New Delhi, June 10: India’s public expenditure on health is one of the lowest in the world.
The government spends a mere 17.3 per cent of its total health budget on the public health system as against England which spends 96.9 per cent, the US that allocates 44.1 per cent, Sri Lanka that earmarks 45.4 per and China’s 24.9 per cent.
An appraisal of the health sector carried out by Social Watch, a group of civil liberties organisations, firmly puts the government in the dock for treating this area of concern so shabbily. “While the Central government’s budgetary allocation for health over the last decade has stood still at 1.3 per cent, in the states it has dropped from 7 per cent to 5.5 per cent,” says a report authored by Social Watch on governance and development.
Health is primarily a state subject but there are enough subjects in this segment that are on the concurrent list, bringing them under the scope and purview of both the Centre and the state. “The Central government, therefore, has enough scope of influencing the health sector through its policies,” says the report.
The scenario in the states continues to be as bleak as before. Severe financial constraints have led to state governments slashing social sector budgets at random. “Under these circumstances, the Centre should have done much more to help the poor-performing states,” says Social Watch.
Instead, the Centre’s budgetary allocations for health between 1992 and 2000 show that it doled out more money to better-performing states like Andhra Pradesh, Gujarat, Karnataka, West Bengal and Delhi while neglecting Bihar, Madhya Pradesh and Rajasthan — states already lagging behind.
The report underlines that the Centre and state governments, while boosting the private sector, are dumping the public health system. The Union budget passed in February this year held out attractive incentives to the private sector, promising to transform India into a global health destination. Private hospitals welcomed the proposals but the voluntary health sector stressed that the Centre should give equal priority to public health, which is in a shambles.
The report points to a spurt in corporate hospitals in the 1990s. Private hospitals mushroomed on land allotted by Central and state governments. The understanding was that the private managements, in return for the land, would provide a “reasonable proportion of their services” free of cost to the poor. “There is increasing evidence that these promises have not been honoured,” says the report.
“The most vulnerable socio-economic groups have lost out the most because of the narrow reach and poor quality of the public health system,” claims the report.
In addition to a ramshackle public health system, the poor are hit hard by spiralling drug prices and lack of easy access to essential drugs. According to the World Health Organisation, only 0.49 per cent of the population in India has access to essential drugs. Countries like Pakistan and Bangladesh, known for their slack performance in the health sector, have a much higher rate with 50 to 79 per cent of their population having access to essential drugs.
The budgetary allocation for 2002-03 offered no provisions for reviving the public health system despite the National Health Policy, adopted in 2002, giving it priority.