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The health ministry, worried about a budget shortfall in public healthcare, highlighted gaps in health infra, human resources and pandemic-related preparedness to the 15th Finance Commission, which submitted its report on Monday.

The ministry suggested earmarking 10% of the devolution amount proposed by the finance commission for health, with at least two-third of it reserved for primary healthcare. It also requested that a composite health index be used as an indicator for deciding performance-based incentives for states and UTs.

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In terms of funding, the ministry sought 41,805 crore for setting up medical colleges attached to district hospitals, 13,257 crore for training 1.5 million workforce in allied sectors and 5.13 trillion for primary healthcare. In total, it asked for 5.74 trillion.

However, it got 31,100 crore for primary healthcare and 4,800 crore for human resources for health and medical education.

“The health infrastructure is highly inadequate and the quality of services is poor. The role of municipalities must be revived. The private service providers, which tend to exploit patients, will have to be regulated. Particularly patients from low-income households are kept in mind when we suggest that the private service providers need to be regulated," said Arup Mitra, professor of economics at the Institute of Economic Growth in Delhi University.

The health ministry’s stand found support from the states, which had also pointed out to the finance commission that out-of-pocket expenditure on medical care is very high for Indians and is symptomatic of the poor quality of public health services.

The finance commission said there is a clear acknowledgement by most states that much greater effort will be needed to expand universal healthcare and that one of the key actions will be an adequate increase in the number of medical personnel.

Their availability is not uniform across rural and urban areas within a state and this, in no small measure, is the result of the reluctance of medical personnel to serve in rural and remote areas and this has been identified as one of the biggest constraints in providing affordable basic services.

“Preventive and promotional health and social indicators such as nutrition, safe drinking water and sanitation all contribute to severe malnourishment and low health status of the poor who have been disproportionately affected by this pandemic and earlier ones too. To remedy the situation, we should strive to strengthen our health systems, primary health services and testing infrastructure," said former Union health secretary J.V.R. Prasada Rao.

These hold relevance as the Union budget has not allocated additional funds to the Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (PM-JAY), which aims to reduce out-of-pocket expenditure for patients and achieve universal healthcare.

PM-JAY is the central government’s flagship assurance scheme to bring quality healthcare to around 500 million poor and vulnerable Indians.

“Allocations for PM-JAY under Ayushman Bharat remain stagnant at 6,400 crore for FY 2021-22. After the outbreak of coronavirus, there was hope that the spends on this account would rise to reduce out-of-pocket private expenditure on health, which continues to be very high," said Poonam Muttreja, executive director of Population Foundation of India, a public health, policy and development strategies firm.

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