[Answered] Health budgetary allocation must go up if India is to prepare for an unpredictable epidemic. Comment.

 

Demand of the question

Introduction. Contextual introduction.

Body. Discuss why health budgetary allocation must go up in India to prepare for an unpredictable epidemic.

Conclusion. Way forward.

 

With the rise in epidemics like coronavirus, there is a need to increase spending on healthcare to prepare for any unpredictable epidemic. We need innovative technology solutions for India’s healthcare requirements and the government’s increased focus on the healthcare sector to tackle any future risk. The next few years are important to remove India’s long-standing healthcare issues, and at the same time, adapt to meet the ever evolving healthcare needs of its citizens.

 

Need of increasing health budgetary allocation to prepare for an unpredictable epidemic:

  1. Rise in demand: With the rise in epidemic cases, for instance the recent coronavirus positive cases, there is ever-rising demands for testing kits, for hospital beds, ventilators, masks and hand sanitisers. This demand for increase in spending on keeping stock of these facilities to match future supply to demand.
  2. Access: Access to healthcare in India is poor. The Lancet in its latest study ranked India at 145th among 195 countries in terms of quality and accessibility of healthcare, behind its neighbours China, Bangladesh, Sri Lanka and Bhutan. Thus, there is a need to increase the health budget to make healthcare accessible in case of future epidemic.
  3. Insufficiency of Hospital Beds: Penetration of healthcare infrastructure, much lower than that of developed countries and even lower than the global average, the bed density in the country is 0.7 per 1,000 population, far below the global average of 2.6 and WHO benchmark of 3.5.
  4. Lack of doctors: India suffers from lack of doctors and clinics, especially in rural areas and in case of epidemics and diseases. India faces a shortage of about 6 lakhs doctors, one million nurses and a large number of paramedical staff. Thus patients are either never diagnosed or diagnosed too late. This requires an increase of health budgetary allocation.
  5. Neglect of Rural Population: According to health information 31.5% of hospitals and 16% hospital beds are situated in rural areas where 75% of total population resides. Moreover the doctors are also unwilling to serve in rural areas.
  6. Abysmal GDP spending: For years, India’s health expenditure as a percentage of GDP has been abysmal at about 1%, compared to 3 per cent in China and 8.3 percent in the United States. Thus, to prepare for any future epidemic there is a need to increase spending on healthcare and mitigating sources.
  7. Per-capita public health expenditure: As per the National Health Profile, 2019, per capita public expenditure on health in nominal terms is ₹1,112 in 2015-16 which is quite low and needs to be increased. A WHO bulletin of 2018 records that out-of-pocket payments remain common in India, which in 2014, was estimated at 62% of total health expenditure.

 

Steps taken by Government:

Support to statesSupport is provided to States under NRHM, to strengthen the health system including establishment and renovation of health infrastructure, engagement of Nurses, doctors and specialists on contractual basis.
National Health MissionNational Health Mission (NHM) encompasses its two sub-missions, the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM). The main programmatic components include- Health System Strengthening in rural and urban areas, Reproductive-Maternal Neonatal-Child and Adolescent Health (RMNCH+A) and Communicable and Non-Communicable diseases.
Ayushman BharatIt has two component- a) Health and Wellness Centre which will provide Comprehensive health care and will be responsible for providing free essential Drug and diagnostics Services, and b) National Health Protection Mission which will subsume the on-going centrally sponsored schemes– Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme.
Jan AusadhiPradhan Mantri Bhartiya Jan Aushadhi Pariyojana Kendra has been set up to provide generic drugs, which are available at lesser prices but are equivalent in quality and efficacy as expensive branded drugs. This will help to reduce out of pocket expenditure.
National Medical Commission BillReplace the medical commission of India with the national medical Commission as the top regulator of Medical Education. AYUSH practitioners are allowed to practice allopathy after completing the bridge course.
Financial assistanceFinancial assistance is provided to the States/UTs for selection and training of Accredited Social Health Activists (ASHA), who act as a link between community and healthcare facilities.

 

Way forward:

  1. National Health Protection Scheme: The government should focus on healthcare financing, particularly for the part of the population that cannot afford healthcare. Launching the National Health Protection Scheme (NHPS) is a step in the right direction.
  2. NITI Aayog Action plan: It aimed at reducing the out-of-pocket spending on health to 50% by 2020 from 63.4% at present. It recommends to focus on public health through significantly increasing government expenditure on it and prioritize preventive care rather than provide curative care.
  3. National commission: The government should appoint a national commission which makes recommendations for the spending on healthcare systems and monitors its performance.
  4. Universal health coverage: State governments should draw up blueprints for universal health coverage and begin experimenting and innovating with pilot programmes.
  5. Involving the private sector: Given that the private sector accounts for nearly 70% of India’s healthcare, this sector has a critical role to play in supporting the traditional public sector-led response to the prevention and tackling of outbreaks. Investing in mechanisms to bring private sector players together is likely to contribute to better coordination, greater resources, more time and expertise during an emergency.
  6. Public health regulatory authority:A public health regulatory authority such as the Food Safety and Standards Authority of India should be established. A public health regulatory authority can propose, review and revise public health legislations on a periodic basis, recommend and provide scientific advice and technical support for the framing of state rules.

 

There is evidence to show that increased public spending on health care has resulted in less financial hardship for communities and better health outcomes.  This epidemic is an opportunity to drastically scale up budgetary allocations for health to facilitate expansion of capacity. Epidemics are known to change the course of history. India must steer this one to harness finite resources optimally for the benefit of all.

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