Connect with us

Analysis

Rs 10,290 Cr Boost For Health Hides Funding Cuts For Key Programmes

Published

on

health budget

Despite a Rs 10,290-crore increase in health funding for 2017-18, an investigation of the central government’s health budget reveals that most of this money is not being spent on India’s health priorities, which, instead, now face funding cuts.

Elimination of tropical diseases (kala azar, filariasis and leprosy) over the next two years; elimination of a vaccine-preventable disease (measles) by 2020. Elimination of tuberculosis (TB) by 2025; and “significant reduction” of infant and maternal mortality by 2020: These were some key proclamations related to health made by Union Finance Minister Arun Jaitley during his February 1, 2017, budget speech for 2017-18.

Given that India has an infant mortality rate (IMR) of 37 per 1,000 live births–or higherthan the average for 154 middle- and low-income countries–the world’s highest TB burden, with 27% of the world’s new cases, and accounts for 58% of new leprosy cases detected globally, Jaitley appeared to address some of India’s most significant public-health concerns. Adequate funding could lead to significant improvement in India’s health systems and health status.

But Jaitley’s budget indicates inadequate allocations or funding cuts to his declared priorities. Most of the Rs 10,290-crore increase will be spent on issues regarded as low priority: New medical colleges, new premier medical institutions and converting health sub-centres into “health and wellness centres”–but with no more than Rs 60,000 per centre annually.

The question then is, where has this additional money gone? To open new medical colleges, new premier medical institutions–while older ones languish–and converting 150,000 health sub-centres into “health and wellness” centres but without adequate funding.

Measles: Ambitious targets and a Rs 1,000-crore funding cut

To eliminate measles, India will need to invest in stronger immunisation systems and social mobilisation. Most countries that have eliminated measles have used some form of a campaign approach, as India has by starting the first phase of a measles-rubella vaccine campaign to immunise 35 million children in 2017 and 410 million children over the next two years, as this World Health Organization statement pointed out.

Has money been set aside to achieve these targets? It appears not.

The union health budget includes a separate head, the National Rural Health Mission (NRHM), to fund state rural healthcare. Within the NRHM budget is a sub head called the “Reproductive and Child Health (RCH) flexi-pool”, which sets aside funds for immunisation, including funding of the polio-eradication campaign. To improve healthcare in urban areas (where measles remains a significant problem due to high population densities), the central budget sets aside money under the head National Urban Health Mission (NUHM).

To fund the measles campaign and eliminate measles, funding under RCH flexipool (for rural areas) and under NUHM (for urban areas) should have been higher than previous years.

Instead, funding for the RCH flexi-pool has been cut 23%, by more than Rs 1,000 crore, from Rs 5,932 in 2016-17 to Rs 4,566 in 2017-18.

Similarly, funding for the National Health Mission, which aims to provide universal access to affordable and quality healthcare and funds both NRHM and NUHM, has been reduced by Rs 197 crore over a year.

TB: As deaths double, a Rs 13-crore cut in funding

India had double the number of estimated TB deaths in 2015–480,000, up from 220,000 deaths in 2014–because previous estimates were too low, as IndiaSpend reported in October 2016..

India has 27% of the world’s new TB cases–one of the biggest infectious disease killers in India. The country had 2.8 million new TB cases in 2015, up from 2.2 million cases in 2014, according to the World Health Organization’s Global Tuberculosis Report 2016.

In such times, moving the goal post from control to elimination makes sense. In January 2017, the Supreme Court also directed the government of India to move from alternate-day medication to a more effective daily regime. But this would be require a larger budget.

As we said, the union budget’s NHRM head provides for healthcare in rural India. Within this budget head is a sub-head called “Flexible Pool for Communicable diseases”, which includes funding for the Revised National Tuberculosis Program.

Now, funding appears to have increased by Rs 87 crore over a year to 2017-18, but the revised budget estimates–drawn up after the budget is presented–reveals a drop of Rs 13 crore over 2016-17.

Adjusting for purchasing power parity, the funds available for TB control would be even lower, which means there are no new investments at a time when the TB programme needs to be expanded.

