Date: 09/02/2023

Relevance: GS-2 and 3 : Issues Relating to Development and Management of Social Sector/Services relating to Health; Government Budgeting

Key Phrases: health sector, Budgets, expanding universal access to high-quality education, Disease burden, investing in public health, Out-of-pocket expenditure, widening inequality.

Why in News?

• Budgets are eagerly awaited because they validate the true intent and vision of the government - who or what it “loves” more. And such a judgment is based on the extent to which the Budget helps in furthering the equitable access of all citizens to basic public goods.

How is the budget disappointing?

• Poverty:
  • A study showed that 230 million Indians slid into poverty due to COVID-19.
• Education:
  • The ASER report shows the abysmal state of education — many Class 5 students are unable to read a Class 2 textbook.
• Health:
  • NFHS-5 data show that among children aged below five years, 35.5% were stunted and 32.1% were underweight.
  • Disease burden is rising with non-communicable diseases, mental health, and geriatric care adding to a load of communicable diseases.
  • India lacks adequate human resources, infrastructure, and access to affordable diagnosis and treatment.
• Stagnant allocation:
  • The allocations for education and nutrition are stagnant. The budget for midday meals was reduced by 9%, not counting for inflation, even as data show a shift in enrolment from private to public schools with private schooling becoming unaffordable.

Fault lines:

• COVID-19 sharply brought into focus three major fault lines:
  • The lack of financial risk protection, which is why citizens incurred huge expenses, estimated to be more than ₹70,000 crores, even as their incomes fell;
  • A broken-down primary health system, particularly in the north, that resulted in a large number of avoidable deaths; and
  • The absence of well-equipped and functioning district hospitals to cope with demand.
• India needs an infusion of resources and a bold imagination to address these.
• Chaotic state of the regulatory framework.
  • Many laws have serious infirmities and embed conflicts of interest. Some need to be scrapped and some amended, for without sound governance, opening up health to market forces can be disruptive and hurt patients, particularly the poor.
  • COVID-19 also underscored the need to invest in public health to build our disease surveillance system and strengthen resilience to such shocks.

Neglecting the health sector creates a vicious cycle:

• Lack of investment in the health sector leads to inadequate access to essential health services, which results in higher rates of illness and disease.
• The high rates of illness and disease increase the demand for healthcare services, but the lack of funding for the health sector means that these services are not available.
• This leads to an increased financial burden on families and communities, as they have to pay for medical expenses out of their own pockets.
• Out-of-pocket expenditure reduces their spending power and overall economic growth, which in turn reduces the government's ability to invest in the health sector.
• The cycle continues, with inadequate funding leading to poor health outcomes and reduced economic growth, perpetuating the vicious cycle of neglecting the health sector.

Need of the hour:

• Addressing the fault lines:
  • For the sustainable, long-term growth of the country, expanding universal access to high-quality education, healthcare, and nutrition (not just food grains but proteins and other supplementary foods that are currently unaffordable) is imperative.
  • It is the responsibility of a government to firewall its citizens against any such eventuality by improving the healthcare system and reducing vulnerability.
  • We need political leadership backed by adequate funding to:
    • Rebuild our public health system,
    • Promote scientific research, and
    • Expand health security.
  • Equity and justice are values that must guide a polity to build a nation.
• Improve measures of money allocation:
  • Measuring policy and money allocation only in terms of political expediency are short-term and unsustainable.
  • When such structures collapse, as they will, the poor and marginalized will suffer disproportionately.
  • Budget allocations should be done in a scientific manner that necessarily addresses the issue of widening inequality.
• Investment in health:
  • Constructing 157 nursing schools and trying the impossible of “eliminating” a genetic disease is no answer to these serious structural problems.
  • The disease is an equalizer — many rich people also died during COVID-19 for want of access to a hospital bed or oxygen.
  • The price we paid then, and the lessons learned, need to be remembered. Neglecting the health sector and denying it critical investments has consequences.
• Promoting Inclusiveness:
  • India should learn from developed countries and allocate resources to promote inclusiveness and reduce disparities in access to health and education services, particularly for marginalized and rural populations.
• Encouraging Public-Private Partnerships:
  • India should explore partnerships with the private sector to enhance the development of these sectors, providing an additional source of funding and resources.

Conclusion:

• Envisioning a welfare state, the social economist William Beveridge sought to address the “five giant evils: want, disease, ignorance, squalor, and idleness.”
• If India’s vision is driven by such an articulation, then investments need to be prioritized first towards basic services such as nutrition, health, employment, education, environmental sanitation, and hygiene, rather than airports, highways, and speed trains.

Source: The Hindu

Mains Question:

Q. Analyze the consequences of neglecting the health sector in budget allocations for India and discuss the implications for its economy and society with suitable examples.