The Union budget 2021-22 is expected to fund COVID vaccinations and other interventions that will speed up the return to “normal”. However, the budget could also provide a way to strategize for a re-imagined Indian public health system. COVID-19 has added to the woes of a public health system already hobbled by inadequate infrastructure and human resources; the pandemic has how ill-equipped the public health ecosystem is to handle such a health emergency at scale.
A recent report entitled, 'The Inequality Virus’, by Oxfam confirms the extensive health inequalities among the rich and poorer communities with regard to the spread of the pandemic and its impact on poor and marginalized, especially women and girls. The experience of the pandemic has highlighted the consequences of continued neglect of the public healthcare system, particularly for people living in poverty. A number of recent studies have predicted that the closure of family planning services will result in 2.95 million unintended pregnancies, 844,483 live births, 1.80 million abortions (including 1.04 million unsafe abortions) and 2,165 maternal deaths.
Inadequate investments in health have led to widening the inequities in distribution of health infrastructure and manpower. With the facilities expected to provide primary health care, function sub optimally, the burden is mounting on the secondary and tertiary care institutions. The Rural Health Statistics for 2019, reveals that only 40% of health care facilities in the rural areas have critical frontline staff like the male health workers, female and male health assistants. Yet another Oxfam report ‘Commitment to Reducing Inequality’ reveals that only half of India’s population have access to the most essential health services and more than 70% of health spending is out-of-pocket. Clearly, this prevents the poorer and marginalized communities from accessing healthcare. While 69% of India’s population reside in the rural areas, there lies an urgent need to make healthcare services available at the doorsteps of these communities.
While substantial efforts are being made to meet the challenge of the pandemic, we also have a unique opportunity to reimagine our public health system to provide universal and quality healthcare. A fundamental change in the basic operations of the health sector is required. We must strengthen hospital infrastructure and expand our public health system with the infusion of significantly more financial resources. The Budget should focus on identifying, skilling, training and upgrading healthcare workers in sufficient numbers, required to provide quality care to our people.The security and well-being of these personnel must also be a budgetary priority.
COVID-19 has reinforced the need for strong preventive health care mechanisms that can avert most infections and improve health outcomes. Strengthening preventive and primary healthcare will also reduce the need for hospitalisation and save costs on secondary and tertiary care, and lessen the excessive burden of care from doctors, nurses and other paramedical staff. Expanding and operationalising digital healthcare as part of the National Digital Health Mission has the potential to reach out to more number of people who are in desperate need of care but unable to physically access facilities due to COVID-19. Strengthening digital healthcare can increase access to primary and secondary care and will help in continuum of care which remains a challenge at the moment.
The Chairman of the 15th Finance Commission, Shri NK Singh had emphasised the necessity for increasing public spending on health infrastructure. This is a welcome move as well as a reaffirmation of the 2017 National Health Policy’s commitment that the government should spend 2.5% of GDP gradually on health rather than 1.2% of GDP it does at present.
An increased budgetary allocation for health in Union budget 2021-22 will be the beginning of a new chapter to reiterate India’s policy commitments and political will to propel the country on a higher trajectory towards achieving universal health coverage.
The author is Executive Director, Population Foundation of India. Views are personal.