Union Budget 2021-22: How good is the hike in allocation for health? - Pragnya IAS Academy - News Analysis.

Union Budget 2021-22: How good is the hike in allocation for health?.

Sitharaman admits high out-of-pocket-expenditure worrying; claims ‘137%’ hike to health and well-being in budget

The Union Budget 2021-22 allocated Rs 71,268.77 crore to the Union Health and Family Welfare Ministry — an increase of about 10 per cent from the previous year’s budget estimates, according to Union Budget presented February 1, 2021.

The revised estimates for last year was Rs 78,866 crores. This implies the budgetary allocation to the Union health ministry came down by 9.6 per cent.

Sakthivel Selvaraj, a health economist with Public Health Foundation of India, called the allocation a wasted opportunity. “This year gave us an opportunity to be an outlier and allocate more than what had been done earlier. But it seems we wasted it.”

The National Health Policy of India, which came out in 2017, envisaged that India spend at least 2.5 per cent of its Gross Domestic Product (GDP) on health sector by 2025. “A 10 per cent hike, that too during the novel coronavirus disease (COVID-19) pandemic, will not take us anywhere close to that goal,” Selvaraj said.

A high-level expert group formed by the Planning Commission in 2012 had suggested that India should achieve this target by 2020.

India spent 1.8 per cent of its GDP on health in 2020-21; it was 1-1.5 per cent in the previous years. This is among the lowest any government spends on health in the world. As a result, India is among the 10 top nations with the highest out-pocket-expenditure (OOPE).

An increase in public health expenditure from the current levels in India to three per cent of GDP can bring the OOPE down to about 30 per cent from 60 per cent, according to the Economic Survey 2021.

“India was ranked 145th out of 180 countries (Global Burden of Disease Study 2016) on the quality and access of healthcare. Only few sub-Saharan countries, some pacific islands, Nepal and Pakistan were ranked below India,” the Economic Survey said.

Sitharaman accepted in her speech that a high OOPE was worrying. She added that the budget estimates for expenditure on health and wellbeing increased by 137 per cent this year as compared to last year. She pointed to the annexure for details; what Down to Earth found, however, found was slightly different.

The 137 per cent hike was calculated by taking into account funds allocation to the Union Ministry of Ayush, department of health research, nutrition, vaccination, finance commission grants to states for water-sanitation and health as well.

Sitharaman also announced PM AtmaNirbhar Swasth Bharat Yojana with an outlay of about Rs 64,180 crores to be released over six years.

“But there is no budget allocation in the document this year. How can a scheme be launched like that,” asked Indranil Mukhopadhyay, a health economist at OP Jindal School of Public and Government Policy.

The allocation to PMJAY, which covers Ayushman Bharat and health and wellness centres, was worth Rs 6,400 crore. This was the same as in the last year’s budget; but double according to revised estimates. For the last few years, the budget estimates for the scheme have remained the same while the revised estimates were half.

The Union government aims to build 1.5 lakh of health and wellness centres by 2022; of this, only 57,874 have been made so far.

The National Rural Health Mission saw a moderate hike of six per cent from last year. The National Programme for Health Care for the Elderly was allocated Rs 105 crore in the budget last year. The revised estimates, however, were Rs 15 crore. The allocation to National Programme for Control of Blindness went down Rs 10 crore when compared with last year budget estimates.

Telemedicne got a big thumbs-up in this year’s Economic Survey owing to online consultations in the wake of COVID-19 pandemic. However, the allocation to it remained stagnant at Rs 45 crore this year as well.

While the budget allocated to Indian Council of Medical Research (under the department of health research) went up this year, the department’s budget came down compared to last year's revised estimates.

The Union Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) got a 40 per cent more than last year. All India Institute of Ayurveda was allocated Rs 313.80 crore (revised estimates) last year as against the budget estimates of 76.50 crore. It went up to Rs 348.87 crore this year. (Source: downtoearth)

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Union Budget 2021-22: How good is the hike in allocation for health?.

Cabinet approved restructuring of National Health Agency as “National Health Authority” - Pragnya IAS Academy - News Analysis.

Cabinet approved restructuring of National Health Agency as “National Health Authority”.

The government said that creation of the National Health Authority will lead to more effective implementation of PM-JAY.

