A recent report by National Health Accounts (NHA) revealed a considerable increase in the government’s expenditure on health. As per the data, Out-Of-Pocket Expenditure (OOPE) decreased to 48.8% in 2017-18 from 64.2% in 2013-14. The NHA, designated as the national technical secretariat by the Health Ministry in 2014, is responsible for these estimations using an internationally accepted accounting framework – the System of Health Accounts 2011 provided by WHO.
The NHA was established under the National Rural Health Mission (NRHM) by the Indian Government in 2006-07. Its mandate includes assisting policy and strategy development, providing technical assistance to states, and capacity building for the Ministry of Health and Family Welfare (MoHFW).
Key Points from the NHA Report
For the fiscal year 2017-18, the government’s share in total GDP concerning health expenditure increased from 1.15% in 2013-14 to 1.35%. In per-capita terms, this indicates an increase in government health expenditure from Rs 1,042 in 2013-14 to Rs 1,753 in 2017-18. The rise in government spending led to increased share of government expenditure in total health expenditure to 40.8% and a decline in OOPE to 48.8% in 2017-18.
Primary and Secondary Health Care
Alongside financial indicators, the proportion of primary healthcare in current government health expenditure also rose from 51.1% in 2013-14 to 54.7% in 2017-18. According to the report, primary and secondary care account for more than 80% of current government health expenditure.
Social Security Expenditure on Health
The NHA report also pointed out a surge in the share of social security expenditure on health. This includes government-financed health insurance schemes, social health insurance programme, and medical reimbursements provided to government employees.
Challenges in the Health Sector
Despite progress, the health sector faces significant issues. The current state of primary health care in the country is limited in scope, often only offering pregnancy care, limited childcare and services related to national health programmes. Poor management skills and lack of appropriate training for health workers hinder delivery of quality health services.
Health Funding in India
India’s health spending amounts to a meagre 1.8% of its GDP in FY 2020-21 and approximately 1-1.5% in the previous years. This is considerably low compared to an average of 7.6% in OECD countries and 3.6% in other BRICS nations.
Legislation and Public Health System
Currently, no single authority legally handles public health, hindering compliance with health standards. This poses a challenge in tackling non-communicable diseases, managing pandemics like Covid-19, and planning preventive measures.
Ratios of Doctors in India
According to the WHO norm of 1:1000, India falls short with a ratio of one doctor per 1,445 people.
Government Initiatives in the Health Sector
The government has launched several initiatives to address the prevailing issues, including the Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK), Free Drugs and Free Diagnostics Service Initiatives, PM National Dialysis Programme, Ayushman Bharat and Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
Recommendations for the Health Sector
To improve the health sector, strategic investments in academic institutions like AIIMS are necessary. There’s a need to focus on Public Private Partnerships (PPP) and leverage private sector expertise. The R&D sector needs incentivising through additional tax deductions and reduced GST on essential drugs. Training, reskilling and upgrading the knowledge of our healthcare workforce is also crucial.