Union Budget for 2018-2019 has promised a National Health Protection Scheme (NHPS), a publicly funded health insurance programme for half a billion citizens of the country. But no sufficient funds have been allocated for what Finance Minister Arun Jaitley said would be the world’s largest government-funded healthcare programme.
In the first phase, 1.5 lakh health and wellness centres are proposed to be set up across the country to provide comprehensive healthcare including free medicines and diagnostic services. But the Budget allocation for this is only Rs 1,200 crore. This works out to about Rs 80,000 per centre. If a centre receives 100 patients on weekdays which will make around 25,000 in a year, the average allocation per patient would be a little over Rs 3 which is much too insufficient even to cover the medicines and diagnostic services, leave aside the overhead expenses on running a centre.
It’s not that the government woke up only recently to the health problems of the people. Union Home Minister Rajnath Singh had observed in December 2014 — a few months after the present NDA government took office — that a major change in the health care system of India was needed. The country, he said, was at present having a fragmented healthcare system which was not at all enough to cater to the needs of the people, particularly the poorer sections of the society.
Addressing the 10th convocation of King George’s Medical University (KGMU) at Lucknow, he said, ‘if the primary healthcare centres are strengthened, almost 85 per cent of the burden on the major institutes like All India Institute of Medical Sciences, Sanjay Gandhi Post Graduate Institute of Medical Sciences and King George’s Medical University can be brought down.’ he added that the Government of India was working to bring about this change.
But the Government had, apparently, other priorities more pressing than the poor man’s health. A parliamentary panel report on health and family welfare released last year pointed out that in India there is just one government doctor for every 10,189 people, one government hospital bed for every 2,046 people and one State-run hospital for every 90,343 people. (Needless to say that most of these facilities are concentrated in urban areas.) With a doctor-patient population ratio worse than Vietnam, Algeria and Pakistan, the shortage of doctors is one of the biggest ailments afflicting the country’s health management system, the panel noted.
Meagre budgetary allocation for health services is the major factor affecting healthcare system, particularly in the rural and suburban areas. But more than that it is the mismanagement born out of indifference of the ruling classes that is plaguing the health delivery system. According to the findings of the Comptroller and Auditor General (CAG) in his report on reproductive and child health under the National Rural Health Mission for the year ended March 2016, the picture that emerges in several States is one of inability to absorb the funds allocated, shortage of staff at Primary Health Centres (PHCs), Community Health Centres (CHCs) and district hospitals, lack of essential medicines, broken-down equipment and unfilled doctor vacancies. In the case of Uttar Pradesh, the CAG found that about 50 per cent of PHCs it audited did not have a doctor, while 13 States had significant levels of vacancies.
A serious effort in this direction has of late been made by the Delhi Government by opening ‘Mohalla Clinics’ for providing free primary healthcare services to the people in the capital. The effort has been lauded by former United Nations Secretary-General Kofi Annan. In a letter to Delhi Chief Minister Arvind Kejriwal, Annan wrote, ‘we understand that this initiative is proving very successful and we commend you on this impressive achievement.’ Annan wrote the letter in his capacity as the Chair of ‘The Elders’, an organisation of independent global leaders founded by anti-apartheid icon and former President of South Africa Nelson Mandela. Dr Kenneth E Thorpe, Chair of Department of Health Policy at the Rollins School of Public Health, USA, remarked after visiting ‘Mohalla Clinics’ during one of his visits to India that these Mohalla Clinics ‘are definitely an important addition to India’s health sector.’
Politicians in power and government servants mostly patronise private nursing homes even for minor and routine ailments. Services in government-run hospitals, dispensaries and health centres will improve substantially if the government stops, by enacting a law or by evolving a convention, reimbursement of expenses incurred by these classes on meeting their health needs in private nursing homes. But the health insurance programme enunciated in the budget is only meant to help further private operators because there is nothing the budget to strengthen government-run hospitals and dispensaries.