Maternity benefit only for first borns; funding short by Rs 11,812 crore

In the 2017-18 budget, funding for Indira Gandhi Matritva Sahyog Yojna (Maternal Benefit Scheme) has risen 226%, from Rs 634 crore ($94.6 million) in 2016-17 to Rs 2,700 crore ($298 million) in 2017-18, but this allocation, as IndiaSpend reported on February 22, 2017, isn’t enough to cover all expectant mothers.

The government had estimated that the the annual requirement for this maternity benefit scheme–which provides iron and folic-acid supplements to pregnant women to prevent maternal anaemia, sepsis, low birth weight, and preterm birth–would be Rs 14,512 crore ($2.1 billion), according the report of the Standing Committee on Food, Consumer Affairs and Public Distribution (2012-13).

“At the rate of Rs 1,000 per month for six months, the scheme expenditure towards maternity benefits to 2.25 crore pregnant and lactating women works out to Rs 14,512 crore per annum,” said the report, quoted in the Indian Express on February 18, 2017.

So, the ministry plans to provide maternity benefits only to first-borns, leaving other children vulnerable.

Of Indian infants who died within 29 days of being born between 2010 and 2013, 48% were underweight or were premature. India has more than 3.5 million preterm births every year, more than any other country, IndiaSpend reported in November 2016.

So where has the additional Rs 10,290 crore gone?

India’s health budget, as we said, rose Rs 10,290 crore in 2017-18 compared to the previous year. While this appears higher than ever, it is inadequate to bring India–which currently spends less than 1.5% of gross domestic product (GDP) on health–close to a minimum desirable health spend: 2% of GDP. As we have seen, this additional money does not seem to have gone to the government’s priorities: Reducing infant mortality or control of TB and other communicable diseases.

Source: Union Budget, 2017-18; * Setting up of two more AIIMS; ** Revised estimates for 2016-17; *** Universal health insurance scheme

Rs 2,855-crore increase for new medical colleges in districts

A major increase in budgetary allocation has been towards more medical colleges at district hospitals, an increase of Rs 2,855 crores, accounting for about 27% of the Rs 10,290-crore rise in health funding.

India does need more medical graduates, but increasing medical colleges will not be easy, considering that even premier institutes, such as branches of the All India Institute of Medical Sciences (AIIMS), set up by ministry of health and family welfare, in state capitals are struggling. For instance, five years after the first batch was admitted, AIIMS Bhopal does not yet have a blood bank and does not conduct surgeries, and important faculty positions are vacant, The Hindu reported in January 2017.

Rs 1,525-crore increase for new AIIMS, while older ones struggle

That bring us to the other significant funding increase: Rs 1,525 crore more over 2016-17 forPradhan Mantri Swasthya Suraksha Yojna (the Prime Minister’s Health Protection Scheme), which is not the same as the more well-known Rashtriya Swasthya Suraksha Yojna(National Health Protection Scheme), which–confusingly–has been renamed the National Health Protection Scheme (more on this later).

The Pradhan Mantri Swasthya Suraksha Yojna is supposed to set up new branches of AIIMS in the states. In addition to the 11 that exist, Jaitley announced setting up of two more AIIMS, in Jharkhand and Gujarat.

Instead of opening new institutes, and investing about 8% of the health budget (Rs 3,975 crore of Rs 47,352 crore) to do so, the government should ideally focus on making sure that the ones already opened are functioning.

Rs 3,000-crore increase to convert health sub-centres to health and wellness centres

Another significant increase of about Rs 3,000 crore is under the “Health System Strengthening” sub-head of NRHM. This is likely to be allocated to another pronouncement: Converting 150,000 health sub-centers nationwide into “health and wellness centres”.

Again, this is not a bad idea, since functional sub-centers can take primary healthcare closer to where people live. But with no plan for this transformation made available–not even how many will be converted this year–Rs 3,000 crore appears inadequate.

For example, even if 25% of the increased allocation under this sub-head is to upgrade sub-centres, no more than Rs 60,000 would be spent per sub-centre.

So, while the current budget’s health proclamations are apt, the funding increases for issues of low health priority are unlikely to make a significant impact on the overall well-being of India’s people.

Correction: We had earlier said that India accounts for 27% of new leprosy cases detected globally. The correct datum is that India accounts for 27% of the world’s new tuberculosis cases and 58% of new leprosy cases detected globally. We regret the error.

