By Chithira Rajeevan*
Finance Minister (FM) Arun Jaitley presented his government’s last budget in the lead up to the general elections in 2019. The budget has directed its lens on the rural communities in the country, with a focus on women, and a few eye-grabbing announcements in the health sector. An outlay of ₹1200 crore has been announced towards bringing quality healthcare to the people through 1.5 lakh health and wellness centres offering maternal and child healthcare services along with free essential drugs and diagnostic aids. In a landmark pronouncement, Jaitley introduced the National Health Protection Scheme (NHPS), touted as the world’s largest government funded programme. The scheme will provide an annual coverage of ₹5 lakh to 10 crore families. This step towards universal health coverage is laudable but requires a closer inspection.
The FMhad announced these schemes in his previous budgets with no significant improvement in the status quo.Of the then proposed 1.5 lakh health centres, the National Health Mission had the capacity to strengthen only 3871 centres in 2017–18. Whether the current allotment would be sufficient for the projected plans seems doubtful, considering the allocation has been decreased by more than 2 per cent. The earlier NHPS remained dormant with the Union Cabinet without any concrete plan towards getting it cleared. The only difference between that and the current scheme seems to be a five-fold increase in the coverage provided, which makes one wonder what exactly has changed. A closer look at the current budget documents reveals no significant details regarding the same.The only contribution towards health insurance seems to be the allocation of ₹2000 crore for the Rashtriya Swasthya Bhima Yojana (RSBY), which was to be replaced with the NHPS by April 2017. The RSBY is currently in dire straits with private hospitals threatening to pull out,due to large arrears, persistently high proportion of out-of-pocket expenditure faced by the patients despite the scheme, and problems of transparency.The funds released and utilised as part of RSBY have also reduced along with the number of participating states. Various studies assessing the scheme reveal concerns including insufficient incentives for those involved in service delivery, exclusion of outpatient care, unethical practices among hospitals and so on.
A scheme that could strengthen our healthcare system, while protecting the poor and vulnerable from financial risk is a welcome move; however, it must be capable of addressing the existing shortcomings. Furthermore, the current allotment towards health has increased by only 12 per cent, which would not be sufficient to meet the aspirational goals set. The proposed funds that would be flowing into the secondary and tertiary hospitals, through the NHPS, must not come at the expense of our primary healthcare system. Our Primary Healthcare Centres and Community Healthcare Centres are already bogged down by poor infrastructure and shortage of personnel. These are concerns that require the same level of attention, if not more, especially in light of the increasing incidence of non-communicable diseases and other chronic conditions in India. The ambitious target of 10 crore families, if achieved, would be a huge success and give a necessary boost for the sector; although it seems far-reaching, considering the status of RSBY enrolment. The government has presently provided neither a clear picture on fund allocation nor a framework for the implementation of the scheme. The government needs to offer more clarity on the exact nature of the scheme, including the service delivery model and its financing, without which this would be just another election promise that does not see the light of day.
*Chithira Rajeevan is Research Assistant at Centre for Public Policy Research. Views expressed by the author is personal and does not represent that of CPPR