Budget 2018: Wish List to Ensure Health for All

By Dr Sanjiv Kumar, Director, International Institute of Health Management Research, Delhi gives an insight into how health must be given a priority by the government.
The following six areas need special attention in the coming budget:
Double the Health Allocation to Reduce Citizens’ Out-of- Pocket Expenditure: The BJP Election Manifesto 2014 had promised to initiate ‘National Health Assurance Mission’ to provide universal health coverage. We hope the government will announcethis in the coming Budget and provide funds for it at least in its fourth year of being in power.
TheCentral Budget for Health must be doubled to about Rs 60,000 crore to fund healthcare for all citizens starting with the poor, the marginalised, the elderly and expanded in a phased manner to cover the entire population of the country. The cost of healthcare is spiralling out of control, but government spending on healthcare has not been increasing proportionately. Naturally, personal health expenditure has been impoverishing many Indians. In 1999-2000 an estimated 3.2% of population or 32.5 million were impoverished because of medical expenses, by 2014 the figure had risen to 94.44 million or 7.47 of the population. Government expenditure on Health as percentage of GDP was 1.3% in 1990;it went down to 0.9% by 2002. The government had committed to increase it to 2% in NHP 2002, but even in 2015 it was spending only about 1.3%. In the National Health Policy 2017 the Modi government committed to raising it to 2.5%. In the coming budget, we will see if the current government is serious about it or, as in the past, it will remain just a promiseon paper. An issue that needs to be addressed is the absorption capacity, especially in the states that are lagging in health indicators.
Strengthen Health System with Necessary Fund: The public health system in the country based on Bhore Committee (1946) and norms set in the 1983 policy and a cadre of ASHA workers and health managers at various levels in the health system added under NRHM/NHM, needs to be expanded to meet the current disease profile and population needs. The vacuum created by lack of expansion of public health system has been filled by unregulated private sector growth both in rural and urban areas. The government must invest in rapid scaling up of Health and Wellness Centres. In last year’s Budget, the government committed to establishing 150,000 health and wellness centres. It must deliver on this promise and scale these centres with adequate budgetary allocation.
The private sector needs to be integrated and brought in the mainstream, rather than being just for the rich. The government must regulate health sector on lines of TRAI and provide funds to establish a regulatory authority for both public and private health. Another thing the government needs to do urgently is to make provisions for funds in Budget 2018 for the creation of an additional cadre of qualified hospital managers to be posted in all public hospitals as is being successfully done in private sectors and in the health system under NHM. This will prevent recurrence of Gorakhpur like tragedies through improved management of hospitals.
Increase Funding to Address the Growing Burden of Non- Communicable Diseases (NCDs): The recently released Burden of Diseases Report showsthat non-communicable diseases are on the rise, accounting for about two-thirds of deaths every year. Keeping in mind the growing burden, fund allocation for NCDs must be increased substantially from the present meagre 3% of the central health allocation. Investment in prevention of NCDs should be an even greater priority and the governmentmust pledge funds for it.
Fund Mechanism to Include Health Component in all Policies: The government must provide a budget to set up a mechanism under the PMO or the Cabinet Committee to make sure that health is included in all policies affecting social determinants of health. For example, air pollution today accounts for 1.1 million deaths annually in India. Deaths related to PM2.5 have increased by 48 per cent since 1990. Similarly, deaths due to ozone have jumped by 148 per cent. Similarly outbreaks of dengue and chikungunya have become an annual phenomenon because of lack of action by other sectors.
Funds for Developing and Scaling up Technology Innovations to Improve Access to Quality Healthcare: Technology innovations have the potential to address bottlenecks in service delivery such as telemedicine, tele-ophthalmology and tele-radiology. Innovations piloted and successfully implemented in some states must be replicated and adequately funded for other states as well. Government must provide adequate allocation in the budget to facilitate their accelerated scale up. The dividends from technology innovations must benefit health sector by improving coverage which must be given a high priority in the coming budget.
Enhance State Governments’ Health Capacity: The budget should reflect the Central government’s efforts to build state governments capacity to address their specific health needs. The current approach of developing models for the whole country in Delhi and then giving incentives to states to scale them up with little flexibility needs to be changed. Healthcare policy, planning and implementation should be steered by the states not by central ‘experts’.