No happy tidings there

It was expected that with the elections just over, and several promises made by the Prime Minister, health will get a more suitable place in the 2019-20 budget than ever before. But it was disappointing to note that in two and half hour budget speech, not a word was mentioned about health by the Finance Minister. On many things (including health), she said that these are mentioned in the text and one can read it. This is belittling the importance of the issues.

A more painful omission was that she did not utter anything to empathise with the families of the children who lost their lives in Gorakhpur and Muzaffarpur. These children could have been saved if there was timely oxygen supply in Gorakhpur, and if the nutritional status of the children in Muzaffarpur had been taken care of. The area is known for repeated attacks of encephalitis. It would have been a good gesture of love and sympathy if the government had admitted its failure and announced special budget to prevent such calamities.

The Alliance of Doctors for Ethical Healthcare (ADEH), a watchdog on health issues, in its observations found that the out of a total budget of Rs. 27,86,349 crore, health has been allocated Rs. 64,999 crore which comes out to be 2.3 per cent of the total budget. In the budget of 2018-19 the health was given Rs. 52,800 crore out of a total outlay of Rs. 23,99,147 which is 2.2 per cent. Thus, there is only a marginal increase of 0.1 per cent in the share to health. If we consider inflation during this period this increase does not carry any value.

The government had earlier declared that it would increase health budget to 2.5 per cent of GDP in coming five years. If that has to happen, budget needs to grow by 30 per cent each year. With the above figures it is unlikely that this promise will be fulfilled. For prestigious PMJAY (Ayshman Bharat) which gives insurance of 5 lakh for 40 per cent population, the experts expect budget of Rs 20,000 crores, But he present allocation is 6400 crores only. How it will meet the desired goals? Moreover, Ayushman Bharat is meant for about 40 per cent population only. It does not cover the OPD care which in fact amounts to nearly 70 per cent of the total out of pocket expenditure on health.

The budget for Rs.1,00,000 fitness and wellness clinics has been increased from Rs.1,200 crores to 1,600 crores. It means for each clinic it is Rs.1,60,000 which means per month it would be Rs.13,333. That includes human resource and infrastructure. It is very inadequate.

The budget for upgrading district hospitals has been slashed–not increased–from 3,168 crores to 2,000 crores, and money is shunted to increase Under Graduate and Post Graduate seats in the existing medical colleges. There is serious apprehension that this is in tune of NITI Aayog's recommendation to hand over district hospitals to private companies to run medical colleges under the PPP mode! This means handing over the government set-up with all infrastructures to the private players to make profit out of it. About one year back a move was planned in Punjab to hand over Primary Health Centres (PHCs) to private players. But after strong opposition from the employees and the civil society the proposal has been kept on hold. A similar experiment has already failed in Bihar.

Nothing has been said about strengthening the ESI which provides social security besides healthcare needs to the workers. There is no policy announced to streamline the drug prices nor to strengthen the public sector pharmaceutical units. There is no policy about the price of medical equipment.

In the past, medical education has been virtually handed over to private sector. Students from lower- and middle-income groups have been devoid of admissions to the medical colleges because of exorbitant fees charged by them. Nothing is mentioned in the budget to sort out this anomaly. The national medical commission had mentioned that it will govern tuition fee of only up to 40 per cent seats; the rest will be at the mercy of the private managements.

In short, there is no intention to empower public healthcare system where thousands and lakhs of poor go.

Medical care is left to the unregulated private healthcare sector. And sadly, the finance minister does not even think of health when presenting the highlights in Parliament. So, the sad story of passive privatisation that began thirty years back is continued, rather with enhanced zeal, healthcare is left to market forces and hence the government is only bent on increasing coverage, nowhere near horizon is the concept of Universal Health Care!

(Dr. Arun Mitra is an ENT surgeon. Views expressed are strictly personal)