The basics are vital (Strengthening primary health care is the key)

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 The basics are vital (Strengthening primary health care is the key)

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• Primary health care : A 2011 study suggested that 70% of all government health spending must go to primary health care. The NHP 2017 (National Health Policy) also advocated upto 66% or more to it, towards achieving the goal of "the highest possible level of good health and well-being, through a preventive and promotive health-care orientation".
• The latest plan : In 2018, Rs.1200 crores was proposed to transform 1.5 lakh sub-health centres into health and wellness centres by 2022. Aim was to give more services than today.
• How much per centre : The government estimated it would need Rs.16 lakh per sub-health centre to convert it to a health and wellness centre. The outlay now is Rs.1600 crores (up 33%) under the NHM (National Health Mission). This is inadequate, and will neither help upgrade nor meet the total target of number of centres (1.5 lakh by 2022).
• NHM situation : The primary health care component is in bad shape, in the NHM. The share of NHM in health budget has gone from 73% in 2006 to jut 50% in 2019, as States did not raise their shares. Total NHM budget for 2019-20 is Rs.31,745 crores (same as in 2017-18).
• Commitment to increase access : Government is committed to improve on access, but it is being done via private players. There is a 167% increase in allocations under PMJAY (PM Jan Arogya Yojana) which is an insurance programme to cover 10 crore poor families. Most of these spendings will be on care received in private sector hospitals.
• Poor infrastructure today : Indian PHC and Sub-Health centres are numerically less, and many are in poor physical condition too. Shortage of medical and para-medical staff is huge.
• What should be the goal : No doubt, making hospitalisation affordable (PMJAY) is giving immediate relief to citizens, but in the medium to long term, there is just one solution - strengthening primary health care systems. A strong primary system reduces the load on the links ahead. 
• Vision 2030 : The ninth dimension speaks of "Healthy India". Without a sustained increase in public health expenditure over the next decade, it may not happen.
• Summary : India needs a sustained increase in health spending, specifically on primary health care, to ensure that the Health India dimension of "Vision 2030" is achieved.

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