A six-point plan for inclusive health system
Sonal Matharu | February 23, 2011
As the country waits for budget announcement by the finance minister Pranab Mukherjee, civil society gears up to highlight the glaring disparities in the society and what possible inclusions in the budget can help fill those gaps for a better economic and social growth of India.
One such initiative was recently taken by non-governmental organisation Centre for Budget and Governance Accountability (CBGA). On healthcare in India, CBGA points out in its background note for national convention on union budget, that the progress on health indicators in the country has been slow with infant, neo-natal and maternal mortality still high despite wide policies and programmes.
To have a healthier society, they have urged the government to increase public investment on health to three percent of the Gross Domestic product (GDP) as against 1.1 percent of GDP at present.
Government schemes like the Janani Suraksha Yojna (JSY) and the Indira Gandhi Matritva Sahayog Yojna (IGMSY) have shown improvements in bringing down maternal and infant mortality and these schemes should be strengthened for better results.
District hospitals should be upgraded to provide quality health facilities. And alongside, private sector should be regulated to check out-of-pocket expenses. All expensive drugs should be brought under price control and regular supply of medicines should be ensured through public health system, the NGO says.
Public investment on health
India ranks lower than the other Asian countries like china, Malaysia, Sri Lanka, Thailand and Bangladesh in public spending on health. It ranks sixth from bottom in terms of public expenditure on healthcare as a proportion of GDP. The centre’s expenditure on health stood at 0.26 percent of GDP in 2003-04, which has only increased to 0.36 percent of GDP in 2010-11.
A major chunk of India’s public spending on health comes from the state budgets.
CBGA suggests that by relaxing the Fiscal Responsibility and Budget Management Act the states can increase spending on health. The states also need to increase their non-plan expenditure on health sector, they suggest.
Investment on human resources
India faces a huge shortage of health workers. Also, quality of medical education is important to ensure quality of services later. Medical, nursing, pharmacy and dental councils of India play an important role and these should be strengthened.
Auxiliary nurse midwives (ANM) and lady health workers (LHW) training courses need to be revised with a view of separating the cadre of midwives from that of public health nurses as also pointed out in the mid-term review of the 11th five-year plan, says CBGA.
It adds that the frontline health workers work under abject working conditions with poor remuneration and no coordination with each other. This must improve to have better health services at the primary and secondary levels.
Infant and maternal mortality
There need to be a fundamental change in the approach followed by the health ministry and the JSY. The government stresses on institutional deliveries, which, they think would prevent maternal and infant deaths. This idea must change to safe deliveries.
Primary health centres (PHC), community health centres (CHC) and district hospitals are not necessarily centres of safe delivery as there is lack of human resources and infrastructure at these medical units. Lucknow-based NGO, Sahyog, has highlighted that many women die trying to reach institutional facility at the time of delivery.
Women and child development ministry started the IGMSY scheme in the 11th plan where a pregnant or a nursing woman above the age of 19 will be given Rs 4,000 until the first two live births. The Ngo suggests that the scheme should be applicable to all women, without any conditionality as the present rules leave a vulnerable group of younger pregnant women who are most at risk.
Number of staff, beds, equipment supply, services availability and population coverage is not uniform in all district hospitals. The government needs to give priortity to upgrading the district hospitals, particularly those in the far-flung and backward areas, CBGA mentioned.
Private sector in health
India’s healthcare system is one of the most privatised in the world. Due to this, the burden of spending on healthcare falls directly on households and is mostly out-of-pocket as the penetration of health insurance in the country is very low. The National Sample Survey Organisation (NSSO) in its 60th round mentions that around 6.2 percent of the total households in the country fell below poverty line (BPL) as a result of healthcare expenditure in 2004.
National Health Accounts 2008-09 show that 26.7 percent of healthcare expenditure was public and 71.6 percent was private.
The World Health Organisation (WHO) estimates that 65 percent of India’s population lacks regular access to essential medicines (2004). Cost of drugs has a direct bearing on the out-of-pocket medical expenses, hence, it should not be kept out of focus, says CBGA.
The CBGA rightly points out that it is not just the paucity of funds that has a negative impact on the health sector, but the systematic neglect of the government institutions and infrastructure has done an equal damage to the healthcare systems in the country. Poor quality of health services are a direct result of this.
Issues of availability, accessibility and affordability of health services remain. Inter-sectoral convergence with departments such as drinking water, sanitation, nutrition and education are required.
Spending on healthcare should not only come from the centre, but initiatives should also be taken from the states.
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