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The annual Budget is a bellwether indicating what the government of the day prioritises. The seven priorities laid out by the Finance Minister include reaching the last mile, and this can be a cornerstone of public health and equity. How this will play out in healthcare, particularly, given that the Ayushman Bharat scheme, which was intended for the poorest in the country, has only managed to serve about half the numbers it was planned for, is unclear. However, one specific call out in the Budget that indicates a commitment to equity is the mission aimed at sickle cell disease, a particular problem in tribal communities in India. There have been many efforts to address this problem previously in fits and starts, but making it a mission mode project might improve the trajectory for the reach and provision of services.
Year after year, for those who believe that education and health are the foundation stones of a social republic, where the benefits accrue to all and not just the most privileged, the pace at which government expenditure of health for these critical areas increases is frustrating. The National Health Policy of 2017 is an excellent document, but its implementation requires significantly more investment and attention.
Indians live longer and are less likely to die at birth or in childbirth than we were 20 or 30 years ago, but if we examine the progress towards the Sustainable Development Goals, we (and many other countries) are not going to meet those goals. But the fact that other countries will not meet the targets we set is no reason for India to be complacent about our pace of progress. The announcement of laboratories and centres of excellence that will focus on 5G technologies will be an enabler of the development of digital health tools, particularly with regard to using machine learning to enhance delivery of services and tools for data collection and programme management and monitoring.
We have had significant achievement in the past few years, particularly with Covid-19 vaccines and vaccination, and the new emphasis on research in the pharmaceutical sector will be important in supporting innovation in drugs, an area that has been neglected by all but a few pharma companies. New drugs will require strengthening of many facilities for evaluation and a strong link between academia, the public sector infrastructure (such as the ICMR laboratories, which will be opened to industry) and private enterprise. This area needs enabling strategies and regulatory support, and it is hoped that there is both a short- and long-term vision to make India a leader in the pharmaceutical sector beyond generic drug manufacture.
The increased tax on tobacco is very good news. Tobacco is the leading cause of preventable deaths, and increasing taxes is recommended as a strategy for decreasing tobacco initiation by young people. It would have been good to see further emphasis on prevention, such as increasing the number of vaccines being given in the Universal Immunisation Programme, or a renewed emphasis on tuberculosis control, where the aim of eliminating TB by 2025 is clearly not feasible without deep and wide efforts for detection and management.
This year, there has been a 2.71 per cent hike in the healthcare budget which, given inflation, is insufficient. However, in a combination of health and education comes a proposal to establish nursing colleges to parallel the medical colleges that have been established since 2014. The need for high-quality nurses is evident, and if good nurses, doctors and other healthcare staff from our top colleges can be given not just the education but also career paths that retain them in India and allow them to serve in remote locations, this could enhance the quality and reach of healthcare in India.
Gagandeep Kang is Professor, Christian Medical College, Vellore
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