Context:

• The COVID pandemic brought to the surface the inadequacies of the health system and the denial of basic care. Coping with this one infection has not only meant denying care to non-COVID patients but also the inability to treat all as per protocol due to limited infrastructure in public and private sectors.
• This led the Rajasthan government to expedite its intention to introduce the Rajasthan Model of Public Health (RMPH) in its budget for 2021-22, embedding in it a public health law making access to health a right.

 

Background:

• In 1947, post-colonial India set off with the ambition of building a modern state on the principles of equality where citizens, by virtue of their birth in the country, would be entitled to a life of dignity.
• While the Constitution provided the rights to life, liberty, nutritional standards and maternity care, it did not explicitly state health as a fundamental right.
• Access to good quality healthcare was, and continues to be, a privilege, enjoyed by those fulfilling conditions of wealth, location and social status.
• This was so despite India being a signatory to the WHO’s Constitution of 1946 which envisaged the ideal of ensuring the highest attainable standard of health as a fundamental right of every human being by allocating the maximum available resources.

 

Health as Human Right:

• The discourse on health as a human right was amplified when the HIV/AIDS pandemic led to the creation of global civil society coalitions that pressured governments to make HIV treatment and sexual freedoms fundamental to human rights.

 

Universal Health Coverage:

• In the last decade, the increasing cost of care and consequent impoverishment of those seeking medical treatment added momentum to the debate by demanding universal health coverage (UHC) to build societal resilience to the devastating impacts of ill health.
• Since UHC is based on the principle of equality and non-denial of care on grounds of affordability, the two ideas of health as a human right and UHC converged to be translated into state policy for creating a legal obligation to ensure access to timely, acceptable and affordable healthcare of appropriate quality as well as to providing the underlying determinants of health such as safe potable water resulting in its inclusion in the 2015 Sustainable Development Goals (SDG) to be realised by 2030.

 

Issue of Financing UHC:

• Given the compulsions of addressing multiple development challenges, allocating the maximum available resources for health has always been a major issue.
• Public health spending as a percentage of GDP has hovered around an average of 1 per cent against the global average of 8 per cent, constraining the building of a rights-based healthcare system.
• In 2018, India’s public health spending as a percentage of total health expenditures was 95 per cent, against the global average of 59.54 percent with just 20 countries spending less than India.
• At 67 percent out-of-pocket expenditure on health, such spending in India was the 13th highest in the world.

 

Findings of study of catastrophic health expenditures: A study of catastrophic health expenditures (10 to 25 per cent of household income) in 133 countries brought out two interesting insights with policy implications: ●       the positive partial correlation between income inequality and catastrophic spending at all income levels and, ●       absence of evidence that the mere increase in health spending or channeling it through private insurance and non-profit institutions provided financial protection.

 

Other Hurdles in UHC:

• Key barriers to universalising access to healthcare are the inadequate availability of services, particularly in rural areas, a severe shortage of human resources and the rising cost of care due to more intensive use of technologies alongside changing perceptions of quality.

 

Rajasthan Case Study:

• For realising UHC, Rajasthan has proposed doubling its budget, setting up medical and nursing colleges, establishing and upgrading primary health centres and substantially improving the delivery of services by expanding access to free medicines and diagnostics, besides adding 1,000 beds and establishing institutions of excellence for cardiology, virology, cancer and maternity and childcare.
• New features to its current health insurance programme are three:
  • expansion of the eligibility criteria to cover two-thirds of the population,
  • providing 50 per cent subsidy for the non-poor sections to avail of the health insurance programme by providing them cover for Rs 5 lakh worth of cashless treatment in government and accredited private hospitals, and
  • assuring coverage of not just inpatient but also outpatient treatment.

 

Suggestion:

• The intention is laudable. But for achieving the goal of arresting catastrophic expenses, it would be essential to sequence investments over the next decade, starting with ensuring universal access to social determinants and primary healthcare services by focusing on malnutrition and filling gaps in accessing toilets, safe water and basic health services.
• This would require an uncompromising attention to substantially and expeditiously improving the primary healthcare infrastructure in terms of buildings, human resources and technology.

 

https://indianexpress.com/article/opinion/columns/rajasthan-budget-healthcare-covid-19-7234817/