public health center

It has now become clear that the contemptible condition of the health services in the State owes to lack of adequate budget and inequitable distribution of the available budget. In Madhya Pradesh, one of the largest states in India, only Rs 65 per child is allocated for the children per year. Kerala and Tamil Nadu are those States where children are given dishes made of eggs, banana and coconut as nutritious food and the total arrangement of complete health care is available at anganwadi level. This led to the malnutrition rate dropping down to half in these States. These southern States also ensured in a planned manner that not only the women are given information on nutrition and domestic health but that the anganwadi workers and Asha workers are in continuous touch with them and keep holding discussions. In the Mitanin programme of Chhattisgarh too, it was ensured that the ailments like Diarrhea, Malaria and worms (in stomach) are treated at village level and if necessary, the children are referred to bigger government hospitals. This too helped in reduction of infant mortality rates. We have 44 percent population categorized as children, but we have no platform and accountable forum created by the state for sheltering children’s right to development, protection, participation and survival.

The problem in context of MP is that here a lot of thoughts were generated but results were not achieved and the infrastructure was played with dangerously. In MP, the local health systems have been totally demolished. Services of 60000 traditional midwives were stopped without making any alternative arrangements that directly affected the health of pregnant women and newborn children. The question is whether or not these traditional midwives would have been given intensive training to become health provider rather than totally eradicating them from the system? On other hand, the state and central governments are not making budgetary allocations for creating new systems for child health.

Since last three to four years, a new analysis is being put forth that the new doctors do not want to go to rural areas, although their remuneration has been hiked to Rs 30000 and other benefits are also being provided. Now the question that should be asked is that why would the young doctors, who spent as much Rs 25 lakh – most of it on loan at interest rate of 14 pc -work in the government system? A mystification is being created that youth do not want to go to rural areas, but the fact is that the government itself allowed the private health sector and private medical education to become unrestrained. Now health is not ‘service’ but ‘market’ and children are the biggest sufferers because they are not in a position to impact family or State structure. They are thus bound to face the impact of all policies and the banes and benefits of the market-oriented system and most of them perish. It is a contradictory situation that while the private hospitals are operative for 24 hours even for emergency services, the dreams of the government to run the sub-health centres and primary health centers for 24 hours remain buried in systemic red-tapism.

Government displays its prioritization for any public issue through budgetary allocation. The complete apathy of government towards children’s health has been laid bare by an analysis of the State’s budget by the Centre for Budget Governance and Accountability. The study shows that the MP government spends only 0.1 pc of its gross domestic produce (GDP) on children’s health and this negligible budget allocation itself raises serious question on the policy intentions of the State Government. According to the budget allocations of 2006-07, 79.7 pc of the budget allocated for children is spend on education, while merely 2 was spend on health.

Under the planned expenditure head of the State, in year 1997-98, Rs 38.3 crores was allocated for children’s health, which remained just Rs 38.1 crore in 2006-07 budget estimates, instead of increasing. The planned expenditure for tribal groups has remained zero. This is the reason that the infant mortality rate in tribal groups is one and half times more than the State average.

Looking at the complete picture, in year 2005-06, the State and central governments allocated Rs 156.8 crores from 2.48 crore children (44 pc of State population), which means that Rs 63.3 per children for one year. It is clear that children’s health is not a priority for the government. Out of total allocation of Rs 4647.7 crores, only 3.4 pc – meaning the lowest pc – was allocated for health purposes.

Presently, on the policy level, there are efforts to bring health under service sector and link it with insurance sector. The ruling Congress at Centre had also advocated bringing all citizens under purview of health insurance in its election manifesto, but the question is whether the insured family (especially if it is poor and deprived) could get an entry into private hospital. The experiences till now suggest that rather than treatment, they get insults and abuses. Insurance sector is profit-oriented sector, whereas health sector demands total freedom from intention of profit. The health insurance scheme could be a success only if the nationalized insurance companies are ready to take responsibility of health insurance and government bears the expenditure. The private health market and the private insurance sector would only further demolish that 77 percent section of society, which according to the Arjun Sengupta report, runs its life at less than Rs 20 per day. Read the rest of this entry »