By Dr. Gyan Pathak
The last two years – 2020 and 2021 – have driven us to a crossroads where we need to decide whither to go. Everybody by now might have witnessed how the heath and economic development are in cyclic order and closely interlinked. Our government at the centre led by the PM Narendra Modi, might have understood by now that their drumming up for health insurance has no meaning if we don’t have access to the healthcare system well equipped with infrastructure, technology, and manpower. The COVID-19 pandemic should be an eye opener, and therefore the Union Budget 2022-23 must focus on capacity building for health to make stronger healthcare system the only way left to us.
What India did for the last two years was only the things that someone does in case of emergency. The pandemic had necessitated the measures that were required urgently to put in place, such as vaccination for COVID-19, the adhoc creation of logistics to carry on the vaccination drive, enhancing the supply of medical oxygen, medicines, etc, providing training for healthcare to even non-health care professionals and so on. The whole system focused on the single point programme, that is, to tackle the COVID-19 patients. And we ignored other serious health conditions, inoculations for other diseases, and general medical care for other patients who were made to suffer due to our incapacity of parallel handling, and additional thousands of patients even lost their lives apart from those 4.75 lakhs due to COVID-19.
All these have proved that our policies were wrong. At a time when people of India were demanding an increase of nurses, doctors, hospitals at a distance they can go at times of emergencies and at affordable cost of accessing them along with medicine and surgical equipments, our Prime Minister came with health insurance programme like Ayushman Bharat. He refused to understand the demand which was so simple that even simpleton can understand. How can the insurance help if there is not nurse, no doctor, no hospital, no medicine, and no health equipments? But the common people neither have voice nor power to get their works done.
After a year of the pandemic, the Union Budget 2021-22 was tabled in the Parliament of India, which did not reflect any wisdom on the part of the Modi government. They had claimed that the health sector budget has been increased 137 per cent to 2.23 lakh crore for 2021-22 as against only 94.45 thousand crore in 2020-21. However, that amount brought forward is a boast actually veiled the real allocation announced for health sector. The outlay included budgets for even Jal Jeevan Mission (Urban), Swachch Bharat Mission, Clean Air programme, and many more.
We hope, this time Modi government will not resort to such hoodwinking of the people. Health budget must be focused on healthcare infrastructure, nurses, doctors, hospitals, other healthcare workers, equipments, medicines, medical and nursing colleges, and so on. Water, food, air, and countless other things do contribute in better health, but it would not be good on the part of the government to add all their budgets to health to show a big allocation.
The fact remains that contrary to claims being made by the Modi government regarding increased health expenditure in 2020 and 2021, India needs a substantial increase in the budget allocation to strengthen the entire healthcare system rather than simply focusing on meeting the emergency healthcare needs.
India needs a strong foundation on which healthcare system can be restructured without which people’s health cannot be protected effectively, not only from the present COVID-19 threats from its emerging variants but also from the future threats. Additionally, Climate change issues are posing numerous other threats to our health, for which India needs to be prepared, since it is one of the worst affected countries in the world.
The Centre must enhance its share in total healthcare expenditure, which according to the National Health Accounts are about 34 per cent, while the 66 per cent is still borne by the state governments since health is in concurrent list of the Union of India. Moreover, prioritization of the consolidated government budgets is badly required, which had been emphasized even in the Economic Survey which mentioned that India ranked 179th out of 189 countries. It was surprising that Modi government ignored this pathetic conditions mentioned in their own document.
Modi government should be credited for coming out with the new National Health Policy in 2017 which had set a target of enhancing the health expenditure from merely 1 per cent of the GDP to 2.5 – 3 per cent by 2025 so that out of pocket expenditure of patients could be brought down from 65 per cent to 30 per cent of the overall healthcare spend. However, in the present scenario we could not wait for so long.
The pattern of expenditure shows that how badly government healthcare centres are performing. Bulk of healthcare is provided by the private sector in the country which is too costly for common and poor people.
In healthcare access and quality, India ranked 145th out of 180 countries, as it is mentioned in the Economic Survey 2020-21. We have come to this situation because health expenditure was merely 1.5 per cent of GDP in 2019-20, ie in the pre-pandemic year. However, in the pandemic year 2020-21, it could be increased only to 1.8 per cent of GDP indicating a dismal performance of Modi government. Some international papers have estimated India’s present need between 9 to 14 per cent of the GDP depending on different scenarios. Modi government therefore must substantially increase the public health expenditure in the coming budget itself. (IPA Service)