(Mohan formerly coordinated health and nutrition programmes for UNICEF’s country office in India and is the co-founder of Basic Healthcare Services, a nonprofit that offers low cost, high quality primary healthcare in rural under-served communities. He is also Director, Health Services, of Aajeevika Bureau, a nonprofit that provides services to labour-migrants.)

We welcome feedback. Please write to [email protected]. We reserve the right to edit responses for language and grammar.

Continue Reading
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Analysis

Modi’s momentum under attack as opposition gears up for offensive

Congress President Rahul Gandhi is also now a more formidable opponent of Modi than he was in 2014 and his attacks are sharper and unrelenting.

Published

on

Vishwashghaat

New Delhi, May 26 (IANS) With his party ‘stopped’ in Karnataka and bracing to face crucial Assembly elections in three major states in the north this year end, Prime Minister Narendra Modi takes his government into the last year in office with the political momentum slightly shaken against the mounting burden of fulfilling expectations on numerous election promises.

Political analysts say that many of the promises of the Modi government have been rhetoric and it needs course correction by being more accommodative over the next year if BJP’s prospects are to improve.

They said the outcome of 2019 elections will largely depend on opposition parties coming together to pose a common challenge to the BJP.

Kumaraswamy's swearing-in ceremony

The BJP’s inability to form the government in Karnataka, despite being the single largest party, has come as a damper to the party. It had suffered jolts earlier this year in defeats in prestigious parliamentary by-elections in Gorakhpur and Phulpur as also Ajmer and Alwar.

“Intolerance has been a major drawback in the last four years,” says political analyst and senior journalist H.K. Dua adding that the idea of India as a plural polity had suffered due to incidents like ‘love jihad’ and lynchings.

“Every incident fouls the atmosphere. India is a composite society and Prime Minister himself said ‘Sabka saath, sabka vikas’ which did not happen. That’s why Dalits have been very angry, tribals have been very angry, farmers have been very angry. Caste divisions are sharper than before. That does not speak well,” he said.

Dua said constitutional institutions “have not been shown the respect they deserve.” He said consensus between the ruling and opposition parties for running parliamentary democracy has been ignored. “The initiative had to come from Prime Minister but that has not come,” he said, adding there is doubt how deep is the faith of government in democratic practices.

“I don’t think in 2019 there will be Modi wave. Opposition will be able to present a formidable challenge if they unite. So the unity is very, very important.

Kumaraswamy swearing-in ceremony

But even as efforts to forge understanding among opposition parties continue at various levels, Modi continues to have a cross-country appeal as the prime vote-catcher of the BJP.

As Prime Minister, he has sought to bring speed to decision-making by cutting red tape, set ambitious targets, launched some imaginative schemes, focused on delivery, simplified norms and shaken off lethargy in the official machinery.

The BJP-led National Democratic Alliance government is seen to be more focused and target-oriented but there is little visible impact of some of its initiatives such as the Swachh Bharat Campaign.

Subrata Mukherjee, a political analyst who taught at Delhi University, said there have been more promises than delivery in the past four years and projects like Start Up India and Make in India have not progressed the way they were made out to.

“The economic record of the government is not very good and they are now postponing everything to 2022. That is beyond their mandate. So it is politics of postponement,” he said.

He said most of the schemes are a rehash of Congress schemes.

Mukherjee said Modi government needs to practice a more “accommodative politics.”

“They will have to work out accommodative politics, bring new segments. The scheduled castes, Muslims are angry. If they want to retain power, they will have to go for drastic course correction,” he said.

He said opposition unity was important for good politics and the proposed federal front cannot do without congress. “BJP will also have to understand that 2019 will be coalition government whether led by it or the Congress,” he said.

Unlike the 2014 elections, when he was the challenger, Modi will be the incumbent in 2019 and the opposition has a plethora of issues to queer the pitch including jobs, price rise, problems of farmers, multi-crore banking frauds, non-performing assets of banks, “write-offs” of corporate houses, and “atrocities” against weaker sections including Dalits.

Congress President Rahul Gandhi is also now a more formidable opponent of Modi than he was in 2014 and his attacks are sharper and unrelenting.

