Squeeze on health funds, say activists

Health activists today decried the budget initiatives and outlay for the healthcare sector as "disappointing and directionless", calling the proposal for a government-supported dialysis programme an arbitrary and piecemeal approach to health-care services.

The Jan Swasthya Abhiyan (JSA), a consortium of doctors and health activists, said the increase in the 2016-17 allocation for health from about Rs 32,000 crore to Rs 37,000 crore, if adjusted for inflation, represents a mere 8 per cent increase.

The budget has proposed initiatives to provide a health cover of Rs 1 lakh per family, use government funds to expand dialysis services to all district hospitals and excise duty incentives to lower the cost of dialysis, and add 3,000 shops selling inexpensive medicines.

Health minister J.P. Nadda had said yesterday that the health ministry was "completely geared up" to implement the schemes announced. He said the health protection scheme and the 3,000 "jan aushadi" stores that would provide inexpensive generic medicines would help lower households' out-of-pocket expenditure on health care.

But the JSA has pointed out that the outlay for the flagship health programme --- the National Health Mission, that covers a range of services including maternal and child health, immunisation, disease surveillance and control, among others --- has increased from Rs 19,135 crore last year to Rs 19,437 crore for 2016-17.

"When we take into account the impacts of inflation and increase in population, the change in allocation actually represents a six to seven per cent decrease in per capita allocation for the health mission," said Amit Sengupta, a physician and coordinator of the JSA.

The JSA said this effective decline in per capita funds appears to reflect a government move to choke financial resources available for public health services under the National Health Mission.

"The budget proposals are in line with the philosophy that the government's role should mainly be that of a regulator and manager of healthcare services," Sengupta told PG Times. "Instead of substantially increasing public funds for health, the government is encouraging the role of the private sector role."

The consortium of health activists has criticised the proposal to introduce a national dialysis service programme under a public-private partnership mode, calling it an example of "arbitrary and piecemeal approach to health-care services."

The JSA said there was a real need to make available dialysis free of cost in public facilities, but the scheme as proposed in the budget seemed directed at outsourcing dialysis services to the private sector.

"It is unclear how this scheme will provide real benefits without a concomitant increase in public services to diagnose and treat kidney disorders. Nor is it clear how resources for the scheme will be harnessed, given that the budget for the national health mission has been effectively slashed," the JSA said.

The JSA has also raised concerns about the proposal to provide Rs 1 lakh cover for each family, saying several research studies have indicated that existing national and state health insurance schemes have so far failed to rein in catastrophic health expenditures by the poor.

"Some of these schemes have been indicted in several states for defrauding the public-funded system by performing unnecessary surgeries, such as unnecessary operations for the removal of the uterus," it said in its statement.

But the JSA has pointed out that the allocation of only Rs 35 crore appears insufficient to support and maintain the proposed expansion of the jan aushadi scheme which currently operates only 137 shops scattered across 20 states.

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