This is the last full budget of the present government and the last opportunity for it to demonstrate its commitment to India’s health and nutrition
Slow improvements in basic indicators of maternal and child mortality, double burden of communicable as well as non-communicable diseases, high out-of-pocket expenditure, a failing public sector and heavily commercialised private sector characterise the healthcare crisis in India.
The year 2017 saw a number of incidents in the health sector across the country which highlight each of these issues.
While the deaths of children in a public hospital in Gorakhpur due to alleged disruption of oxygen supply highlighted the systemic failures in public health provision, the cases of excessive billing and negligence in big corporate hospitals (e.g. the case of dengue death in Fortis Hospital, Gurugram) showed that the unregulated private sector is no solution to India’s healthcare problems. The protests against the NEET examination, mainly in Tamil Nadu, brought forth the complexities involved in ensuring a fair and inclusive system of medical education. On the other hand, the resistance to the Karnataka Private Medical Establishments Act (KPME) demonstrated the difficulty in regulating the private sector and the influence of doctors working in the private sector.
The list is long and endless, but what all of these point to is that the health sector in India needs serious overhaul and much greater attention.
Public spending on health
One of the central problems has been the low levels of public spending on health and as a result the poor access to affordable and good quality healthcare for the majority of India’s population. The public expenditure on health at about 1.2% of the GDP is amongst the lowest in the world. Public health facilities suffer from poor infrastructure and human resource inadequacies. For instance, according to the Rural Health Statistics 2017, 13% of the sanctioned health worker (female) posts and 37% of the health worker (male) posts remain vacant. Overall, only 11% of sub-centres and about 13% of primary health centres (PHCs) are functioning as per Indian Public Health Standards (IPHS). There is therefore an urgent need for more resources to be allocated for public healthcare along with measures to strengthen the delivery of health services.
The National Health Policy 2017 aims to “increase health expenditure by Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025”
Although it has already been reported that the health budget is not going to see a significant increase, it has to be noted that without a substantial enhancement in the allocations much of the needed reforms in healthcare provision will not be possible. Achieving this, requires not just an enhancement in the central budget but also increases in each of the state budgets as well. However, the central government can play an important role.
Further, it also needs to be recognised that a number of states currently do not even have the spending capacity (one big reason for this is also the lack of human resources) and therefore along with the increase in allocations, a number of steps need to be taken towards strengthening the public health system.
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