Congress General Secretary Ashok Gehlot said people had trusted Modi but he “betrayed” them. As a member of the opposition, he sees an all-round failure in the government.

“Farmers, youth, traders, women, everyone now feels betrayed. There is sense of fear and mistrust among people. Fuel prices are sky-rocketing. This is a loot. The situation in the country is such and all sections of society are so unhappy that the people will force every party in the country to come together to defeat Modi and the BJP,” he said.

BJP Spokesperson G.V.L. Narsimha Rao, however, as expected, termed the last four years as “epoch-making.”

“These will be best remembered for ushering in a New India Era with corruption-free governance, inclusive economic growth with special focus on farmers, women and marginalised sections,” Rao told IANS.

He said that Prime Minister Narendra Modi’s government has fulfilled long neglected basic needs of the common citizens with innovative schemes like Ujjwala.

The Ayushman Bharat scheme, announced in this year’s budget which aims to provide health insurance cover of Rs 5 lakh to around 10 crore families is an ambitious move to connect with the poor and, if successful, can help BJP earn goodwill in run up to 2019 Lok Sabha polls.

The elections in Madhya Pradesh, Rajasthan and Chhattisgarh later this year are expected to set the tempo for the Lok Sabha polls and the BJP is the incumbent in all three states facing tough contests.

(Prashant Sood can be contacted at [email protected])

Continue Reading

Analysis

Four years of Modi failed to deliver crore of jobs: Swaraj India

Prime Minister Modi had promised to deliver one crore jobs every year but the number of jobs have decreased in reality.

Published

on

Yogendra Yadav

New Delhi, May 26 (IANS) As the Narendra Modi-led NDA government completed four years on Saturday, Swaraj India alleged although it has provided some evocative slogans like ‘Make in India’, ‘Skill India’, ‘Beti Bachao, Beti Padhao’, but scored a near zero score in performance, especially in its promise to deliver one crore jobs every year.

“The Modi government only made an onslaught on the Constitution and democracy, and saw jobless growth, increasing communal tension, rural distress and overarching insecurity among Dalits, minorities and women in country. All the key promises of the BJP government have turned out to be hollow.

“Prime Minister Modi had promised to deliver one crore jobs every year but the number of jobs have decreased in reality,” said Swaraj India national spokesperson Anupam.

Swaraj India chief Yogendra Yadav said that the violence against religious minorities, especially Muslims, is spreading openly.

“The country is unsafe because despite the claims of surgical strike, incidents of encroachment and terror attack from Pakistan have increased. Relations with neighbouring countries and even old friends are seeing a challenging phase and China’s movements have become more aggressive,” he said.

Senior party leader Prashant Bhushan meanwhile decried the rise of corruption, eroding authority of anti-corruption bodies, shielding of corrupt officers are being shielded, the “disaster” of demonetization, no change in the black money situation and putting of the Lokpal issue in cold storage.

Continue Reading

Analysis

After 1,460 days of Modi rule, ‘achhe din’ yet to come

I do not blame this government for not being able to deliver ‘achhe din’. Which government since Independence has?

Published

on

Narendra-Modi

New Delhi: There’s only one year more to go for the BJP-led regime before another test at the hustings. But is the country any nearer to Prime Minister Narendra Modi’s promised ‘acche din‘ (good days)? Four years ago, the country had voted the present regime to power on hopes of better days in all socio-economic-political spheres. But despite some strong structural reforms like GST, and gut-wrenching changes like demonetisation, the jury may still be out on how good it has been, according to economists and others experts.

Despite India’s GDP growth of 7.2 per cent in the third quarter (October-December) of 2017-18, some economists feel that the demonetisation drive, avowedly taken to “cleanse the system” of black money, had ended up damaging the country’s economy instead.

“Demonetisation was a terrible mistake by the government, for which the common people paid the price. It has reduced people’s trust in the banking system, as they were denied their own money during the period of cash crunch. It takes so much time and work to build institutions and policies — it is so much easier and faster to break things,” Jayati Ghosh, Economics Professor at Jawaharlal Nehru University (JNU), told IANS.

The government decided to ban 1,000 rupee and 500-rupee notes on November 8, 2016, taking away 86 per cent of the total currency in circulation. “May be this move had served the government’s purpose politically, but economically it was a bad one,” Ghosh added.

