Boost public health spending, strengthen rural infra: Health experts ahead of Budget ‘18

With just days to go for the next Union Budget, health experts stress on the need for a focus on primary health care, and say that the budget must address the same.

The country is trying to battle communicable diseases in large numbers, but non-communicable diseases are also on the rise. Therefore, ensuring better access to healthcare in all pockets of the country is essential, they explain.

Dr Usha Manjunath, Director, Indian Institute of Health Management and Research, said that the healthcare sector is growing fast and would be valued at an estimated $230 billion in a few years to come.

“In India, the investments in public health and per capita investments are low. This must be addressed,” she said.

She stressed the need for the government to increase spending on public health.

“The National Health Mission is a great way to ensure better access. Increasing allocation in this sector is important,” she said.

As the country continues to battle challenges such as tuberculosis, maternal mortalities and child mortalities, Dr Usha opines that there is a long way to go.

“We have certainly improved when it comes to maternal and infant mortalities. However, there is a long way to go. The Gorakhpur tragedy incident reminds us of the same,” she said.

There is a need to address the growing numbers of non-communicable diseases as well, she points out.

“Screenings must be increased at the primary health care (PHC) level. This applies not just to urban areas as the numbers for non-communicable diseases have gone up in rural areas as well.”

“There is a need to ensure capacity building under the National Programme for Control and Prevention of Cancer, Diabetes, Cardiovascular Diseases and Stroke. We need to operationalise it better. The focus must be on training specialists at the PHC level and providing better access to medicine and labs,” Dr Usha added.

Besides ensuring healthcare access, Dr Usha added that more regulatory provisions are necessary.

One of the key expectations experts in the healthcare sector have from the upcoming Budget is the announcement of Universal Health Coverage. 

Another key aspect to be taken into account is that compared to other countries, India’s spending on healthcare is very low, said Dr H Sudarshan Ballal, Medical Director, Manipal Hospitals.

“We just spend 1.5% of our total GDP on healthcare. Most health economists are of the opinion that it has to be anywhere between 4-5%. It would be tough to expect the change to happen in a year. If we boost it even by 1% every year, it should help,” he said.  

Dr Ballal is of the opinion that focus needs to be on preventive and primary health. It is better to create wellness than to treat illness, he said.

“It starts with providing safe drinking water, better sanitation, antenatal care and promoting public health,” he said.

“Upgrading government hospitals is important. The poor are now forced to head to private hospitals even when it is way over what they can afford. This creates a lot of unrest. If government hospitals are improvised, this would not happen,” he said.

Priority, he believes, must be given to PHCs. 

"We have over 6,000 PHCs in the country today. There is a need to strengthen this and man it well. The focus must be on providing vaccines and nutrition.”

Dr Ballal believes that providing better access to health could also be done by strengthening district hospitals and establishing medical colleges in every district.

Meanwhile, Dr S Gurushankar, Chairman of the Meenakshi Mission Hospital and Research Centre in Madurai says the low priority the healthcare sector has got in the Union Budget is inexplicable.

“From independence, the healthcare sector has got the least priority in every Union Budget. This is inexplicable because a country cannot progress if its people are unhealthy and keep dying for want of basic healthcare. Most of the Indian population lives in rural areas, but it is unfortunate to see that majority of hospitals exist in urban areas,” he said.

“One of the biggest challenges the country is facing is the acute shortage of hospital beds in rural areas. Healthcare services are lopsided in favour of cities. A major thrust is needed to increase the number of hospital beds in rural areas to improve India’s healthcare parameters and save lives of millions of people every year,” he added.

He places the blame for healthcare services being lopsided towards urban areas squarely on the government.

“Historically, governments have given no incentives to entrepreneurs to set up hospitals in rural areas. Whether it’s a city or a village, the construction and running costs of a hospital are largely the same, and so is GST on medical equipment. However, the affordability factor of an urban patient is several magnitudes higher compared to that of rural patients. Therefore, it makes far more sense for a healthcare entrepreneur to build hospitals in cities rather than rural areas. It is a sad situation – while government healthcare facilities are non-existent in rural areas, there are no incentives to build private hospitals either. Consequently, rural people are forced to live without healthcare services. Do their lives have no value?” he lamented.

To rectify this, he proposed three steps that can be taken - a 10-year tax holiday for new hospitals in villages and rural areas; accelerated depreciation (100% in the first year itself); and zero GST for life-saving medical equipment used in setting up rural hospitals.”