The unmet health challenge

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The unmet health challenge

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• High hopes on health: Everyone expected a major upgrade in public health spending, post Covid-19 pandemic. 

1. The Economic Survey spoke of raising public spending from 1.5% (present) to 2.5% - 3% of GDP. Why? So as to minimise the OOPE for citizens (out of pocket expenses).
2. It also found no major outcome difference between private and public sectors, and hence asked for NHM strengthening (National Health Mission, launched 2005) alongwith Ayushman Bharat (PM-JAY, launched 2018, insurance financing using taxpayer money for private healthcare).
3. It called for better regulation of private health services in India.

• What FM said: The finance minister claimed in Budget speech that there was a 137% growth in healthcare spend, and it was a pillar for this year. Claims were made on "One Health" for India, including PMANSY (PM Atmanirbhar Swasthya Yojana), water and sanitation. But the truth is different.
• Factual story: 

1. Department of Health and Family Welfare (NHM, PMJAY) got a 9.6% rise
2. Small departments got big rise (AYUSH etc.)
3. Finance Commission grant of Rs.13000 cr and Rs.35000 cr for Covid vaccines are one-time
4. Core health ministries got only 11% rise
5. Health services gor only 2.21% of total central budget (down from 2.27% in 2020-21); so in real terms it is negative growth
6. Water and sanitation got a 179% rise (from Rs.21518 cr to Rs.60030 cr). This is for Swachh Bharat and Jal Jeevan.
7. Nutrition scheme Poshan 2.0 got minus 27% allocation (two programmes combined in it now)
8. Summary - healthcare and nutrition actually decreased, while water, sanitation, nutrition and health got most of the 137% rise.

• PMANSY: This new scheme got Rs.64180 cr over 6 yrs, but is not calculated in Budget figures! So will it come from 2022? It has the intent to strengthen primary, secondary and tertiary service institutions, but that can be done in NHM itself. 

1. NHM allocations have been stagnant since 2014, but this year’s 1.3% rise (to Rs.30100 cr) shows govt. now realised public hospitals matter. 
2. But can Rs.11000 cr per year really make PMANSY ensure 'universal health coverage'? Can it reduce OOPE? 
3. Expert Group on Universal Health Coverage had estimated far higher allocations, ultimately reaching 10% of total budget (presently 2.21%).

• Is it a dream: So public provisioning of universal health coverage is not happening anytime soon. Option now is to make low-cost and rationalised service system. Insurance schemes are not the solution, as they look affordable while adding to people's costs. The only way is community and public services. (for any country)
• Water and sanitation: They are crucial, but how can their allocations be taken under "health and well-being" to create the sense of more allocations? It is diverting attention from the urgent task of building a real universal healthcare system.

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