India's Union Budget 2014-15 provides an opportunity to give a push for tackling pre-mature deaths and disability in the country
Non-communicable diseases – primarily cardiovascular disease, chronic respiratory disease, diabetes and cancer – account for 53 per cent of deaths in India, as per a Word Health Organization 2011 status report.
The budget proposals, if implemented, in right earnest, can give a boost to preventive health care. “This has become critical in the light of the fact that the UN General Assembly issued a statement on the same day as the Finance Minister presenting the Union Budget – July 10 – calling upon member States to intensify efforts towards a world free of the avoidable burden of non-communicable diseases,” said Dr Vivekanand Jha, Executive Director of The George Institute for Global Health India.
To start with, the free drugs and diagnostics scheme conceived by the previous government in 2011 as part of the National Rural Health Mission has received the right thrust in the budget proposal. This along with the penetration of technology which has also been emphasized in the budget can ensure that more people are able to get preventive care thus bringing down the out-of-pocket expenditure that goes along with OPD treatment.
“Studies done by The George Institute India show that the use of technology to provide clinical decision support can shift the burden of screening basic non-communicable diseases from the doctor at the primary health care centre to the village level health worker. Such empowerment of the non-physician health care workforce along with the involvement of all key stakeholders can make the process really sustainable,” said Dr Jha, adding that evidence-based implementation is the key for the free drugs and diagnostic scheme to work effectively at the grassroots.
“The budget seems to have created the climate for a development-implementation-audit cycle and building on the right kind of evidence on how to implement such schemes, we can ensure that more and more people are diagnosed early,” said Dr Jha.
While the allocation for health care in the Union Budget has increased only by 1.7 per cent, experts feel that the proposal to set up five new AIIMS and 15 research facilities across the country can help give a boost to tertiary curative care. However, preventive care is also important when it comes to tackling public health issues.
“For this to happen, we need to closely look at entrepreneurship based models of health care delivery in India where more value is created for patients using existing resources and facilities and at lower cost,” said Dr Jha. “Such innovative models of public-private partnership can bring in the much needed efficiency in health care and the evidence for the same exists in different parts of the country.”
Similarly, increasing FDI in insurance is an opportunity for the health care insurance industry to reinvent itself and ensure that the coverage is expanded to include everyone in the population. “The spiraling health costs demand new models of financing innovation and accordingly, new ways of health security measures need to be put in place,” said Dr Jha, adding “Insurance companies need to innovate for covering people at the bottom of the pyramid.”
The other measure that has been introduced in this budget is steeper excise duty for tobacco and sugar-sweetened beverages. “Health-related food taxes may help in shifting consumption, but more needs to be done to tackle the burden of diabetes and obesity in our country. We need education and awareness along with lifestyle modification,” said Dr Jha. He added “It is important to empower consumers with the right kind of knowledge so that they are aware of the salt and sugar levels in all the food products and take wise decisions. Stricter nutrient labeling norms for packaged foods are also essential.”
The decision to set up two National Institutes of Ageing – one at AIIMS in Delhi and the other in Chennai – will also ensure that proper care pathways are developed for the elderly. “Studies done by The George Institute in other countries show that disability and deaths can be prevented by evolving an inter-disciplinary approach to care that can help in providing right intervention at the right time with minimal delays,” Dr Jha pointed out, adding that the elderly population is rising in the country as a result of changing demographics and we need to ensure that they age with dignity and grace.”
All in all, the Union Budget proposals to boost health care for 2014-15 needs to be seen in the context of the shifting health care needs of the population and how the urgency to tackle non-communicable diseases is building up in India. “The budget is an opportunity to focus on the need for affordable innovation that is both sustainable and can deliver health care to those who need it the most,” sums up Dr Jha.