The National Health Profile (NHP) 2018 released recently by the ministry of health and family welfare is both congratulatory and alarming. The health finance indicators along with information on health infrastructure and human resources in health reveal many steps still to be taken in the country while gains in healthcare indicators reflect progress. For instance, 22% reduction in maternal mortality since 2013 seems impressive as also improvements in infant mortality rates, reduction in incidence and prevalence of some of the communicable diseases but India’s public health expenditure—1% of its gross domestic product (GDP), a negligible improvement from 0.98% in 2014—is still behind many countries, some of which belong to low-income categories. India’s neighbours Bhutan, Sri Lanka and Nepal, much smaller in size, spend 2.5%, 1.6% and 1.1% of their respective GDPs on health. There is hope for the coming years, with the government proposing to raise the public health expenditure to 2.5% of the GDP by 2025 as envisaged under the National Health Policy 2017.
In this context, some pertinent questions that arise are whether increased spending on health will show increments in human resource development in the health sector and, in addition, if the better health infrastructure will deliver quality healthcare in both rural and urban areas and, also critically, in remote areas such as mountainous terrains that are, at present, health services deficient. That the availability of doctors across the nation is not even, is a well-known fact. What steps are being taken to reduce the deficit of health care personnel? As NHP 2018 indicates, the shortage of doctors is a problem most felt in in rural areas where there is one allopathic doctor catering to over 11,000 people. It is true that in the last few years there has been some improvement in availability of doctors at the primary and community health centres, but then the quality of services and infrastructure for diagnosis and investigations at these centres often is under the mark. Simply increasing seats in undergraduate and post-graduate institutions and opening more medical colleges with the aim of improving the supply of health manpower in the country is not a holistic approach to improving healthcare facilities. Factors like accountability, accessibility, and affordability of healthcare services and related issues have to be taken care of.
A top concern in improving healthcare services and facilities in the country relates to the budgetary allocation to the health sector. It is disappointing, with multi-fold repercussions for health infrastructure and manpower in the country, if the ministry of health and family welfare receives just `30,129.61 crore—as it did for FY19, against a projected plan outlay of `34,882.32 crore under the National Health Mission (NHM). Clearly, the shortfall in budgetary allocation will affect many aspects of healthcare. Not only will there be a resource crunch affecting the upgrading of health services such as building more hospitals and bettering facilities and standards in existing health institutions, but also the expansion of diagnostics infrastructure and interventions will be affected. This means that it will impact the implementation of programmes aimed at reducing the burden of non-communicable and communicable diseases, and in the long run, there will be limited efforts at improving health status of the population despite stated intentions and promises. Equally important in meeting healthcare requirements of the people is for the states to utilise all of the allocated healthcare funds. That only 55% of allocated funds were spent by the states in 2017, as a study by National Institute of Public Finance and Policy points out, with some states using less than 50%, is a disturbing fact indeed. No doubt the out-of-pocket expenditure on healthcare is high in India, a situation which the government should take note of and adopt ways to reduce it.
In India, as health status statistics indicate, the burden of non-communicable diseases is growing while there is still much to be desired in reducing the impact of communicable diseases. Our programmes for expanding the outreach of pneumococcal vaccines to the vulnerable population in all the states—along with vaccination against measles rubella, rotavirus and other diseases that affect children particularly—not only need significant expansion, but also there is a need for newer interventions to reduce the incidence and prevalence of chronic ailments and various non-communicable diseases. There is hardly any emphasis being laid on providing formal long-term care facilities and palliative care provisions despite the increase in demand for such facilities to improve the quality of life for the masses and to maintain a robust healthcare status. The budgetary allocations for healthcare facilities and services must keep in tune with the goals of National Health Policy 2017 for the country to actualize the NHM and provide universal, equitable, affordable, quality services and infrastructure to meet the so far unmet health needs of the population. The success of Modicare is dependent on significantly lowering the cost of healthcare and scaling up healthcare facilities which requires a commitment towards increasing healthcare expenditures.
By Mala Shankardass Kapur, Associate professor, Maitreyi College, University of Delhi