Poor state of primary health care
- Today, the condition of our primary health infrastructure is lamentable:
- Short in numbers: There is a shortage of PHCs (22%) and sub-health centres (20%). There is also a huge shortage of medical and paramedical staff at all levels of care, including doctors and auxiliary nurse midwives.
- Short in quality: Only 7% sub-health centres and 12% primary health centres meet Indian Public Health Standards (IPHS) norms.
- Short in infrastructure: Further, numerous primary-level facilities operate out of rented apartments and thatched accommodations, and lack basic facilities such as toilets, drinking water and electricity.
Low expenditure on primary health care
- National Health Mission for primary health care:
- National Health Mission (NHM) is India’s flagship programme in primary health care.
Lack of sufficient funding:
- NHM’s share in the health budget fell from 73% in 2006 to 50% in 2019 in the absence of uniform and substantial increases in health spending by States.
- The Ministry of Finance, in August 2018, projected a 17% increase in allocation for the NHM in 2019-20. However, there has only been only an increase of 3.4% this year.
- With this, the NHM budget for this year (Rs. 31,745 crore) is about the same as the actual spending on the programme in 2017-18.
- Health and wellness centres for primary health care:
- The Ayushman Bharat scheme of the union government proposed to transform 1.5 lakh sub-health centres into health and wellness centres by 2022.
- These health and wellness centres would provide a wider range of primary care services than existing sub- and primary health centres (PHC).
- As per 2017 estimates, it would cost Rs. 16 lakh to convert a sub-health centre into a health and wellness centre.
Meeting the target of their creation not possible at current rate:
- Building health and wellness centres at the given rate (15,000 per year) can fulfil not even half the proposed target of 1.5 lakh health and wellness centres till 2022.
Funding also shows this is not a priority:
- In 2018, only an outlay of Rs. 1,200 crore was made for these health and wellness centres.
- This year, the outlay is Rs. 1,600 crore (a 33% increase) clubbed under the National Health Mission (NHM) budget.
- The current outlay is less than half the conservative estimate even to build the health and wellness centres at a low rate per year.
Government focussing on hospitalization costs (through PMJAY):
- The union government is committing more resources to increasing access to hospitalisation care, predominantly through private players.
- This reflects in the 167% increase in allocation this year for the PMJAY, and the government’s recent steps to incentivise the private sector to open hospitals in Tier II and Tier III cities.
- Pradhan Mantri Jan Arogya Yojana (PMJAY) is the union government’s the insurance programme which aims to cover 10 crore poor families for hospitalisation expenses of up to Rs. 5 lakh per family per annum
Primary health care must remain the focus
Strengthening primary health care is a must for a healthy society:
- While making hospitalisation affordable is a good move, there is no alternative to strengthening primary health care in the pursuit of an effective and efficient health system.
- Performance of health and wellness centres is instrumental in reducing the greater burden of out-of-pocket expenditure on health.
Spending on hispitalisation must not be at the expense of primary health care:
- The increase in the PMJAY budget is a welcome step — spending on this massive insurance programme will need to rise considerably with every passing year so that its commitments can be met.
- However, the same coming at the expense of other critical areas is ill-advised.
Strong primary health care will reduce PMJAY expenditure:
- A weak primary health-care system will only increase the burden of hospitalisation.
- Thus, the role of health and wellness centers will be critical in the medium and long terms to ensure the success and sustainability of the PMJAY insurance scheme.
Much higher spending on primary health care needed:
- In 2011, a high-level expert group on universal health coverage (under Prof. K. Srinath Reddy) reckoned that nearly 70% of government health spending should go to primary health care.
- The National Health Policy (NHP) 2017 also advocated allocating resources of up to two-thirds or more to primary care.
- Based on the current trends and projections on primary health care, the allocation of resources will be far from what is required.
- The government seek achievement of the highest possible level of good health and well-being, through a preventive and promotive healthcare orientation.
- The government reiterated this in this year’s interim budget by incorporating ‘Healthy India’ as the ninth dimension of “Vision 2030”.
- Apart from an adequate emphasis on primary health care, substantial and sustained investments in public health are needed over the next decade.
- Otherwise, the ninth dimension of Vision 2030 will remain unfulfilled.
GS Paper II: Health Issues
While making hospitalisation through PMJAY and other measures will reduce out of pocket expenditure, there is no alternative to strengthening primary health care. Comment.