[Editorial Analysis] Missing the healing touch

Mains Paper 2: Governance

Prelims level: NRHM

Mains level: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Context

• There is an increase of more than Rs 7,000 from last year’s expenditure on health in this year’s budget from Rs 56,045 crore to Rs 63,298 crore.

• The country’s primary healthcare system taken a backseat.

• Allocation under the National Rural Health Mission (NRHM) which provides funds for rural primary healthcare has been reduced in real terms (accounting for inflation) from 52 per cent in 2015-16 to 41 per cent this year.

• Within the NRHM, there have been budget cuts for reproductive and child healthcare projects and maintenance of rural healthcare infrastructure.

Allocation for tackling communicable disease

• The allocation for controlling communicable diseases under the NRHM has been reduced in real terms.

• Communicable diseases like TB, diarrhoea, pneumonia, hepatitis and other infections are still a major problem for India.

• The National Urban Health Mission has been allocated only Rs 950 crore estimated Rs 3,391 crore from Central funds.

• Allocation for tertiary care components the Pradhan Mantri Swasthya Suraksha Yojana (a programme for building-AIIMS like institutes), for example has also remained stagnant in real terms.

• Funds for upgrading district hospitals have been reduced by 39 per cent in real terms.

• Majority of the increase in the budget’s health component has gone to fund the Rs 6,556-crore Pradhan Mantri Jan Arogya Yojana (PMJAY).

Highlights of the NSS data

• The National Sample Survey’s (NSS) health data of 2014 shows that out of an estimated total 24.85 crore families in India, 5.72 crore had to resort to hospitalisation.

• By that calculation, out of the 10-crore families, there would be roughly 2.3 crore hospitalisations in a year.

• National Rural Drinking Water Mission and the Pradhan Mantri Matru Vandana Yojana have utilised only 78 per cent and 50 per cent of the budgeted funds, respectively.

• The government’s flagship programme, Swachh Bharat Mission (rural), also did mnot fully utilise the Rs 15,343 crore allocated in 2018-19.

• Its allocation has been further reduced to Rs 10,000 crore for 2019-20.

Conclusion

• Priority should have been towards improving the worn-out public sector district hospitals, community health centres, primary health centres and subcentres in under-served areas.

• NSS 2014 data shows that 97 per cent episodes of illnesses in India are treated in out-patient care centres and this accounts for 63 per cent of the overall medical expenditures.

• Buying healthcare services from the private sector is not pro-poor policy.

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Prelims Questions:

Q.1) Air closer to the Earth’s surface is heavier because of

a) Gravitational forces acting on air

b) Jet air circulation in upper atmosphere

c) Cloudiness near equator and poles

d) Higher air pressure in stratosphere

Answer: A

Mains Questions:

Q.1) Modest increases in budgetary allocation to health should have been directed towards reviving primary healthcare not an insurance scheme that does not cover a majority of the treatments. Critically analyse the statement.

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