Health Budget: Reality Check

Its traditional approach to public investment is out of step with changing needs

The health budget this year has made special provisions for elimination of five infectious diseases, strengthening of rural sub-centres, recruitment of specialist doctors in government hospitals, increased allocation for programmes for women and children, and free treatment for the elderly poor. Missing in this list is a mention of increased budgetary support for the prevention, control and care for non-communicable diseases like cancer, diabetes, hypertension and heart diseases — the major causes of ill health, disability and death in the country today.

These diseases do not only afflict urban residents. They are the major cause of death and ill health in rural areas, where incomes are lower, and medical services are more difficult to reach. A small part of this distress could have been addressed through additional budgetary provisions. This would also have reflected an acknowledgement on the part of policymakers, that these conditions, and not infectious diseases, are now the major cause of ill health in the country.

Since Independence, a significant portion of the health budget has been channelised into infectious disease control programmes, so that these diseases now account for less than 10 per cent of deaths and only 15 per cent of ill health in the country. The intention to eliminate five infectious diseases can be debated, especially as disease elimination is an unpredictable public health investment. The prolonged expenditure to eradicate polio is a recent example. India eradicated guinea worm, yaws and maternal and neonatal tetanus, without the hullabaloo associated with the much-hyped programmes that eradicated smallpox and polio. Eliminating kala-azar and filariasis, now restricted to a few areas in the country, may be feasible. The epidemiology of leprosy and tuberculosis are so different that financial investment for their elimination warrants caution.

India has, in fact, burnt its fingers once by declaring that leprosy was not a public health problem, only to realise that leprosy cases were increasing. The goal of tuberculosis elimination highlights another public health issue that has not received mention in the budget. Investments are needed for strengthening health services for the urban poor. The unhealthy, over-crowded and impoverished living conditions of urban slums provide the ideal environment for proliferation of infectious diseases, and could easily undo targets of eliminating tuberculosis and leprosy.

Even as the health budget has announced increased provisions for government programmes for women and children, it is time to re-examine the increased prioritisation of care for pregnant women. For over a decade now, institutional deliveries and immunisation have been incentivised. Perhaps it is time to taper off this programme that pays women across India to deliver at hospitals, some of which may not necessarily be up to required healthcare standards.

With reducing fertility, women experience two to three pregnancies. Maternal deaths have reduced significantly across the country and are now the 10th largest cause of death among women. At this time, investing in the creation of clean, accessible, and supportive mother and child clinics might be more cost effective.

True, planning to address the health problems of India is a daunting task especially as health priorities vary widely across the country, and India has to combat both infectious and non-communicable diseases. While the health budget has retained a rather traditional approach, more innovative allocations, like the budgetary provision for the elderly poor, were required.

This latter allocation reassures people that public health investments acknowledge the reality of the changing demographics and health status of the country. They reflect the fact that policymakers are preparing for the changing health status of the population that accompanies the economic progress of the country.

The writer heads the public health school at Pune University

Source: 6-02-2017