“So-called less developed states such as Chhattisgarh spend more at Rs 1,671 per person and Telangana spends Rs 1,801 per person,” stated JAA’s Dr Ravi Duggal and Dr Abhijit More. The national figure stands at Rs 1,538 per capita for 2017-2018.
On Thursday, the JAA presented an “alternative budget” for healthcare. The alternative budget said the state should shun insurance-based schemes and public-private partnerships. “Analyses of government insurance schemes have shown that a small percentage of the population benefit from it,” said Dr More.
“Maharashtra is known as a progressive state but it spends only Rs996 per person on public health expenditure. The amount is much lower when compared to national average (Rs1,538) and even lesser developed states such as Chhattisgarh (Rs1,671) or Telangana (Rs1,801),” said Dr Abhijit More from JAA.
The people’s budget, focused on development of areas such as hiring of quality human resources, universal free and adequate medicine schemes, up gradation of rural health services and adequate funds and training for urban health posts to relieve the stress of medical services provided by tertiary are medical facilities.
“Even today, majority of vacancies in healthcare sector — doctors, nurses and paramedic staff — are filled on contractual basis. The contractual employees are paid less salaries, which in turn impacts the quality of care to patients,” Dr More added.
JAA officials said an additional Rs267 crore to be added to the budget to ensure availability of staff in each sub center, public health center and district hospitals.
Citing the current state medicine budget allocation of Rs471 crore, JAA members said that if Maharashtra wants to ensure fill availability of medicine in all public health facilities they need to copy the Rajasthan model, which spends about Rs 65 per capita on medicines. The total cost
of the scheme is quoted to be Rs728 crore.
The activists also demanded allocation of Rs400 crore to develop nutritional rehabilitation centers in rural and district hospitals. Currently there is only one center per district to attend to malnutrition and underweight children cases from that district.
“The funds can be used to provide nutritious food to malnourished children, medicine and food allowance to parents and daily wages to the parents, on lines of social security benefits provided in the United States,” said nutrition expert Vinod Shende from Right to Live.
If Maharashtra improved its revenue collection, then it would be able to spend more on health. “Maharashtra is eighth from the bottom as far as revenue collection among Indian states is concerned,” said Duggal. Maharashtra only collects Rs 306 per capita as revenue from non-ferrous mining while Gujarat collects Rs 1,579 per capita. As Maharashtra has huge revenues locked in uncollected taxes, experts said that better tax administration could rake in up to Rs 20,000 crore annually. The experts gave examples of Rajasthan and Tamil Nadu, which distribute free medicines to its citizens.
“The tendering process in Maharashtra is lax unlike the system followed in Tamil Nadu,” said Dr More. The JAA suggested that it would help the state if ASHA (accredited social health activists) in both urban and rural areas are put on full-time payroll and given a monthly payment of Rs 5,000.
Universal free and adequate medicines could be provided if the state hiked its medicine provision from Rs 471 crore to Rs 728 crore. On the National Health Protection Scheme, the JAA’s stand is that the state should follow the example of Karnataka or Tamil Nadu, instead of agreeing to the Centre’s health insurance mechanism. The National Health Protection Scheme, which was announced by the Union government on the budget day, envisages a health insurance cover of Rs 5 lakh per family for 10 crore families. “These states have set up a trust that takes care of the healthcare expenditure,” said Dr Duggal