Recent media reports of a slash in the healthcare budget of 2014-15 are a matter of serious concern. The government — reportedly — has mandated a nearly 20% allocation reduction in public healthcare due to fiscal pressures. This means that more than Rs6,000 crore has been slashed in a total budget allocation of Rs31,640 crore, for the financial year ending on March 31. Apparently, the decision is part of the government’s strategy to achieve its 2014-15 fiscal deficit target of 4.1%. 

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The negative implications of the slash can hardly be overstated. Let’s not forget that government allocation in healthcare has always been dismal. And that’s putting it mildly. While much of the conversation in policy matters has primarily hinged on economic reforms — FDI, SEZs et al — no such corresponding attention has been paid to the health sector. At the heart of the skewed prioritisation is the difference in perspectives that frames development strategies. Nothing elaborates this better than India spending around a mere 1% of its gross domestic product (GDP) on public health. This is in stark contrast to China’s 3% and United States’ 8.3%. The allocation to health was sluggish even when India’s economic growth soared; even after school education became an important subject of discourse among policymakers. The public health system simply didn’t make the cut in policy discourse. 

To unravel the reasons for this lopsidedness, one must locate the problem within the larger development paradigm of competing policy frameworks. For instance, the main bone of contention between the noted economists Amartya Sen and Jagdish Bhagwati is essentially about policy priorities. While Sen argues for boosting India’s social infrastructure as a means to increase economic productivity, Bhagwati believes that single-minded attention to growth alone will generate enough resources to fund social sector schemes. Unfortunately, the term ‘reform’, in contemporary vocabulary, has come to signify economic policies alone. Even as the imperatives for reforming other social sectors or gender relations are equally if not stronger.   

Successive governments at the Centre and in states seem to have followed the doctrine propagated by Bhagwati and not Sen. In their pursuit of a particular growth model, these dispensations have consistently divulged a callous disregard for public health issues that are critical to ensuring a decent quality of life for the vast majority of people. At present, they have no access to decent healthcare; the health services turn more and more decrepit as one moves away from the metropolitan cities and into villages. The World Health Organization’s 2000 World Health Report ranked India’s healthcare system at 112 among 190 countries. Against such a bleak background, what are the most effective ways to reform the healthcare system?

On his ascension to power, Prime Minister Narendra Modi assured the electorate of his intent to upgrade basic health infrastructure. Medical care, Modi promised, would be made affordable for the poor. To make good that tall promise, Modi, needs to correct a long-standing policy distortion. He has to substantively increase public spending on the health sector. Even a bigger challenge will be to refurbish the dilapidated and inadequate health infrastructure. India needs to meet its basic health concerns in HIV, malaria, tuberculosis, and diarrhoea.

It must be stressed that increased financial allocation alone will not be enough to refurbish India’s wobbly healthcare. In addition, delivery systems have to be improved and strengthened. True, the National Rural Health Mission (NHRM) launched in 2006, has made valuable interventions. But these are few and far between. Innumerable government schemes existing on paper are shoddily implemented; the benefits erratically reaching those for whom they are intended. 

Too much time has already been lost. Modi government has to act fast on reforming the health-care system. It can signal a fresh beginning by allocating a respectable budget for health care.