Double the number of doctors, nurses……..Debashish Mishra
Decades of neglect has resulted in a crumbing health infrastructure and very poor access to quality public healthcare in India. While the total health spending is about 5-6% of the gross domestic product, the government contribution to the same is a little over 1% of GDP. Budget allocation for health in 2008-2009 was Rs 16,534 crore.
The National Rural Health Mission (launched in 2005) has been envisioned to bring about fundamental improvement in basic healthcare delivery. The government has intentions to increase spending on healthcare to up to 3% of GDP.
The underutilisation of funds, particularly in the poorer states, is a big concern as it widens disparity of health outcomes within the country. The government must increase efforts in capacity building in institutional delivery, training of accredited social health activists and use of ICT in improvement of health services. To improve health services, the number of health workers (70 lakh doctors and 90 lakh nurses) needs to double. Which means the country immediately needs more medical and nursing colleges.
The results of the National Family Health Survey of 2005-06 showed a significant difference in health status of urban poor and non-poor populations. Health status of the urban poor, in many instances, is worse than the rural poor. The government has planned the National Urban Health Mission (NUHM) with the aim of providing basic primary-level care in urban areas. We expect NUHM to be announced in this Budget with an allocation of at least Rs 8,000 crore.
Currently, less than 10% of the population is covered under some form of insurance. Under the Rastriya Swasth Bima Yogana, launched last year, every BPL worker in the unorganised sector and his family would get health cover of Rs 30,000. There are mixed views on the effectiveness of these programmes, but they are critical for the poor and most vulnerable people in society. A national programme for the elderly, with an outlay of Rs 400 crore, was announced last year and should be stepped up this Budget.
Because of the poor pubic health system in India, the private sector has proliferated. But this has happened in a fragmented manner, without proper regulation and widely varying standards. But one cannot, and need not, wish away the private system.
Meanwhile, incentives such as tax holiday for setting up hospitals in tier 2 and tier 3 cities should be continued. Public-private partnerships in public health have succeeded in pilot initiatives in areas such as TB-DOTS, leprosy treatment, HIV/AIDS, the adoption of public health centres these experiences need to be scaled up in other areas.
Unfortunately, India suffers from double whammy of dealing with both communicable and chronic diseases. TB, malaria and HIV/AIDS are as much a threat to the country as are diabetes and cardio-vascular diseases. We have both infant and maternal mortality rates worse than Bangladesh and Nepal. This is our opportunity to correct the situation.
The government must scale up spending on preventive health and IEC interventions, which today does not get priority. Effective convergence of health, nutrition, water and sanitation services is critical for more effective outcomes.
To its credit, this government reversed the trend of a declining public health spending; the legacy will be well remembered if India can achieve three of the eight millennium development goals (MDGs) relating to health before the United Nations deadline of 2015.
The writer is executive director, PricewaterhouseCoopers