Anwer Sadat studies the condition of healthcare infrastructure in the country and budgetary allocations to the Health Ministry since Independence, and underlines the need for increase in the budgetary allocation for healthcare in the Union Budget 2023-24.
The gross inequality in the accessibility and affordability of health facilities is a matter of great concern for India even after 75 years of Independence. Facing the Covid-19 pandemic barely changed the behaviour of the government toward healthcare infrastructure.
HEALTH IS NOT A PRIORITY
It is not hidden that health has never been a priority for the Indian government. It took India 36 years to introduce its first prominent policy on health that is the National Health Policy 1983 with key initiatives like the “Network of comprehensive primary healthcare services” with the target year 2000, National Health Policy 2002 with more programmes and emphasis on healthcare infrastructure and National Health Policy 2017 with again some more programmes with no major development in infrastructure and human resources.
There are 1,57,921 Sub Centres (SCs), 30,813 Primary Health Centres (PHCs), 5,649 Community Health Centres (CHCs), 1193 Sub-divisional Hospitals (SDHs) and 810 Districts Hospitals (DHs) in the country. There is a shortfall of 46140 SCs (24%), 9231 PHCs (29%) and 3002 CHCs (38%) across the country as per the Rural Health Statistics (RHS) 2020. Most of these centres have few or no human resources and lack medical equipment or the available ones are barely usable.
One of the major causes of the low performance of these policies or better to say their failure is low financial support from the government. The amount allocated to the health ministry in its first Union budget was `3,75000 only, about 0.017% of the Budget. In the year 1983-84, after the introduction of the first National Health Policy 1983, the budget to the health ministry was `176 crore that is 0.52% of Total Budget, and `86200 crore that is about 2.10% in Union Budget 2022-23. Although the 21st century has witnessed significant fund allocation to the health ministry, especially by the Modi government, most of them are to direct benefit schemes or programmes based on individualistic approaches rather than community approaches. The immediate need is to increase the expenditure to 2.5% of the Union Budget 2023-24.
HEALTH PROFESSIONALS’ AVAILABILITY
Low expenditure on health not only affected the healthcare infrastructure but also fewer medical and nursing colleges resulting in a low doctors-to-population ratio. Currently, there are 22.8 healthcare workers per ten thousand population whereas the WHO standards are 44.5. Most of the doctors don’t want to go to rural areas or small cities and are concentrated in urban areas and metro cities, so even if the primary healthcare centre or sub-centre is constructed in the village, it is generally managed by community health workers appointed by the government. Other reasons for good doctors not joining the government setup are low salaries, longer duties, and higher patient pressure with safety issues. Due to higher demand, quarks and untrained healthcare workers also provide the service which sometimes proves to be lethal for patients.
Allopathic medication has always been prioritised over all other indigenous medicines. Due to fewer opportunities, people do not opt to study or practise indigenous medicine, which increases the burden on allopathic medication further. Indigenous medicine has proved to be very efficient for primary healthcare issues but due to the hegemony of allopathic institutions and global allopathic pharmaceutical giants, indigenous medical practices are decreasing day by day.
PRIVATE SECTOR DEPENDENCE
From the beginning, the Indian government promoted private healthcare setups by providing land at subsidised rates, and other benefits. Public-private partnerships and non-profit healthcare setups were also encouraged to decrease the burden on Government Hospitals. Today India has a vast network of private healthcare setups distributed across the nation. The growth of private healthcare setup resulted in the shift of skilled health professionals in the private sector due to more salary and perks, in small towns even government doctors set up their clinics and come to the government hospital for only attendance or short duration. The high price of private healthcare institutions can’t be afforded by low-income groups and also results in high out-of-pocket health expenditures.
The high cost of drugs, vaccines, and other medical accessories due to import duties or other taxes and no subsidies also makes healthcare facilities unaffordable for the lower-income group even in government hospitals. Due to corruption or fewer funds, government hospitals do not provide costly medicines and other medical accessories used in treatment or surgeries, and patients are bound to buy them from the market at higher costs. Some medicines even cost crores, and with no help from the government, the patients wait to die or beg for money through public donation sites. Pharmaceutical companies’ tie up with doctors to prescribe their medicine also results in the high price of medicines due to the expense of convincing more and more doctors.
[The writer is Coordinator, Medical Service Society, New Delhi. Email: [email protected]]