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23
February 2017
Health Budget (The Total Investment & Insurance
Solutions)
Despite a
Rs10,290-crore increase for 2017-18, an analysis of the Union governments
health budget reveals that most of this money is not being spent on Indias
health priorities, which, instead, now face funding cuts. The Total Investment & Insurance Solutions
Elimination
of tropical diseases (kala azar, filariasis and leprosy) over two years;
elimination of a vaccine-preventable disease (measles) by 2020; elimination of
tuberculosis (TB) by 2025; and "significant reduction" of infant and
maternal mortality by 2020 -- these were some key proclamations related to
health made by Union Finance Minister Arun Jaitley during his February 1 budget
speech.
Given that
India has an infant mortality rate (IMR) of 37 per 1,000 live births (higher
than the average for 154 middle- and low-income countries), the world's highest
TB burden (with 27 per cent of new cases), and accounts for 58 per cent of new
leprosy cases detected globally, Jaitley appeared to address some of the
country's most significant public-health concerns.
Adequate
funding could lead to significant improvement in health systems and health
status. But Jaitley's budget indicates inadequate allocations or funding cuts
to his declared priorities.
To eliminate
measles, India will need to invest in stronger immunisation systems and social
mobilisation. It is starting the first phase of a measles-rubella vaccine
campaign to immunise 35 million children in 2017 and 410 million children over
the next two years. The Total
Investment & Insurance Solutions
Has money
been set aside to achieve these targets? It appears not.
The Union
health budget includes a separate head, the National Rural Health Mission
(NRHM), to fund state rural healthcare. Within the NRHM budget is a sub-head
called the "Reproductive and Child Health (RCH) Flexi-pool", which
sets aside funds for immunisation, including funding of the polio-eradication
campaign. The Total Investment
& Insurance Solutions
To improve
healthcare in urban areas (where measles remains a significant problem due to
high population densities), the budget sets aside money under the head National
Urban Health Mission (NUHM). The Total
Investment & Insurance Solutions
To fund the
measles campaign and eliminate measles, funding under RCH flexipool (for rural
areas) and under NUHM (for urban areas) should have been higher than previous
years.
Instead,
funding for the RCH flexi-pool has been cut 23 per cent, from Rs 5,932 in
2016-17 to Rs 4,566 in 2017-18. Similarly, funding for the National Health
Mission, which aims to provide universal access to affordable and quality
healthcare and funds both NRHM and NUHM, has been reduced by Rs 197 crore over
a year. The Total Investment &
Insurance Solutions
India has 27
per cent of the world's new TB cases -- one of its biggest infectious disease
killers. As we said, the Union budget's NHRM head provides for healthcare in
rural India. Within this budget head is a sub-head called "Flexible Pool
for Communicable Diseases", which includes funding for the Revised
National Tuberculosis Programme. The
Total Investment & Insurance Solutions
Now, funding
appears to have increased by Rs 87 crore over a year to 2017-18, but the
revised budget estimates -- drawn up after the budget is presented -- reveals a
drop of Rs 13 crore over 2016-17.
In the
2017-18 budget, funding for Indira Gandhi Matritva Sahyog Yojna (Maternal
Benefit Scheme) has risen 226 per cent, from Rs 634 crore ($94.6 million) in
2016-17 to Rs 2,700 crore ($298 million) in 2017-18, but this allocation isn't
enough to cover all expectant mothers.
The
government itself had estimated that the the annual requirement for this
maternity benefit scheme -- which provides iron and folic-acid supplements to
pregnant women to prevent maternal anaemia, sepsis, low birth weight, and
preterm birth -- would be Rs 14,512 crore ($2.1 billion), according the report
of the Standing Committee on Food, Consumer Affairs and Public Distribution
(2012-13).
So, the
ministry plans to provide maternity benefits only to first-borns, leaving other
children vulnerable.
So where is
the additional money going? A major increase in allocation has been towards
more medical colleges at district hospitals, an increase of Rs 2,855 crore,
accounting for about 27 per cent of the Rs 10,290-crore rise in health funding. The Total Investment & Insurance
Solutions
India does
need more medical graduates, but increasing medical colleges will not be easy,
considering that even premier institutes, such as branches of the All India
Institute of Medical Sciences (AIIMS), in state capitals are struggling. For
instance, five years after the first batch was admitted, AIIMS Bhopal does not
yet have a blood bank and does not conduct surgeries, and important faculty
positions are vacant.
That bring
us to the other significant increase: Rs 1,525 crore more for Pradhan Mantri
Swasthya Suraksha Yojna (the Prime Minister's Health Protection Scheme), which
is supposed to set up new branches of AIIMS in the states. In addition to the
11 that exist, Jaitley announced setting up of two more AIIMS, in Jharkhand and
Gujarat. The Total Investment
& Insurance Solutions
Instead of
opening new institutes, and investing about eight per cent of the health budget
(Rs 3,975 crore of Rs 47,352 crore) to do so, the government should ideally
focus on making sure that the ones already opened are functioning. The Total Investment & Insurance
Solutions
Another
significant increase of about Rs 3,000 crore is under the "Health System
Strengthening" subhead of NRHM. This is likely to be allocated to another
pronouncement: Converting 150,000 health sub-centers nationwide into
"health and wellness centres".
The Total Investment & Insurance Solutions
Again, this
is not a bad idea, since functional sub-centers can take primary healthcare
closer to where people live. But with no plan for this transformation made
available -- not even how many will be converted this year -- Rs 3,000 crore
appears inadequate.
For example,
even if 25 per cent of the increased allocation under this sub-head is to
upgrade sub-centres, no more than Rs 60,000 would be spent per
sub-centre. The Total Investment
& Insurance Solutions
So, while
the current budget's health proclamations are apt, the funding increases for
issues of low health priority are unlikely to make a significant impact on the
overall well-being of the people.The
Total Investment & Insurance Solutions
