The Finance Minister, Arun Jaitley, is known for his close association with cricket. It is not surprising that his recent budgetary announcements reflected a combination of the long, short and ultra-short versions of the game. His steps to scale up medical education by starting “diplomate national board” courses in district hospitals had the timed elegance of a Test cricketer, while the pronouncement on transforming 1,50,000 health sub-centres into health and wellness centres for strengthening primary care conveyed the one day game’s sense of urgency. The bravura of several infectious disease elimination targets, set to be achieved in a very short time frame, suggested the audacious ambition of a T20 stroke-maker.
The Health Ministry lost the toss and had to accept a very modest increase in allocation, while the Minister set it on a daunting chase of tough targets on a difficult pitch. The overall budget of the ministry rose by less than ₹10,000 crore, of which the increase for the National Health Mission (NHM) was about ₹5,500 crore. Despite the huge mandate to improve India’s lagging health indicators, in the face of multiple public health challenges, the health budget continues to be disappointingly low. The expectation that the National Urban Health Mission component of NHM would be soon launched to scale is belied by the meagre increase in NHM’s finances.
Maternal, child health
The emphasis on maternal and child health is well placed. The Budget proclaims intent to reduce the infant mortality rate from 39 in 2014 to 28 by 2019, and maternal mortality ratio from 167 in 2011-13 to 100 by 2018-20. While a further acceleration of the recent decline in these two rates is likely, sharper declines will call for many effective actions — from promoting the health and nutrition of adolescent girls and pregnant women to improving the quality of care in institutions where women go to deliver. The Maternity Benefit Programme needs to be universal rather than conditional if it has to reach the most vulnerable sections and skilled health professionals will be needed to assure safety of the mother and the newborn. Raising standards of care in sub-centres, primary health centres and community health centres will need more human and financial resources.
The Minister also announced that kalazar and filariasis will be eliminated in 2017 — yes, this year! — leprosy by 2018, measles by 2020 and tuberculosis by 2025. While such optimism can energise the health system, it is prudent to be aware of technical factors that influence these targets — leprosy has an incubation period of 3-5 years and we will have to wait at least till 2022 to know if we have finally overcome the problem. Tuberculosis will pose many stiff challenges — health systems across the country and both public and private care providers will have to markedly improve their practice patterns in diagnosis and treatment.
After the big boost for kidney dialysis in the last Budget, non-communicable diseases got a dot ball this year, despite their rising threat to health and economy. Will the introduction “wellness” at sub-centres stop with yoga or will it also involve prevention, early detection and care of high blood pressure, diabetes and attention to mental health and common cancers? Cigarette taxes went up a bit but beedis again received a “free hit” from the Minister.
The proposal to promote generic drugs and control drug prices is welcome. However, the absence of any reference to the National Health Protection Scheme, announced last year and expected to be operational from April this year, was a total surprise. It is not known what the current thinking on creating a national framework for universal health coverage is. Are both the Health and Finance Ministries waiting for the final decision of the “Third Umpire”?
Prof. K. Srinath Reddy is president, Public Health Foundation of India. The views expressed are personal.