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Insights into Editorial: Fight for the finite: On budgetary allocation for health

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Context:

In India: SARS-CoV-2: Lowest Testing Rates:

It is an incontrovertible truth that material resources are finite.

Demand in most sectors will continue to exceed supply in times of a pandemic.

With the number of SARS-CoV-2 positive cases on the rise, and the number of deaths going up as well, the question is whether national and state health systems will be able to cope with ever-rising demands — for testing kits, for hospital beds, ventilators, why, even masks and hand sanitisers.

While most of China’s neighbours have been able to contain the spread of COVID-19, countries far from it are seeing an exponential surge in cases.

Early testing and wider coverage distinguish such Asian countries from Western countries.

However, India is dangerously placed as it has among the lowest testing rates.

More tests meant better results:

  1. The number of virus tests per million population as of March 9 against the number of COVID-19 cases as of March 13 for nations that have provided this data.
  2. Hong Kong, S. Korea and Taiwan scaled up their test rates and contained the spread, whereas the S. and U.K. have not done so and have seen an exponential rise in cases. India too has not scaled up the rate of testing.
  3. This extraordinary demand has traditional production and systems of delivery choking and most often, unable to match supply to demand.
  4. Health-care resources, limited to begin with, are even more so when under stress.
  5. In India, though the testing rates are abysmal. But the exponential rise of cases in Western nations, which have similarly low rates of testing, should set the alarm bells ringing.

India is in stage 2 of the pandemic, characterized by local transmission among families, for instance.

To ascertain if it has reached stage 3 of broader community transmission, ICMR has initiated surveillance for cases of influenza-like illness among people who have no history of travel to an outbreak country or being in contact with an infected individual.

COVID-19: Masks and sanitisers are now essential commodities:

  1. The Centre can include new commodities as and when the need arises, and take them off the list once the situation improves.
  2. For instance, masks and hand sanitisers were declared as essential commodities on March 13, 2020.
  3. This is due to a shortage of these commodities in the wake of the COVID-19 pandemic.
  4. 2 ply and 3 ply surgical masks, N95 masks and hand sanitisers have also been included in the list of items under ECA till June 30, 2020.
  5. The State has also issued an advisory under the Legal Metrology Act to ensure these items are not sold for more than their MRP.
  6. The ECA gives consumers protection against irrational spikes in prices of essential commodities.
  7. Under ECA, the States and Union Territories can ask manufacturers to enhance their production capacity. This is to make these products more widely available to consumers.
  8. An offender under the Essential Commodities Act can be punished with imprisonment up to seven years, or a fine, or both.
  9. Consumers can also register complaints in this regard with the National Consumer Helpline 1800-11-4000 or at consumerhelpline.gov.in.

Now, there is an chance to increase in Public sector health infrastructure:

  1. A WHO bulletin of 2018 records that out-of-pocket payments remain common in India, which in 2014, was estimated at 62% of total health expenditure.
  2. While questioning whether these incremental efforts are sufficient, one needs to factor in the substantial skew in different States in terms of public sector health infrastructure and wherewithal.
  3. At a time when the disease did not have a name, and much less by way of character, in mainland China, the rapidly climbing numbers went far beyond the capacity of the country’s renowned industry (where a hospital was built in record time), and the health systems struggled to cope.
  4. Reports indicate that in Italy, which has emerged the hub of the epidemic outside of China, the strain on health systems is massive.
  5. With India crossing 100 positive cases, it is impossible to ignore the question about whether the health system is robust enough to meet this emergency. What is known, however, does not inspire confidence.
  6. For years, India’s health expenditure as a percentage of GDP has been abysmal at about 1%.
  7. As per the National Health Profile, 2019, collated by the Central Bureau of Health Intelligence unit of the Directorate General of Health Services, there has been no significant change in health-care expenditure since 2009-2010.
  8. The highest it has been in the decade is 28 % of the GDP, and hit the nadir at 0.98 % in 2014-2015.
  9. The report does record that per capita public expenditure on health in nominal terms went up from Rs.621 in 2009-10 to Rs.1,112 in 2015-16.

Conclusion:

There is evidence to show that increased public spending on health care has resulted in less financial hardship for communities and better health outcomes.

Prime Minister Modi made a promise to increase public health spending to 2.5 % of GDP by 2025.

The government would do well to treat this epidemic as an opportunity to drastically scale up budgetary allocations for health to facilitate expansion of capacity.

Epidemics are known to change the course of history; India must steer this one to harness finite resources optimally for the benefit of all.