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The Economic Survey presented on January 31, 2020, listed several achievements of the Union government in the health sector, which hid more than they revealed.
Many of the achievements listed were due to implementation of Ayushman Bharat, an umbrella scheme of the government that was conceptualised in 2018. It has two principal components — upgradation of health centres in rural areas to health and wellness centres (HWCs); and giving insurance cover of Rs 5 lakh to families.
Around 28,005 HWCs have already come up, according to the Economic Survey. However, this is not even half of the target that was to be achieved by 2022. The government has to build 1.5 lakh such centres by that time.
According to the government’s own document, the aim is to convert Sub Health Centres (SHCs) and Primary Health Centres (PHCs) into HWCs.
“At all levels, tele consultation would be used to improve referral advice and undertake virtual consultation,” the survey said. However, the Rural Health Statistics — 2019 (RHS) paints somewhat a different picture. Out of 7,821 SCs converted to HWCs, only 1,433 have arrangement of tele-consultation. Out of 8242 PHCs, only 2,439 have such a facility.
The number of PHCs, Community Health Centres (CHCs) and Sub-Centres have gone up to 1,89,784 in 2018 from 1,82,709 in 2014, the survey said in the context of overall rural healthcare infrastructure. However, it did not say anything about shortage of manpower.
According to RHS 2019, against the requirement of 5,335 physicians at CHCs, there is a shortfall of 4,002. Against the requirement of 157,411 male health workers in SCs, there is a shortfall of 98,063. In PHCs, there is a requirement of 21,340 specialist doctors. But they face a shortfall of 17,459.
PHCs must subscribe to Indian Public Health Standards parameters in terms of infrastructure and manpower, according to the Economic Survey 2018-19. Only 20 per cent PHCs in India fulfil these norms. This year’s survey is silent about whether the situation has improved or not.
The Economic Survey of 2019 claimed that in addition to all these achievements, Pradhan Mantri Bharatiya Jan Aushadi Pariyojana had reduced out-of-pocket expenditure (OoPE) on drugs but did not quantify.
However, according to the National Sample Survey report published in November last year, out of five major components of expenditure namely doctor’s fee, medicines, diagnostic tests, bed charges, medicines and others, people spend the most on medicines per hospitalisation per patient in private hospitals — Rs 6,818. Even in public hospitals, the maximum expenditure is on medicines in rural areas, the report had said.
The Economic Survey 2019 also took credit for the fact that the OoPE had declined to 58.7 per cent in 2016-17 from 64.2 per cent in 2013-14. What it did not say was that India ranked 182 out of 191 countries in terms of OoPE, according to a report submitted to the 15th Finance Commission in January this year.
The per cent of GDP spent by the government on health also did not seem to be in line of achieving the desired target. India had aimed to up its health budget to 2.5 per cent of GDP.
The report submitted to the Finance Commission had said even if this was to be achieved by 2025, a plan proposed by the commission will have to be worked out, setting targets for every year. In the last five years, the per cent of GDP allocation to health by the government has remained between 1.2 to 1.6.