By Rattan Chand
Finance minister Nirmala Sitharaman will present the Union Budget 2021 on February 1 in most extraordinary circumstances. The world is under the grip of the worst health crisis since the outbreak of Spanish Flu of 1918 and the most severe economic crisis since the Great Depression of 1930s. Tackling the twin crises will take some extraordinary measures in the eighth Budget of the Narendra Modi government.
India is among of the hardest hit nations by the crises. The lessons learnt in the current financial year will be crucial for the country’s emergence as a global economic powerhouse. Here are some suggestions for the finance minister as she prepares the Budget proposals for the healthcare sector. These suggestions may not require huge expenditure, but they will go a long way in improving the delivery of health services.
Increase government expenditure on health
The government expenditure on healthcare was is 1.6% of the gross domestic product (GDP) of the country in financial year 2019-20, which is slightly higher than 1.5% spent in the previous year. This level of funding for health services may be enhanced for well thought-out schemes.
The government must ensure that money does not come in the way of strengthening research and development, medical education, infrastructure, manpower, logistics as well as information and surveillance systems. Private practitioners may be roped in to provide health services, wherever required.
Improve programme management
In India, there is an absence of a professionally trained cadre of public health professionals. Allopathic doctors, mostly handling clinical treatment, are positioned as heads of block / district / state health services and they find it difficult to manage various administrative and logistics functions.
There is a need to have state level and all India level public health cadres to efficiently manage the health systems. At present, only few states have public health cadres.
Shift from curative to preventive services
Health is a state of complete physical, mental and social well-being and not merely the absence of diseases or infirmity. About 70% of deaths globally occur due to non-communicable diseases (NCDs) and 80% of the chronic diseases can be prevented by adopting a healthy lifestyle — regular physical activity, proper nutrition and abstention from smoking and alcohol.
The healthcare services need to focus more on prevention of communicable diseases (CDs) and non-communicable diseases. The current healthcare system focuses more on curative services that are costly. The Indian systems of medicine, which are more focused on healthy living and disease prevention, have been neglected for long due to political or other reasons and are seen as inferior to the western system of medicine. There is a need to correct this bias and efforts are needed to mainstream Indian systems of medicine.
Re-orient medical education
There is need to have a holistic medical education system based on both modern and the traditional knowledge. At present, the allopathic and ISM systems work in silos and there is little integration between the two. There is a need to develop integrated curriculum for graduate level medical course, incorporating good aspects from the disciplines of allopathy and ISM, including naturopathy and yoga. This curriculum should be made compulsory for medical graduates of any discipline.
The integration of curriculum should continue for the post graduate degree courses too. This would strengthen the health systems and remove animosity between the practitioners of different systems. Further, education about disease prevention should universally start from the school level and continue throughout the lifecycle of the individual.
Reduce out of pocket expenditure on health
Every year, more than 150 million individuals throughout the world face high health expenditure, and more than 100 million individuals are pushed into poverty. People have to cut down on the necessities such as food and clothing, or are unable to pay for their children’s education.
India with 62% of the health expenditure is out of pocket is ranked at 182 among 191 countries. Concerted efforts need to be made to reduce out of pocket expenditure on health, though the government of India has taken some initiatives in this direction.
Reduce hospitalisation expenditure
Pradhan Mantri Jan Arogya Yojana (PM-JAY) has been launched to take care of hospitalisation expenses by covering approximately 50 crore rural and urban poor population. PM-JAY covers medical and hospitalisation expenses for almost all secondary and tertiary care procedures. In order to make this scheme successful, it is suggested that speedy approvals be given to those requiring hospitalisation and timely payments be made to public and private hospitals empanelled under the scheme.
There should be a system to periodically include families that are left out of the scheme due to poor data quality. There is also a need to regulate hospitalisation costs for the benefit of those not covered under PM-JAY.
Better monitoring and surveillance
Union and state governments need to establish efficient programme monitoring and disease surveillance systems to get real-time data to take prompt corrective and follow up action. It may be ensured that the data from these systems is used for regular reviews, planning and policy purposes.
Reduce OPD expenditure
There is an excellent primary healthcare service delivery infrastructure in the country with a sub-centre for every 5000 citizens, a primary health centre (PHC) for every 30,000 people and a community health centre for every four PHCs. There is a need to efficiently govern these health facilities by positioning required strength of doctors and para-medical staff, equipping them with specified essential medicines and diagnostic.
There is a need to develop trust in public health system by providing quality healthcare services. Wherever required, more health facilities should be opened to provide easy access to people and cut travel time and cost. The government plans to convert 150,000 of the existing SC and PHCs into health and wellness centres across the country by 2022. However, training and positioning of community health officers at these HWCs is a challenging task.
To ensure that the CHOs stay at the HWCs, it would be essential to train local nursing or ISM graduates with suitable bridge course and position them as CHOs at HWCs. The HWCs should be made fully functional with required manpower, drugs and diagnostics. This will go a long way in strengthening the primary health care services, especially in rural areas.
The prices of medicines and diagnostics need to be regulated and more Jan Aushadi Kendra may be opened across the country. Opening of diagnostics centres on the lines of Janaushadhi kendras may also be considered.
(Rattan Chand is a public health expert based in Delhi. He is a director of EGROW Foundation, a Noida-based think tank.)