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#NotesforMrJaitley 4: five things he must focus on in the Health Budget

Vishakh Unnikrishnan | Updated on: 14 February 2017, 5:40 IST
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The crisis

  • India has cut its health spending by 20% since 2013-14
  • NDA hasn\'t come good universal insurance, drug costs promises
  • The successful HIV and TB eradication programmes are collapsing

The need

  • Health ministry says hike National Health Mission budget to Rs 40,000 cr
  • Gradually raise health spending to 3% of GDP from 1% now, say experts
  • Roll out universal insurance, free medicine schemes, rein in drug costs

Yalappa Dhange's 4-year-old son has acute lamphoblastic leukemia, a type of cancer that needs intensive care and expensive treatment. Dhange needs Rs 4 lakh over the next two years to get his son treated at Bombay's Tata Memorial Hospital.

To raise the money, Dhange, a marginal farmer from Maharashtra's drought-prone Solapur district, has already sold his farmland for Rs 50,000 and raised Rs 1 lakh through various charitable trusts. From the government, he doesn't expect any help.

Had Dhange been enrolled for Rashtriya Swasthya Bima Yojana, a universal health insurance scheme, or had access to cheap life saving drugs he may not have had to sell his farmland.

The government has policies for people like Dhange but they are far from effectively implemented.

Also read: #NotesForMrJaitley1: how to make this year's budget more farmer friendly

The NDA's last budget, in 2015, outlined the need for expanding and reforming India's healthcare system. It envisioned setting up of more hospitals modelled on the AIIMS and reducing tax on health insurance.

At the same time though, the government cut the already inadequate health budget allocation by 5.7%, Rs 35,163 crore in 2014-15 to Rs 33,152 crore in 2015-16. In all, the budgetary allocation for health has been slashed by 20% since 2013-14.

Not surprisingly, the Narendra Modi government has been unable to fulfill even its major poll promises on health - a new national health and insurance policies, better regulation of medical education and Big Pharma.

But now, as Arun Jaitley readies the 2016-17 budget, is the NDA regime's chance to redeem itself.

Catch spoke with doctors, activists and experts to understand, broadly, what the finance minister needs focus on to give the healthcare sector the impetus it urgently requires.

1) Implement the National Health Policy

The National Health Policy seeks to ensure universal health coverage, reduce maternal and infant mortality, increase access to free drugs and diagnostics in state hospitals. While rolling out the policy early last year, the health ministry had said it was meant to make health a fundamental right like education.

The policy hasn't got going, however. Several experts cite the failure to rope in private sector in the programme as the main reason.

The draft policy for the scheme has been in public domain for a year, but there is no clarity on whether it's the definitive framework the government wants to adopt while deciding it's priorities.

2) Provide comprehensive universal health insurance

India's "out of pocket expenditure" on health services is 60%, one of the highest in the world. To redress this, the NDA has repeatedly reiterated its intention to launch a universal health insurance scheme. It has only ever remained an "intention".

While the Rashtriya Swasthya Bima Yojana, launched by the previous UPA regime, which provides for cashless hospitalisation in both public and private hospitals, has seen some reform, experts have argued that the scheme itself can't guarantee "health assurance to all".

Also read: #NotesForMrJaitley2: Let Raghuram Rajan clean up the bad loan mess

"The present insurance schemes covers only hospitalisation. What is needed is not universal health insurance but a more comprehensive universal health assurance that covers outstation costs like that of medicines," says Prof Vikram Patel, Co-Director, Centre for Chronic Conditions and Injuries, Public Health Foundation of India.

3) Focus on disease eradication programmes

India has made substantial efforts to reduce the incidence of HIV/AIDS, tuberculosis, malaria. But due to a budget crunch, most of these efforts, like the National Aids Control Programme and the National Tuberculosis Control Programme, have come to a standstill - unfortunately after drastically reducing their incidence.

In fact, since the Modi regime took power in 2014, there have been regular reports of stock-outs of essential drugs for HIV and tuberculosis, which has marred the eradication programmes.

"What is needed is for the government to focus on the already well-planned disease control programmes. These programmes have a clarity on what they wish to achieve," says Dr Soumya Swaminathan, the head of the Indian Council of Medical Research.

Also read: Health hazard: In many states, obesity has doubled in the last 10 years

"The TB programme had a very good five-year plan, 2012-17. If fully funded, we could achieve much more in TB control that what we have achieved so far."

"Diseases like filariasis and kala-azar are on the brink of elimination. A final push is needed and for that appropriate budget allocation is imperative," she adds.

4) Roll out the promised free medicine scheme

This government has talked about rolling out a "free medicines scheme" to ensure availability of and access to life-saving drugs free of cost. But there has been no progress on it, other than an incentive to states to initiate such schemes.

Also read: #NotesforMrJaitley3: How to tackle the subsidy beast without harming the poor

However, such state schemes, even if launched, would be doomed without substantial central assistance.

Besides, according to Amit Sengupta, the convener of the Jan Swasthya Abhiyan, the government has only listed 50 medicines as essential to be included in the proposed scheme, which is highly inadequate.

Also, the National Pharmaceutical Pricing Authority has found it difficult to bring more medicines under price control due to pressure from Big Pharma.

5) Increase funding for the National Health Mission

The health ministry earlier this month asked for the National Health Mission budget to be increased from Rs 33,000 crore to Rs 40,000 crore, after finding that most states have shown a increase in expenditure under this scheme.

Kerala, for one, nearly doubled its expenditure over 2015, from 51% to 98%. Rajasthan, Madhya Pradesh and Chhattisgarh too witnessed an increase in the expenditure, while Bihar only used 46% of its budgetary allocation.

The National Health Mission focuses on increasing access to healthcare, especially in rural areas, by roping in social health activists and providing free diagnostic services for the poor. The need to substantially increase the investment in this scheme can't be overstated.

More money, sharper focus

All this clearly underlines the need to significantly increase the health budget, according to healthcare experts.

Prof Patel of the Public Health Foundation argues that "adequate financing" of the universal health insurance coverage plan is of paramount importance.

"Also, the annual budget should give an idea of what the government's intention is over the next five years," he says. "The aim should be to raise the health budget to at least 3% of the GDP." Currently, India barely spends 1% of its GDP on health.

Dr. Swaminathan argues for an increase in the budget allocation for nutrition programmes - mid-day meal, the Integrated Child Development Scheme - to improve and expand them. She also emphasised the need to focus on nutrition programmes for pregnant women, adolescent girls and children.

Also read: Lancet concerned with healthcare in India. Did we expect anything else with such budget cuts?

"There should be more investment in health research, with a focus on research that could help eliminate diseases which have a greater chance of being eliminated and for which an elimination framework has recently been announced such as leprosy, measles, filariasis and malaria," she says.

Clearly, India's public health urgently needs a well thought out, generous health budget.

Edited by Mehraj D. Lone

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First published: 15 February 2016, 10:46 IST
 
Vishakh Unnikrishnan @sparksofvishdom

A graduate of the Asian College of Journalism, Vishakh tracks stories on public policy, environment and culture. Previously at Mint, he enjoys bringing in a touch of humour to the darkest of times and hardest of stories. One word self-description: Quipster.