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Increase to India’s health budget is not enough, say doctors

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1428 (Published 04 March 2013) Cite this as: BMJ 2013;346:f1428
  1. Soumyadeep Bhaumik
  1. 1Kolkata

Doctors’ leaders have expressed disappointment at the amount of funding allocated for health and family welfare in the Indian budget for 2013-14, saying it is inadequate to meet the needs of the population.

P Chidambaram, India’s finance minister, presented the union budget for 2013-14 on 28 February. He allocated Rs373.3bn (£4.5bn; €5.2bn; $6.8bn) to the Union Ministry of Health and Family Welfare, a rise of 7% on the Rs349bn allocated to health in the 2012-13 budget. The proportion of the budget set aside for health was 2% this year, the same as last year.

The budget also provided Rs212.4bn for the National Health Mission, the government’s new showcase programme to deliver healthcare in rural areas that has recently been expanded to include urban areas.1

“Health for all and education for all remain our priorities,” said Chidambaram in parliament.

However, the Indian Medical Association is disappointed with the new allocation. Narendra Saini, the association’s honorary secretary general, told the BMJ, “The allocation to health is almost one third of the one that we have demanded. Currently it is around only 1% of GDP [gross domestic product], while India needs at least 2.5% to 3% of GDP allocated for the purpose of health. Much of the increase is to take care of inflation and rising expenses. This amount is not sufficient to deliver supportable, acceptable, and quality healthcare to the people. The money allocated for the new mission is also insufficient.”

Raman Kumar, the president of the Academy of Family Physicians of India, is also concerned that the proposed funding is not enough. The Planning Commission of India, which formulates and monitors the five year plans for the government of India, had recommended allocating at least 2.5% of GDP to health, he said.

“The National Health Mission is a good move, as it will take care of the urban poor and the slum dwellers. But even though the right kind of allocation at the primary health centres and the district hospitals is important, allocating the budget is not the end of the matter. Appropriate use is of utmost importance,” Kumar told the BMJ.

Chidambaram also announced that there would be eight new regional geriatric centres under the national programme for the healthcare of elderly people, which will have a total budget of Rs1.5bn. Although many commentators have welcomed the move, Kumar warned that having separate programmes for every priority health group was simply not feasible. “Comprehensive programmes that integrate all services and rolling out universal healthcare are essential,” he said.

A sum of Rs47.3bn has been allocated for medical education and training, and another Rs16.5bn for the six new public medical schools (institutions similar to the All India Institute of Medical Sciences) that were set up in 2012. The government has also proposed Rs10.7bn for incorporating alternative systems of medicine, such as ayurveda, unani, siddha, and homeopathy.

Saini welcomed this last proposal, which must be approved by parliament, because it would encourage alternative practitioners to develop an evidence base, he said.

The finance minister commended the integrated child development scheme for successfully spending the entire Rs158.5bn allocated in 2012-13 and proposed increasing the budget by nearly 12% to Rs177bn in 2013-14.

A multisectoral programme to tackle maternal and child malnutrition, announced last year, will also be implemented in 100 districts during 2013-14.

Saini said that the government has identified important issues but has failed to allocate enough funds for them to operate successfully. “Overall the amount of money allocated for health is very much less than is needed to achieve health for all. If the government cannot provide adequate money to these sectors—which we have been demanding—it should provide incentives for the private sector to develop them.

“Infrastructural support like soft loans, rebates, tax, and excise concessions must be provided to the private healthcare sector.”

Notes

Cite this as: BMJ 2013;346:f1428

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