A healthy population is the foundation on which successful nations are built. Healthy individuals are a prerequisite for the economic progress of a country. No government can ignore public health as it could have serious repercussions on the national economy. So, they usually ensure adequate policy and budgetary support to this key sector. Nirmala Sitharaman will present Budget 2022, her fourth as the finance minister in the Narendra Modi government, on February 1. This article identifies some steps to strengthen the public health system in India.
Social determinants of health
In Budget 2021, the government took steps to integrate the budget for health with those for drinking water, sanitation and nutrition. This was a step in the right direction and efforts to deepen the integration should continue with more budgetary allocation for the ongoing and for future activities.
In many urban areas, one can see open drains carrying sewerage waste. These drains emit a foul smell and untreated water from them flows into rivers and other water bodies. There is a need to provide an adequate budget for covering these drains and installing sewage treatment plants so that the treated water can be utilised for irrigation purposes. Activities related to the control of air pollution may also be integrated under the health budget.
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Integrate, unshackle medical education
The National Education Policy 2020 emphasises the integration of the healthcare education system. This means that students of allopathic medical education must also have a basic understanding of Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy (AYUSH) systems of medicine and vice versa. Speedy action is needed to integrate the education systems of allopathic and AYUSH streams.
Unfilled vacancies of doctors troubled successive governments since Independence and they failed to remedy the situation. The solution lies in producing a vast pool of medical personnel at a local level which can be absorbed in the public health system or private sector.
Assam, Chhattisgarh and Jharkhand have started a three-and-a-half-year B.Sc. course in community health and successful candidates are positioned as community health officers at the village sub-health centre level to provide primary healthcare services. Such courses may also be started in other states to meet the shortage of healthcare providers, especially in rural and semi-urban areas. An adequate provision may be provided in the budget for starting such courses, which will improve the availability of skilled workers for the public health system.
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Budget 2022 and the infrastructure gap
At present, 90 districts in the country do not have district hospitals. Immediate steps should be taken to establish district hospitals in these districts. There is a shortage of around 34,000 sub-health centres, 500 primary health centres and 2,200 community health centres in the country. These centres need to be established on a priority basis.
Urban healthcare infrastructure comprising primary health centres and community health centres is inadequate in the country and such centres need to be established on priority. The implementation of schemes for establishing more AIIMS and converting district hospitals into medical colleges need to be expedited.
Reduce out-of-pocket expenditure
Out-of-pocket expenditure for healthcare in India is around 62% of the total health expenditure and the country ranks at 182 out of 192 countries. This is a grave situation and there is an urgent need to reduce this as out-of-pocket spending on hospitalisation, medicines and diagnostics pushes many families into poverty.
The government may increase the Prime Minister Jan Arogya Yojana (PM-JAY) budget and simplify its guidelines to enable the poor to get hospitalisation services whenever in need. In addition to this, the government may also increase budget allocation for opening more Jan Aushadhi Kendras offering free medicines, transport and diagnostics under the National Health Mission.
Health and wellness centres
The government plans to establish 1,50,000 health and wellness centres across the country by December 2022. It may, therefore, ensure that all sub-health centres and primary health centres are converted into functional health and wellness centres with adequate staff and regular supply of medicines, consumables and diagnostics.
Promote telemedicine
With the increasing reach of the internet even in villages, it is suggested that specialist services be provided through telemedicine as it is not possible to position specialists at the primary or sub-health centre level.
Improve governance
The state governments have agreed to develop public health management cadres by March 2022 for better management and efficient implementation of healthcare programmes. The Union government may impress upon the states to fulfil this commitment and provide budgetary support for it. The states also need to take systematic steps to fill the vacancies of crucial staff like specialists, staff nurses, lab technicians, and pharmacists in the public health system.
Further, let the year 2022-23 be one of consolidation and completion of infrastructure schemes that have been initiated. Frequent transfers of key officers at the state and district levels may be avoided and a fixed tenure of key officers may be assured.
Review and monitoring
Periodic reviews and regular monitoring of health programmes is key to efficient implementation and corrective actions. IT-enabled health management information systems (HMIS) should have a provision for the generation of customised national to village-level reports. The reports generated through HMIS may only be used to review health programmes to promote data use and its quality.
Digital health records
Steps may be taken for the speedy implementation of the Ayushman Bharat Health Account (ABHA) card so that the beneficiaries can have all their medical records in this card.
Health insurance
There are many insurance companies providing health insurance, but several illnesses are not covered by them. The government may develop model health insurance policies covering most diseases to make the policies more transparent.
The government has already launched a large number of public health initiatives. While earmarking more for healthcare, there is a need also to evaluate and consolidate the efforts. Budget 2022 comes at a time when the super spreader Omicron variant is threatening to overwhelm the public health infrastructure. The situation will require close coordination between the Union and state governments to curb the spread of the pandemic and put the Indian economy back on track.
(Dr Rattan Chand is director, EGROW Foundation, a Noida-based think tank.)