Rural health, malnutrition get attention

Health sector overall allocated even less than what it received last year, say experts

By Sonal Matharu
Published: Friday 16 March 2012

Supply of free generic medicines, increased funding in public health sector and universal access to healthcare were some of the promises the Central government made prior to the budget. But none of the issues found a mention as Finance Minister Pranab Mukherjee’s presented the budget in Parliament today.

“Forget the 2.5 per cent of GDP that was promised for the health sector, the government’s allocation does not even touch two per cent of the GDP on health. If adjusted for inflation, the health sector has actually received less than what it was given last year,” says Narendra Gupta from Prayas, a non-profit.

Though more money has been pooled in for the National Rural Health Mission (NRHM), the Union Ministry of Health and Family Welfare saw only a marginal increase from Rs 26,760 crore for 2011-12 to Rs 30,477 crore for 2012-13. NRHM will receive Rs 20,822. It received Rs 18,115 crore last fiscal year.

With more money in NRHM, the responsibilities of the Accredited Social Health Activists (ASHAs) have also increased. They would now have to work towards preventing iodine deficiency disorders, ensuring 100 per cent immunisation and better spacing of children. “At the community level, a more active role is envisaged for ASHAs as the convenor of the Village Health and Sanitation Committee and also to support the initiative on malnutrition. Since ASHAs receive activity-wise, performance-based payments, this will also enhance their remuneration,” said Pranab Mukherjee.

Widening the services for primary healthcare, the launch of National Urban Health Mission was announced in the budget. But no further details were mentioned on what will be covered under the mission and how it will be done.

Out of the total allocation to the Union health ministry, the Department of Health and Family Welfare will receive Rs 27,127 crore as against Rs 23,560 crore last fiscal year. Budget for the Department of AYUSH has been increased to Rs 990 crore from Rs 900 crore last fiscal year and that for the Department of Health Research has been increased to Rs 660 crore from Rs 600 crore. The budget for the Department of AIDS Control of the health ministry, however, remains unchanged at Rs1,700 crore. This, despite the health minister Ghulam Nabi Azad promising increased government funding for the next phase of the National AIDS Control Programme, starting in 2012, after several international donors pulled out of India’s AIDS programme. (See ‘HIV bill at risk’, Down To Earth, December 16-31, 2011).

Life-saving drugs exempted from excise duty: 

  1. Raltegravir potassium (for HIV)
  2. Rotavirus vaccine (for rotavirus)
  3. Pneumococcal polysaccharide vaccine (for thalassemia)
  4. Posaconazole oral suspension (for life threatening fungal infections)
  5. Temsirolimus concentrate (for advanced renal cell carcinoma)
  6. Natalizumab (for relapsing forms of multiple sclerosis)

“Whether the money allocated for health in the budget is adequate to meet the needs of the universal healthcare coverage the government wants to achieve in the 12th Five Year Plan is not clear yet,” says Akhila Sivadas, executive director of the Centre For Advocacy and Research (CFAR), a non-profit.

The budget has, however, exempted six life saving drugs for diseases, including HIV/AIDS and renal cancer, from excise duty (see box).

Tobacco to be costilier

In an appreciable move, all forms of chewing tobacco, unmanufactured tobacco and hand-rolled bidis will now come costlier with the slight increase in basic excise duty. Units producing up to 20 lakh bidis per annum will, however, remain exempt. Mukherjee said, “The rates of duty specified per packing machine for these items are being stepped up taking into account improvements in the efficiency of machines used by this industry.”

The non-profits against tobacco welcome the move. “The budget should have done higher increase in the excise rate to keep the next generation healthy. Even a small percentage of increase in excise on tobacco products in the budget of 2012-13 is appreciable,” said Bhavna Mukhopadhyay, director of Voluntary Health Association of India.

Vaccine units to be revived

“To achieve vaccine security” as Mukherjee said during his presentation, the budget proposes to set up a new vaccine unit in Chennai, while modernising the existing public sector units.

“The proposed vaccine unit is not a new one. It was first proposed after the public sector vaccine units were closed down in 2008,” says Y Madhavi, scientist with the National Institute of Science, Technology and Development Studies in New Delhi. “The vaccine units used to supply 80 per cent of the country’s requirement. If after revision of these units, good manufacturing practices are followed, India can be self-sufficient in vaccine production,” she adds.

Malnutrition gets due attention

Taking note of the high-level of malnutrition in the country, the government put malnutrition in the list of its top five priorities for this year’s budget.

To address maternal and child malnutrition in 200 high-burden districts, the government plans to strengthen and restructure the Integrated Child Development Scheme (ICDS) under the Union Ministry of Women and Child Welfare. It has increased its budget by 58 per cent—from Rs 10,000 crore in 2011-12 to Rs 15,850 crore in 2012-13.

Budget for the mid-day meal programme has been increased to Rs 11,937 crore as against Rs 10,380 crore last year.

Rajiv Gandhi Scheme for Empowerment of Adolescent Girls, SABLA, that was introduced last year with a view to address the nutritional needs and educational and skill development of girls in the age group of 11 to 18 years, will get Rs 750 crore for 2012-13. “It is appreciable that the government did not succumb to the demand of giving cash instead of food to the poor that a section of the society was demanding,” says Sivadas.

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