The absence of significant statements of intent or noteworthy financial outlays on health in the Union budget is glaring, given that these are the two identified priorities for the Twelfth Plan starting this year. Both these sectors need inspiring governmental leadership to realise the demographic dividend from a young population. On healthcare, Finance Minister Pranab Mukherjee announced only an incremental increase of about Rs. 2,700 crore in the allocation for the National Rural Health Mission. He referred to the planned launch of a National Urban Health Mission and improvements to some government medical colleges for better tertiary care. This is all very welcome, but none of this measures up to the scale and scope of the reform proposals now before the Planning Commission, seeking to provide a certain level of guaranteed, tax-funded Universal Healthcare (UHC) to all Indians through public and private hospitals. It must be emphasised that this issue, along with education, deserves the same level of commitment from government as Defence. In his speech, the Finance Minister said the outlay of Rs. 1.93 lakh crore for Defence Services was based on present needs, and any further requirement would be met. The approach to healthcare during the Twelfth Plan should be no different. If State governments join the effort, as indeed they should, a suitable taxation regime by the end of the Plan can make UHC self-sustaining.
Significant government support would be required to make progress on a National Health Package offering free treatment under UHC. Several tasks have to be accomplished in parallel. These include creation of trained public health cadres, setting up of a National Health Regulatory and Development Authority to evolve norms for treatment, costs and so on, and developing an Information Technology platform to administer the massive enterprise. The challenge to achieve quality and access is staggering. The global average of hospital beds to population is 2.9 per thousand, but India has 0.9 beds. If there is a focus on preventive care, a lower ratio of 2 per thousand would be able to meet the national requirement by 2022, estimates say. But what is particularly worrying is that half of the beds now available in government facilities are listed as “non-functional”, along with 30 per cent in the private sector. It must also be pointed out that rural citizens have shockingly low levels of hospital bed access, especially in central India, compared to urban counterparts. Evidently, it will take a Herculean effort over the next five years to create a foundation for UHC. The finalised Plan and the financial outlays will reveal whether a revolution is on the anvil.
Keywords: NRHM, healthcare sector, Union budget 2012
Presently, the annual average withdrawals/transactions from the banks are roughly as under:
Rs.165 lakh crores cheque transactions per annum
Rs. 45 lakh crores cash transactions per annum
Note- These do not include inter bank transactions, ECS, Credit Card/Debit card transactions.
Indian population is around 120 crores. Assuming that we need to raise an annual premium of Rs.2000 per citizen, we would need Rs.2.40 lakh crores per annum.
If at the withdrawal stage of moneys from the Bank, a mere 1% levy is made towards what we may call “National Insurance Fund” against a total assumed withdrawal of Rs.210 lakh crores referred to above, we should be able to generate 2.1 lakh crores of Insurance Fund. I am leaving the rest to the imagination of the governments.
Healthcare and education are not the constitutional duties of the
government.What is the purpose of existence of union government?.Why
do the people of India need a Union government?.The only
responsibility of the union government should be National Defense,Foreign policy and Judicial System(Enforcing Law and
Contracts).The healthcare and education must be taken care by state governments.Socialism in Healthcare is not required.Socialism spreads
poverty and suffering across the society as we saw in soviet union and
still see in north korea and cuba.The government involvement in health
care will result in higher costs and lower quality as we have experienced in last 60 years ourselves.What we need is more private
hospitals and doctors,which will result in competition,higher quality
and lower price for healthcare just like the telecom sector.
Healthcare in India like many other sectors is in bad health. We can't
use double standard prism to view health of rural and urban population.
Health is as important for urban people as for rural. Today as things
stand none of the two is getting satisfactory health services. But the
situation for rural population is terrible. Urban people have at least
something to cheer about. There is no such concept like primary health
care in villages like mine which by the way falls in a Bhojpur district
in Bihar. In case of any emergency we need to run a minimum of 25km for
minimal help at maximum cost in near by village town. The government
hospital, "SADAR HOSPITAL" as they call it was anything but a shelter
to stray animals and hounds. Recently it got some rejuvenation thanks
to state government fund. But it is till not in good health as per the
standards. Rural health needs honest and prompt attention to prevent
our backwaters taking course to becoming black-water.
Why is there no criticism over the huge increase in defence budget? there should be a rational analysis over the current threat perceptions which mostly is unconventional. The bogey of nuclear armed neighbors is not an excuse to throw vast sums of money to the army when children are dying of malnutrition, people lack toilets and the poor are getting more miserable.Indians are prone to hyperbole when it comes to the defence services and everyone and his aunt becomes a 'true patriot'. The planners should get their priorities right and not turn the country into a police state.
Every citizen of the country has the right to get proper health amenities. But, it is the Government who has been drawn a line for which a poor man can not able to pay for health spending. In this the institution of National Health Regulatory and Development Authority might be a good sign but suspicion still alive regarding its availability for the poor people. At the same time budget allocation for the health sector is not satisfactory!
In India, Some states like AP are implementing programmes like 'Aaroyga Sri' where all white card holders are provided by free health care all over across AP including private hospitals. Central Govt. if in its coming 5 year plan would come with such proposal,it would be a great thing....
Making UHC reality will be a challenge for both government & civil society just like food security.
Note that in case of food security, government has made committment from as early as 2009 Election Manifesto. But for UHC, there is firm no committment yet. So, on citizen's part, its responsibility of media & citizens to inform, educate more & more people about what is UHC & what is its potential. So that wide awareness & consesus and ultimately pressure on government can be build up - just like food secuity.
Thank you The Hindu for this article.
The JNMCH covers the health needs of 50 km radius around Aligarh,with 4 lakhs patients attending OPD annualy. The funding of JNMCH is by UGC is meagre 2 crore/ year. The hospital authorities are unable to provide free drugs and medical equipments for patients.The basic essential drugs, intracatheter and equipments of emergency are not available in adequate quantity as in other government hospitals.. The hospital is 1150 bedded with only 3 functional ventilators in ICU. So the RDA has a demand to increase the revovlving fund per year for JNMCH .Meanwhile, during his surprise visit to the medical college in jan 2010,Ghulam nabi Azad is reported to have expressed his "strong displeasure" at the "pathetic condition" prevailing in different wards of the medical college hospital. Still JNMCH, Aligarh is waiting for increased funds from government.
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