Budget 2018: Behind the facade of effective healthcare

By Vritika Mathur

While the general impression after the announcement of healthcare policies in the budget was that of awe, a detailed look at its schemes proved otherwise. The revised estimates for the current year show that overall allocations have gone up only marginally or even worse, they have been slashed.  

Healthcare within the budget

In the budget announced not too far from the general elections, citizens expected favourable announcements regarding slashes in the expenditure from the government. However, these rising expectations were met with disappointment when it came to the healthcare sector. While the data is cleverly veiled, on further analysis, one finds that money set aside for the 2018-19 programmes has declined from the allocations made,

Finance Minister Arun Jaitley announced schemes directed towards, “world’s largest national health insurance programme” in his speech. However, an analysis by Factchecker shows many instances of reductions in funds. There exists a 2.1% decline in the allocation towards the National Health Mission, which stands to be India’s largest programme dedicated to the health and family welfare of all the citizens. There has been a 0.23% funding to the Human Resource Development (HRD) ministry from the union budget’s share, making it the lowest since 2014-15. Further, there has also been a 7% cut in allocation for the Swacch Bharat Mission budget as compared to the 2017-18’s estimates. The analysis revealed that the increase in spending is for the social-protection sector and is centred on scholarship opportunities for the scheduled class students and other backward classes. To fund the increased spending, Jaitley said “In order to take care of the needs of education and health of BPL and rural families, I have announced programs in Part A of my speech. To fund this, I propose to increase the cess by 1%. The existing 3% education cess will be replaced by a 4% ‘Health and Education Cess’ to be levied on the tax payable. This will enable us to collect an estimated additional amount of  Rs`11,000 crores

Existing and newly introduced schemes

In the 2018-19 budget, Arun Jaitley announced two major initiatives as a part of the “Ayushman Bharat” programme, which is, “aimed at making path-breaking interventions to address health holistically, in the primary, secondary and tertiary care system covering both prevention and health promotion.” The National Health Protection Scheme (NHPS) was announced under this and aims to provide a health insurance cover of Rs. 5 lakh a family per annum. The scheme will attempt to cover 10 crore families, with approximately 50 crore beneficiaries. While the approach towards social insurance is idealistic, past experiences in Asian countries such as China, Korea, Indonesia and the Philippines present themselves as red flags. In their cases, expenditure for programmes was spun out of control, service coverage was cut down and people were left to fend for themselves and pay for uncovered services from their own pockets. Medicine and outpatient services already incur high expenses in India. An ambitious goal, NHPS would have a lot of potential in the country, if not for the lack of funds.

The National Health Mission (NHM) is an already existing programme that was introduced in 2005 and funds infrastructure for primary health care. A cut down in allocation resulted in funds decreasing from Rs. 31,292 crore to Rs. 30,634 crore. According to a report published by the Centre for Policy Research, a break up of the total NHM budget indicates that this decrease is primarily driven by a decrease in allocations for Reproductive Child Health (RCH) Flexipool and Flexipool for Communicable Diseases by 30% and 27 %, respectively.

Another scheme, which is the National AIDS and STD Control Programme, was on the receiving end of a cut down from Rs. 2,163 to Rs. 2,100 crore. Frequent reports state that HIV drugs continue to remain unavailable, which suggests that the amount spent this year could be considered inadequate as well. Allocations for the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), which focuses on setting up AIIMS-like institutions, as well as upgrading the already existing medical institutions, was slashed as well from Rs. 3,975 crore to Rs. 3,825 crore. This is a decline of about 4%. In the face of the necessity for improvement in medical facilities as well as basic drug requirements, these cuts prove to be a shoddy decision.   

Reason behind the cuts

One of the key reasons why there has been no increase in funds despite the health ministry’s demands is the already existing share of unutilised funds. This non-utilisation of funds sparked the decision to cut down on existing allocations. There was an increase in unspent funds in total grants under the health care department in 2016-17 as compared to 2015-16, as indicated in the reports presented by CAG. This non-utilisation could have been due to factors such as lack of professionals to help plan and implement their use. Even where funds are directed, quality of help remains poor. India’s failing healthcare system could thus also be a consequence of inadequate surveillance and data monitoring. With poor quality inspections, India continues to remain highly vulnerable to infectious diseases. Moreover, there are other weaknesses in the system such as failure to conduct recommended tests, proper administration and adequate help for health services. There is an urgent need for more funds for newly introduced schemes and an even direr requirement for execution of the policies already introduced in the first place.

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