Health in small doses

Updated: Jul 14 2014, 17:37pm hrs
The Union Budget of 2014 offers some symptomatic palliation to the health sector while more definitive treatment is still awaited. More allocations have been provided for tertiary care institutions in the public sector, public private partnerships in infrastructure may expand hospital services and raising the foreign direct investment cap in insurance may open up private insurance in the health sector. However, the proposed National Health Assurance Programme remained invisible and primary health care remained unaddressed except for setting up of 15 model Rural Health Research Centres. Happily, sanitation and safe drinking water are being accorded high priority and the raised taxes on tobacco products and sugar sweetened beverages (SSBs) are good public health measures.

Much of the modest increase in the allocation for the health sector has gone to institutions of advanced medical care. Four new AIIMS like institutions are set up, in keeping with the plan to set up an AIIMS in every state. While the intent to expand access to specialised tertiary care all across the country is laudable, it must be a part of a larger plan to strengthen and connect health services across the whole range from the village level sub-centre to the regional AIIMS, with primary and community health centres, district hospitals and medical college hospitals linked in. Otherwise, people will continue to crowd tertiary care institutions for common conditions that could have been handled at other levels or complications that should have been prevented by early and effective basic care. The government will also face the problems in recruiting senior faculty for these institutions where private practice is not permitted unlike in many state health services. It may need to establish an All India AIIMS Cadre for this purpose.

The proposal to provide Free Drug Service and Free Diagnostic Service as part of the move towards Health For All is timely, since it will improve access to these essential elements of health care and reduce the horrendously high out of pocket spending (OOPS). However, it is not clear how this will be implemented, in the absence of a specific allocation in the budget. Will the funds come from the overall pool of the National Health Mission What will be the centre-state split in the spending on this scheme The answers will probably have to come from the health ministry. It is good to see new funding for expanding and strengthening the network of state drug testing laboratories. This will improve drug safety and enable our domestic drug industry to better withstand the challenges posed by foreign regulators.

Though not part of the health budget, the emphasis on sanitation and clean water is very welcome for the immense health benefits that will accrue. It is also heartening to note these major determinants of health receiving attention in the Railway Budget too. Initiatives to improve nutrition and air quality must also be prioritised for funding in the next budget. The 5% tax on SSBs is a well-intended but should have been at least at the level of the 10% soda tax that Mexico legislated in October 2013. Mexico also imposed 8% tax on junk foods containing more than 275 calories per 100 grams. Reduced consumption of SSBs will not only yield health benefits in terms reduced risk of diabetes, obesity, cardiovascular disease and dental caries, but also partly conserve the huge quantity of potable water that is diverted for making these products.

The finance minister has done well to increase the taxes on cigarettes and other tobacco products. As global experience shows, raised taxes increase the price and effectively drive down the consumption of tobacco, especially among the poor and young. However, Beedis seem to have again escaped the tax net despite the fact they are the form most frequently smoked by the poor in India. This renders them highly vulnerable to tobacco related diseases and their catastrophic health care costs. Gutkha is mentioned among the higher taxed products, though there is now a legal ban on Gutkha across India (only two states are yet to legislate). Oral tobacco products are now the most frequently consumed form of tobacco in India and need even higher taxes than proposed.

Overall, the health sector component of the budget is like the proverbial curates egg- good in parts. The finance minister deserves thanks for his intent to provide stronger support to the sector but can we hope for a more balanced approach to funding for different elements of the health system in the next budget, by which time the government would have had more time to appraise the health needs of the people I, for one, would like to see Jaitley taking greater pride in funding innovative schemes for improving primary health care than in setting up of new AIIMS. That, despite my own pride at having been student and faculty at the original AIIMS!

K Srinath Reddy

The writer is president of Public Health Foundation of India (PHFI).