than a third of the population lives.
For a country that has faced major healthcare issues since its inception, the least-recommended step would be to starve its already-dilapidated system. But that is exactly what we see in the case of the finance minister Arun Jaitley’s otherwise balanced annual budget.
The allocated budget for healthcare in 2015-16 is Rs. 33, 152 crore, a little over last year’s Rs. 30, 645 crore. The total amount spent in the first three years of the 12th Five-Year Plan has been around Rs. 70, 000 crore, which falls way below the Rs. 2, 68, 000 crore allocated for the 5 year period. While the government aims to meet its fiscal deficit target, slashing Rs. 60 billion from the budget sets our frail healthcare industry on a pitiable expedition. Our healthcare sector will be unable to meet the minimum expenses.
Currently, India spends a little over 1% of its GDP on public health, in contrast to China’s 3%, Brazil’s 4.1% and US’ 8.3%.
The intention for building an integrated system for delivering affordable and accessible healthcare for all is clearly there, but it is not reflected in this year’s distribution.
It is impractical to simplify the public healthcare scenario. We have understaffed, overcrowded hospitals and clinics, rife with corruption, absenteeism and inadequate resources. Their facilities are far from meeting the requirements for dealing with basic issues, such as malnutrition, infections, and preventive healthcare.
More children die because of preventable illnesses, such as diarrhea and pneumonia in our country than in the neighbouring countries, such as Bangladesh and Sri Lanka. Adults face no less a challenge, when as many as 80 per cent of those afflicted with dengue every year either never seek medical care, or are turned away from overcrowded hospitals.
We also have a nation with a teeming population, decreasing mortality rates, and rising life expectancy rates. All of these have lead to an increase in instances of non-communicable diseases, such as diabetes, and cardiovascular diseases.
Out-of-pocket expenses on dealing with these healthcare problems push an estimated 39 million Indians to poverty every year. Under addressed mental health issues too paint a tragic picture as India’s suicide rate in the age group of 15-29, arguably the most productive period of an individual’s life, is the highest in the world.
The cutback affects schemes concerning a range of issues including malnutrition, right to education, health, child protection, and support to the disadvantaged groups – the scheduled tribes and castes. While allocations in these areas have always been significantly less, these cuts will push some of the schemes further back and ensure that they can’t be launched at all.
Schemes such as Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM) have been hit hard just as they were beginning to show results. Worse still, the Finance Ministry has ordered a cut in the spending for India’s HIV/AIDS program by about 30 per cent to Rs. 13 billion, an absurd step for a nation that accounts for more than half of all AIDS-related deaths in the Asia-Pacific region.
Another missed opportunity was the lack of incentives for the pharmaceutical industry, which has recently come to the forefront as the leading producer of generic drugs worldwide. Facing stiff competition from China, the dearth of support for its capital investment needs, research and development investments, or tax exemptions is a major setback. The ‘Make in India’ campaign’s aid to the development of Indian pharmaceuticals and medical devices would have given a boost to the health industry as well as the economy.
On the positive side, the proposition for the extension of health cover and initiatives to boost health insurance will reduce the out-of-pocket spending. Setting up AIIMS in different locations across India, would strengthen the tertiary care infrastructure in these states. However, the need of the hour is to reinforce primary and secondary healthcare facilities, as is evident from the ongoing crisis of Swine flu.
Further, the spotlight on Swacch Bharath Abhiyaan concentrates on sanitation. Moreover, the tax exemption provided under this program is a commendable step; its acceleration and implementation can help keep disastrous diseases, such as Malaria under check.
Nevertheless, the government has a long road to travel if it is to win back the confidence of its people as well as its healthcare providers. Recent tragedies such as the botched sterilizations in Chhattisgarh have alienated even the poorer classes from accessible facilities. Meanwhile, the morale of its healthcare providers remains at an all-time low. With underpaid staff, under-resourced health centres and a neglected medical education system, they need serious attention from the centre.
India needs to raise its public healthcare expenditure to at least 2.5% of the GDP so as to fulfill the promise of universal health coverage. Tackling the issue requires getting to its multiple roots, including hygiene, female empowerment, and literacy.
The government must gear up to accommodate a dual battle against a developing country’s health concerns and a host of developed world disorders. New methods of fund transfer, procurement, and a supply of life saving drugs and diagnostics for the implementing units should be conceived for better healthcare.
Let’s hope that the Centre considers all these aspects and rethinks its budget allocations for subsequent years.