The Union Cabinet on Wednesday approved the re-structuring of existing National Health Agency as “National Health Authority” with an aim to efficiently implement Pradhan Mantri – Jan Arogya Yojana (PM-JAY). With this, the existing society, “National Health Agency”, has been dissolved and its status now stands enhanced to that of an Authority.
The National Health Authority shall have full autonomy, accountability and the mandate to implement PM-JAY through an efficient, effective and transparent decision-making process. Dubbed as “Modicare” the PM-JAY, is being described as the world’s largest health insurance scheme. It is a cashless and paperless access to health services up to Rs. 5 lakhs per year to poor and vulnerable people identified as per the socio economic caste census.
“The world’s largest healthcare scheme rightfully deserves the most efficient and effective governance structure with total accountability,” said J P Nadda, Minister for Health and Family Welfare.
The government said that creation of the National Health Authority will lead to more effective implementation of PM-JAY as it will align the accountability with responsibility. With the authority, faster decision-making will be done, as the multi-layered structure has been simplified and the role of the Authority has been clarified.
Availability of quality services will be there as the Authority will be able to specify treatment protocols and enforce their compliance. Government said that there will be reduction in leakages as the Authority will have stronger mandate to prevent, detect and control frauds and abuse and redress grievances. Government is also looking at increase in private sector investment in healthcare services, as the Authority will have the clear mandate to be a strategic purchaser and be able to set appropriate rates.
“The existing multi-tier governance structure has been replaced with a Governing Board (GB) chaired by the Minister of Health and Family Welfare with representation from the Government and domain experts. Since the Authority is now fully autonomous, the post of Joint Secretary (NHA/ Ayushman Bharat) will be transferred from Ministry of Health and Family Welfare to the National Health Authority,” Indu Bhushan, Chief Executive Officer, NHA said.
“The creation of the National Health Authority will lead to faster decision-making and more accountability and efficiency to ensure availability of quality services to beneficiary families through strategic purchase of healthcare services, preparation of list of health packages and their rates, robust fraud control and increase in private sector investment in healthcare,” he said.
PM-JAY completed 100 days of implementation on 31st December 2018. So far, 41.5 lakh e-cards have issued to the beneficiaries with more than 6.95 lakh beneficiaries having availed services under PM-JAY through a network of 16,157 empaneled (and in process) hospitals, amounting to the tune of Rs. 924 crores.(Source:Livemint)


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Cabinet approved restructuring of National Health Agency as “National Health Authority”.

The 50 districts with the poorest health outcomes in India - Pragnya IAS Academy - News Analysis.

The 50 districts with the poorest health outcomes in India.

A majority of the 50 districts with the poorest health outcomes in the country are situated in the three states of Uttar Pradesh, Bihar and Jharkhand.

Over the past decade, India has made significant strides in bringing down rates of child undernutrition and infant mortality. Yet, several parts of India continue to be weighed down by some of the worst health outcomes in the world, with rates of undernutrition and infant mortality much higher than some of the poorest parts of Sub-Saharan Africa.
A Mint analysis of the National Family Health Survey (NFHS) data released earlier this year shows a stark gap in health outcomes between the north and the south. Most districts with a high health deficit score are clustered in the middle and the northern parts of the country.
Most districts with better health outcomes are clustered in the extreme south.
The health deficit score is a normalized score that is based on five indicators—infant mortality rate (IMR, per 1,000 live births), share of underweight children, shares of adult men and women with low body mass index (BMI), and tuberculosis prevalence (per million adults). Given the problems with administrative data on illnesses, only data from the latest NFHS survey of more than 600,000 households in 2015-16 has been used. Beyond the north-south divide, the analysis shows a sharp divide between the 50 worst districts (marked in red in the map) and the rest of the country. The IMR for the 50 worst districts is 64 compared with 37 for the rest of the country. The share of underweight (low-BMI) women is 34% in the worst-performing districts, 12 percentage points higher than in the rest of the country. And TB prevalence at 9,440 (per million adults) is more than double the rest of the country.
While 24 of these districts are part of the list of the so-called ‘aspirational districts’ of the NITI Aayog, 26 of them are not part of that list.
More than two-thirds of the 50 districts lie in just three states—Uttar Pradesh, Bihar, and Jharkhand.
Life in these districts is marked by low life expectancy, and high morbidity. And things are unlikely to improve soon given that these districts also tend to be under-served by health services.
Across India, districts with poorer health outcomes tend to have lower proportion of pregnant women who receive the recommended number (four) of antenatal care visits. These districts also have a higher proportion of people who are dissatisfied with the public health system.
While the less storied component of the Ayushman Bharat health insurance scheme is aimed at revamping India’s poorly performing public health system, the measly outlay of ₹1,200 crore for that programme—it amounts to less than 5% of the health budget—is unlikely to make much of a difference.
The major component of the Ayushman Bharat programme, focused on medical insurance, is likely to receive a far bigger outlay of ₹10,000 crore.
But while it may offer respite to the poorest when faced with health shocks, it won’t fix India’s basic health deficits.
As several health economists have noted, the biggest bang for buck in healthcare comes from investments in preventive public health—including waste-management, sanitation and disease surveillance systems.
It is investments in these systems that have helped most countries lower infant mortality and improve health outcomes since the second World War, the Nobel Prize winning economist Angus Deaton wrote in his 2013 book The Great Escape: Health, Wealth, and the Origins of Inequality.
Unfortunately, such lessons have been ignored by Indian policymakers for most of independent India’s history.
This is the concluding part of a four-part data journalism series on India’s healthcare challenge. (Source: Livemint)

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The 50 districts with the poorest health outcomes in India.