For myriad health challenges, Budget should aim at decentralisation and not focus on building systems
True decentralisation of knowledge, decision-making authority and financial control should be promoted, which is probably the only way to effectively solve the myriad health challenges in a diverse country like India
As the Finance Minister Arun Jaitley gives final touches to the union budget for FY 2017-18, his strategy to deal with the enormous health challenges faced by the country as well as prepare India for the march towards achieving Universal Health Care, will be of considerable interest to all especially healthcare professionals.
Considering that India as a nation has one of the lowest public spending on health care, at this stage, a pragmatic approach for the FM would involve creating a framework for flexible funding and strengthening institutions to build high absorptive capacity at the Center and the State level. This will also be aligned with the focus on federal structure of governance emphasized by the Prime Minister.
The essential component of this framework must begin with establishing robust data systems, including conducting national regular surveys providing district and even block level granular data on both the existing as well as the emerging health challenges of India, such as non-communicable diseases, mental health and substance abuse. Simultaneously, focus should be on improvising the regular HMIS to ensure the integrity of the same and its regular use in health planning by the State authorities. The ‘Digital India’ mission provides excellent platform to leverage technology for the same, and a fundamental shift in this budget can be the explicit focus on outcomes, instead of inputs and processes.
In fact, the financial support from the Union Government can be categorically made conditional on the same. At the same time, the budget can be an opportunity to ensure that financial allocation is not fragmented and made extremely rigid through a large number of vertical programs, which is the current trend, and instead focuses on building health systems able to address wide variety of health challenges. Instead, true decentralisation of knowledge, decision-making authority and financial control should be promoted, which is probably the only way to effectively solve the myriad health challenges in a diverse country like India.
The state of Medical Education of course requires an urgent overhaul, and hence all eyes will be on the budget session to pass the new bill of Medical Council of India. Hopefully, that will be the beginning of the re-imagining of the Medical Education in India. Similar effort should be to promote the development of the public health human resource in India. It is crystal clear that only a specialised and critical mass of public health professionals can truly manage India’s health programs, not generalists.
The strength of India is in its vibrant civil society, speaking in several voices, but hence ensuring community engagement, bringing about attitudinal and behavioral change, fostering innovation and effectively nurturing democracy. Several national and state level health programs are a testimony to the outstanding work undertaken by such organization, and hence budget can consider supporting the establishment of fifty Centers of Excellence in Civil Society Organizations, with the clear mandate to serve, conduct field research, impart training and influence policy through ground up advocacy.
Hence, with a reform and outcome oriented vision for improved healthcare in India, we need a budget which is innovative, disruptive but pragmatic.
(The writer is Advisor, Health - Tata Trusts)
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