Budget 2011 has boosted the allocation for health by 20%. That doesn’t really say much for the government’s flagship health programme, the National Rural Health Mission (NRHM). The Sarva Shiksha Abhiyan (SSA), aimed at providing elementary education to all, has in comparison received a 40% increase in allocation.
My sense is that India’s public health spending is very low at about 1.4% of gross domestic product (GDP). I have always maintained that India should be spending no less than 3% of GDP on public health. Surely that can’t be attained in one financial year. But we need to have substantial increases every year. That, I am afraid, I don’t see happening in the health sector as of now.
I believe NRHM’s absorptive capacity is considerably higher now, and hence much higher levels of public health spending can be absorbed by it. For health, it would have been great if the budget had proposed to step up the plan allocation in 2011-12 by 40% instead of 20%. India needs to provide for major increases year-on-year so that the public health spending reaches at least 3% of GDP by 2015 and between 4.5% and 5% by 2020.
The increase in the education sector budget is welcome, but I would like to see more quality upgradeation funds for primary schools. The universal education programme has been operational since 2001 and funds for it have been increasing annually, but a large part of spending on primary education needs to be worked on. We need to start looking at learning and teaching outcomes.
So you have a fair amount of money going into construction of schools and hiring and training of teachers and infrastructure. But now we need interventions in classrooms and we need resources to upgrade the curriculum and revise school books. There is a big disconnect between how much is taught and how much is retained.
I would argue that a large part of the SSA budget should be spent on quality upgradation.
Under the Integrated Child Development Scheme (ICDS), the income of anganwadi workers and helpers has been doubled. While one has seen that ICDS hasn’t really been delivering the way it should have, we also need to think about how these workers are performing, who is watching over them, and whether or not there is any accountability. Merely by raising salaries, I don’t think system will start delivering. Along with that we need some accountability. For a long time we have been saying that the accredited social health activists of the NRHM should be paid much more than they are now and must be given greater performance-based incentives. Moreover, many don’t receive payments since it’s all done through cheques and the system hasn’t been upgraded to electronic transfers. The government also needs to get the National Urban Health Mission up and running. There are huge disease burdens in the urban sector, especially due to non-communicable diseases such as diabetes, obesity, cardiovascular problems, hypertension and cancer. Before the problem becomes bigger, some amount of resources and interventions and some amount of awareness is needed on an urgent basis.
Nirupam Bajpai, director, Columbia Global Centers, South Asia
As told to Radhieka Pandeya