Budget 2020-21: Just as Anganwadi workers will be equipped with smartphones, frontline health workers too must be technology enabled to make primary healthcare more accessible, efficient and less doctor dependant
The Union Budget directs public financing towards social sector programmes that promote health through improved sanitation, clean water supply and air pollution control, while shifting to greater reliance on the private sector for provision of healthcare. While population level health protection and promotion programmes definitely need a strong push, putting the private sector in the driver’s seat of public funded hospitals raises concerns about unintended consequences.
The overall allocation to health has gone up by 10% compared to the last Budget. The inflation adjusted increase would be lower. It does not impart the needed momentum towards the stated goal of providing 2.5% of the GDP for health by 2025, which calls for near doubling of that percent allocation in five years. Public health advocates plead year on year for higher public financing to transform an ailing health system, just as a patient in pain plaintively pleads for palliative care from a preoccupied physician. Despite sympathetic words, required level of relief continues to be elusive in both cases.
Of the two components of Ayushman Bharat, hospital care provision (PMJAY) continues to take the pride of place over comprehensive primary healthcare. The recent threat of coronavirus conveys a strong message that effective surveillance, case and contact identification and triage for home or hospital management are public health functions that must be strengthened for delivery through a competent primary health care system. Even as the government proposes to invest in development of vaccines against new viruses, the need for effective primary health services for their delivery must be recognised. Fire extinguishers of primary care will obviate the need for fire engines of panicked pandemic response racing through the country.
The selection of aspirational districts for enhancement of PMJAY services has led to the adoption of a PPP model for upgrading district hospitals and transfer to private management through attachment to private medical colleges which would be established with government support. Priority would be given to districts without empaneled hospitals. The neglect of district hospitals has led to this sorry state. Now the private sector, which has been reluctant to invest on its own, is being invited to take over these hospitals. A further incentive is support for establishing private medical colleges attached to these hospitals. This will please the private managements who can earn profits both from the medical college and the government established hospital that will continue to receive some public financing. Funding for these hospitals would be mobilised from higher duties on medical devices. Will this lead to private managements overusing medical devices in PMJAY to generate more funds for themselves through this route? Great caution must be exercised to prevent inappropriate use through a perverse incentive. Will the National Health Authority develop strong safeguards against such a conflict of interest?
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Training of nurses, paramedical staff and caregivers through bridge courses to be jointly developed by health and skill development ministries, to equip them for employment abroad, will improve their prospects of lucrative jobs. However, skill development is needed even more urgently for filling the gaps in our own health system. Just as Anganwadi workers will be equipped with smartphones, frontline health workers too must be technology enabled to make primary healthcare more accessible, efficient and less doctor dependant. An effective and equitable health system will boost our economy far better than a remittance model. When training programmes yield surplus human resources, export of our health workforce becomes justified. Till then, India takes precedence.
The writer is president, Public Health Foundation of India (PHFI)