Just money can’t get us good public health, Siddaramaiah, you need to spend it right

Walk into a well-constructed PHC, and there's often nothing, not even a doctor
Just money can’t get us good public health, Siddaramaiah, you need to spend it right
Just money can’t get us good public health, Siddaramaiah, you need to spend it right
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Karnataka Chief Minister Siddaramaiah should listen to The Beatles. If he did, he would know that there are some things that money just can’t buy. Like love. Or faith in the public health system, which people are abandoning by the droves.

In a meeting earlier this week, Chief Minister Siddaramaiah was very worried: “The government is spending crores of rupees on improving health infrastructure but the number of patients visiting government hospitals is on the decline. People prefer private hospitals.”

He asked bureaucrats to find out why this was happening when the government was spending around Rs 5,000 crore a year on public health.

But as the head of the state government, Siddaramaiah should know better than anyone else, that merely spending money does not translate in efficacy or results.

In an interview with The News Minute, Akhila Vasan, a public health researcher with Karnataka Janaarogya Chaluvali, says the government has a dysfunctional system on its hands, but money isn’t going to set everything right. She briefly outlines ways in which one could make a start:

Right side up please

At present, health expenditure is guided by skewed priorities and bad policy. The government spends more on tertiary care and the least on primary care. Primary care is meant to promote overall health, and not just provide treatment for illnesses.

So to achieve good health, governments – rural, urban or state – also need to pitch in: provide safe drinking water, ensure mosquito control, convince people to stop open defecation, use hygienic menstrual practices, etc.

Follow the money please

If you follow the money some more, you’ll find two things.

One, quite a bit of it is going to private hands but not translating into care for the public. For instance, 98% of the money set aside for health insurance schemes (about Rs 400 crore), goes to private medical establishments for expensive surgeries. What if that money could go to district hospitals instead? Also, these insurance schemes aren’t designed with any idea of how many people require it.

Two, money is sunk into building things without complementing them. Karnataka’s physical PHC infrastructure is actually fairly adequate, and largely adheres to Indian Public Health Standards. But walk inside a PHC, and there’s no doctors, essential medicines, often, even drinking water.

Regulate education please

Medical education is a completely unregulated sector that needs to be reined in. (It’s an open secret that several politicians are invested in the lucrative business of running educational empires.) Medical education has become more about super specialization than good health. If you’re paying Rs 10 crore to become a fancy neurosurgeon, would you want to go to public health system?

Increase the budget please

While taking the above steps, increase overall health expenditure. The Karnataka government spends an abysmal amount of money on public health. During the 11th plan, Karnataka spent less than 1% (0.9%) of its Gross State Domestic Product. It should be at least four times this figure.

Attempting to buy public popularity for the government health care institutions isn’t going to work. But working up the courage to take on corrupt, lazy, systems and resisting vested interests will restore faith. After all, Tamil Nadu and Rajasthan do very well. So it’s not that it can’t be achieved.

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