The Government must focus on promotive and preventive health
By Dr Girdhar Gyani
The society is beginning to be conscious about healthcare needs. The Government too is seen to be sensitive about it. Healthcare is gradually becoming an election agenda and that indeed is the good sign. We generally measure and identify the progress in healthcare with curative component i.e. hospital-based care. This is because India is faced with double burden of communicable as well as non-communicable diseases. In a democratic set-up, the Government is expected to provide support and ultimately pave the way for universal health coverage. Budget is the first indicator for Government to demonstrate its commitment towards taking care of health needs of population.
The central Government budget provided Rs 52,800 for health in the preceding year 2018-19. This was just 5% higher than revised budget in year 2017-18 i.e. 50,079/. This was 25% up as compared to preceding year of 2016-17. One reason for lower increased allocation in 2018-19 was cited as poor utilisation of budget by centre as well as state Governments. Thus on one hand we have been complaining of very poor allocation for health, and on the other hand we are unable to utilise the existing budget.
Considering that the Government has embarked upon ambitious Ayushman Bharat scheme, which will extend cashless healthcare to 40% of population, it is estimated to cost 120 billion annually, 60% of which will come from the central budget. It is likely to be met from education and health cess. Besides 1.5 lakh sub-centres would progressively over three-years need up-gradation to health and wellness centres. As 60% beds are with private sector including 90% of tertiary beds, the Government would need to cater procuring medical services at market rates and for which budget must make provision. In a short span of launching of PMJAY on 23rd September, the scheme has failed to bring private sector on board for want of appropriate rates presently fixed for 1,350-medical procedures.
The shortage of human health resources is the main reason that we have not been able to deliver healthcare needs to population. We were short sighted in the past to overlook this aspect. Any amount of increase in budget will not be of any help unless we have qualified human health resources. As per rural health statistics, there is 81.5% shortage of surgeons, gynaecological and paediatricians specialists in community health centres. In terms of healthcare staffing, 13% female and 37% male positions are vacant. Only 11% sub-centres and 13% PHCs are equipped as per IPHS. These are the basic reasons for our slow improvements in basis health indicators like IMR/MMR.
Our budget needs to have long term as well as immediate goals in mind. We need urgent focus on how do we make good the shortage of specialists (not merely the MBBS doctors). We need to open institutes like PGIs and not so much the AIIMS, which are unable to function for want of specialist faculty. We have not been able to revamp nursing council to have nursing reforms, due to which there is decline in young girls taking nursing as career. Only recently (November 2018), the Government have introduced Allied Healthcare Profession Bill to regulate, standardise education and services. This should have been done much earlier. The budget must provide appropriate component to fast track functioning of this council, so that young generation is attracted toward skill-based education and long-term career in health services.
After human resource, budget next must cater to improve accessibility of health services. We might have achieved 1-bed per 1000 population, which to an extent is inching towards ensuring availability, but due to heavily skewed distribution, there is poor accessibility. As an example we have about 170-hospitals with 100-bed and above in state of Telangana, out of which 150-are located in Hyderabad. It is the same in all states. The budget must provide incentives to private sector to set up hospitals in tier-II/III cities.
The Government of late has been taking initiatives like price control for medical devices, components and drugs with aim to make healthcare affordable. At present most of medical equipment are imported. The Government can reduce import duty till we have indigenous availability. Another area is to provide relief in electricity tariff. Surprisingly hospitals are being charged electricity at same tariff as being charged from cinema halls or shopping malls.
Lastly, the Government must focus on promotive and preventive health. It is saying that one rupee spent on preventive health can save one hundred rupees on curative part of healthcare. This can be achieved by engaging NGOs and gram panchayats to promote sanitation, clean water and healthy environment. Presently, different ministries are looking after these functions, may be these could come under integrated ministry. Equal emphasis is required on making good the nutritional needs. And a good portion of the budget must be allocated on this aspect. ‘Pradhan Mantri Matrititva Vandana Yojana (PMMVY)’ which provides Rs 5,000 cash benefit to pregnant and lactating women is one such excellent initiative, but for want of effective implementation, its benefit is not reaching to desired levels.