This time, the government would need to push and manage finances in way that both central and state budgetary allocations are raised steadily every year to increase public health spending to 2.5% of gross domestic product (GDP) by 2025 which is currently around 1.2% only.
“There is an urgent need to revisit the policies which have been framed many years ago and need changes in tune with the present time. We will look at increasing the health budget," said Harsh Vardhan, union minister of health and family welfare.
While Modi has already delivered on its previous poll promise by rolling out Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Mission Indradhanush and National Health Policy 2017 (NHP), his second term at office will now require his government to strengthen these ventures over the next five-year tenure. The Centre would also need to indentify loopholes and find solutions to fix problems, inherent in any government scheme.
“A country that aspires to become a 10 trillion-dollar economy in one decade from now, a rapid and substantial acceleration in budget allocation is extremely critical. The fiscal health of the economy has demonstrated that the country’s tax-GDP ratio has multiplied several times with an expanding economy in the last two decades, but the fiscal space for health remained subdued during this time period," said Shaktivel Selvaraj, Director, Health Economics, Financing and Policy, Public Health Foundation of India (PHFI).
The overall allocation to health sector accelerated to ₹61,398 crores in the Interim Budget for 2019-20, a moderate increase 13% from previous year (2018-19). Over 60% of this increase was on account of higher allocation to PMJAY -- Modi government’s flagship scheme. But the other focus area of Ayushman Bharat, namely strengthening primary care through health and wellness centres, received a mere Rs.1,600 crore in 2019-20 as against a revised estimate of ₹1,400 crore in 2018-19.
“One of the flagship health scheme since 2005 is the National Health Mission which received an allocation of Rs. 31,745 for the year 2019-20, up from Rs. 30,683 crores in the revised estimate for 2018-19, an increase of a mere 3%, but in real terms, this would mean a negative rise," said Selvaraj.
“AB-PMJAY played an important part in influencing voters. With the re-election of the government, we hope the PMJAY scheme will continue to receive sufficient focus and funds from the state. We also hope that in the future, considerations will be made to expand this scheme to include the middle-class citizens as well by creating more affordable premium models or co-pay modes," said Dharminder Nagar, managing director, Paras Healthcare said.
The first term of the National Democratic Alliance also saw the government successfully bring in several health laws ranging from Mental Health Act and HIV/AIDS Act. This time around, there are several more in the offing which are likely to get a leg up with the re-election of the Modi-led government.
“The National Medical Commission Bill and the Allied Healthcare Professions Bill, which are needed to usher regulatory reforms in health professional education, must be quickly advanced through parliament. The Clinical Establishments Act must be adopted across the country and regulatory systems for drugs, devices and digital health must be strengthened," said Dr Rajeev Sood, Dean at Postgraduate Institute of Medical Education and Research (PGIMER)- Ram Manohar Lohia (RML) Hospital.
The previous NDA government also initiated various measures such as reducing treatment costs for patients, price control preferred market access to local suppliers, quality control order and development of Indian standards. “Post Ayushman Bharat and price caps on stents, the public got assurance of extending further price controls to other medical devices in the BJP manifesto," said Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AiMeD.)
However, the biggest barrier to Modi rolling out affordable universal health coverage (UHC) is the huge shortage of workforce needed to deliver the promised services.
The government has been trying to incentivize doctors to practice in rural areas, such as a 50% reservation in Post Graduate Diploma Courses for Medical Officers in the government service who have served for at least three years in remote and difficult areas, and a 10% incentive of the marks obtained for each year in service in remote or difficult areas up to maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses. Despite schemes like AB-PMJAY, rural areas still do not have access to healthcare facilities including qualified doctors.
“We should give some time to the government to complete the tasks that they started such as AB-PMJAY. It is working well but will take more time to fully reach all the beneficiaries. The government would need to strengthen the primary healthcare system and place more doctors in rural areas first. Majority of doctors are serving and those passing out want to serve in the urban areas only," said Shakti Kumar Gupta, Head, department of Hospital Administration and Medical Superintendent Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi.
For sending out more and more doctors to rural areas, the government will need to provide monetary incentives and provide facilities for their families. For this, they will firstly need to build the necessary infrastructure, schools, and basic facilities in rural areas, Gupta said.
According to Selvaraj, if India were to harness its demographic potential of its 1.3 billion people, including a 500-million workforce, making the country healthy is more compelling than ever before. This would mean providing clean environment and potable water so that infectious diseases are contained to the minimum, a stress free and a healthy lifestyle to ward off growing threat of non-communicable diseases and to provide financial risk protection in order to stem medical impoverishment and catastrophe associated with households’ payment towards health care.