Echoing similar views, Arun Kumar, former professor of economics at the JNU, told IANS that when the NDA government came in, the Indian economy was already on an upward trajectory. The quarter, in which the government took over, the growth climbed to eight per cent. In October 2016, India was the fastest growing economy in the world when China slowed down a bit.

“But then the government administered a shock to the system with demonetisation. It had a negative impact on the unorganised sector that comprise 45 per cent of production and 93 per cent of employment in the country. According to some estimation, 50-80 per cent of that got damaged,” he said.

Kumar, who is now Chair-Professor with the Institute of Social Sciences, added: “Government did no survey at that time and hence no data is available. Even data from International Monetary Fund and World Bank, which rely on government data, do not show any estimates (on impact).”

After demonetisation, credit off-take in the country declined sharply. “Between November-December 2016, it was at historic low of 60 years. Investment into the country also took a big hit,” he said. However, Ranen Banerjee, Partner & Leader, Public Finance and Economics, at PricewaterhouseCoopers (PwC) has a different take on some of the benefits flowing from the action.

“Demonetisation had positive impact as far as digital payments were concerned. It shot up sharply during that period but came down subsequently. The level is still higher earlier. But demonetisation as a measure did not deliver all the results that it was supposed to deliver,” Banerjee said.

The government’s other major thrust, though, on Goods and Services Tax (GST) — rolled out on July 1 last year, got better billing. Economists are hopeful that it will bring in beneficial changes once the hiccups are over. Banerjee says GST would change the entire landscape of tax compliance in the country by creating a multiplier effect. “GST was a bold move which is showing positive results,” he added.

Ghosh, though, thinks GST goes against the grain of federalism. “A unified system is not so necessary in a federal structure — for example, the US does not have it and still has a very modern economy. In a federal structure you have to allow states to have some money raising power. Further, GST implementation has been really bad.”

Kumar said: “Introduction of GST has hit the unorganised sector badly. Even in Malaysia where GST was introduced in 2015-16 at 26 per cent, government decided to scrap it. The organised sector is rising at the expense of unorganised sector. Disparity is rising.”

Industry chambers have by and large welcomed government initiatives, especially the decision on GST. “The overall economy is strong with GST having settled down and reforms firmly on the right path,” Chandrajit Banerjee, Director-General of Confederation of Indian Industries (CII), told IANS.

Over the last four years, according to him, the government had systematically addressed major “pain points” for the economy such as ease of doing business, non-performing assets of banks, foreign direct investment rules, infrastructure construction and exit of failing enterprises.

“The government’s mission-mode development campaigns have delivered notable results, adding to overall growth multipliers. The firm level and sectoral level numbers look promising for the next year in terms of orders booked and capacity utilisation,” said CII’s Banerjee.

Former economics professor at Indian Statistical Institute, Dipankar Dasgupta, who holds that the economy was yet to recover from the hit it took because of demonetisation, says that on GST he was hopeful that with time it will stabilise. “In the other countries where it was introduced there were teething problems too,” he said.

The government also took up the job to cleanse bad loans of banks. It is pumping in Rs 2.11 lakh crore as capitalisation, spread over two years. But a number of banking scandals and rising non-performing assets (NPA) may have reduced the faith of people in the bank system, after the shock of demonetisation. “We have declining deposits in the banking system due to people’s rising mistrust,” says Ghosh. Dasgupta says recapitalisation should be followed with caution so that it does not widen the fiscal deficit.

The government, though, has got support in its effort to tackle the issue of NPAs. The bankruptcy law has put everyone on notice. “People are taking the issue of NPAs seriously trying to resolve it. Companies are opting for out of court settlement. Propensity to comply has increased as borrowers know that there will be consequences on not servicing a loan,” Banerjee of PriceWaterhouseCoopers said.

Yet, overall the promise of the golden pot at the end of the five-year rainbow, as promised by Modi in his of speeches — where he had painted the BJP rule in attractive hues — has not materialised in four years. BJP’s best salesman may have oversold the hope. “I do not blame this government for not being able to deliver ‘achhe din’. Which government since Independence has?” asks Dasgupta rhetorically.

Continue Reading
Advertisement

Most Popular