Non-communicable diseases miss Budget

India continues its battle against non-communicable diseases (NCDs), which has been rapidly rising, accounting for 42% of all deaths. This battle has been characterised by relatively low government spending in the health sector and high out-of-pocket expenses incurred by individuals which often leads them into poverty.

Research reveals that the common risk factors for NCDs in India are tobacco use, harmful use of alcohol, lack of physical activity and a poor diet. It also revealed that socioeconomic determinants influence people’s vulnerability to NCDs, such as poverty, illiteracy, poor health infrastructure, social inequality and demographic transition in terms of increasing life expectancy, urbanisation and globalisation. The financing burden for NCD treatment falls disproportionately on the poor due to under-budgeting and spending on NCDs by the government. It is in this scenario that the Union Budget was eagerly awaited by the health sector.

The overall health budget proposed in 2017 has increased from Rs 39,879 crore (1.97% of total Budget) to Rs 48,878 crore (2.27%). The more ambitious targets are to bring down the maternal mortality rate to 100 by 2018-2020, infant mortality rate to 28 by 2019, eliminate kala azar and filariasis by 2017, leprosy by 2018, measles by 2020 and tuberculosis (TB) by 2025.

Some announcements in the Budget reflect a positive direction, such as the plan to harmonise policies and rules for the medical devices industry to encourage local manufacturing thereby improving affordability for patients; amendments to the Drugs and Cosmetics Act to promote generics and reduce the cost of medicines; the proposal to establish two All India Institute of Medical Sciences (AIIMS) in Jharkhand and Gujarat; plans to restructure medical education and add 5,000 post gra­duate seats for specialist courses; converting 1.5 lakh sub centres in villages to health and wellness centres to provide more comprehensive care. All these announcements will increase the accessibility and affordability of healthcare for the masses.

Surprisingly, there is no mention of increased budgetary allo­cations for the prevention, control and care of NCDs like cancer, diabetes, hypertension and heart diseases — which are the main causes of mortality and morbidity. The NCDs affect both rich and poor, urban and rural populations and are becoming a great concern in the rural setting where access to healthcare and emergency services is poor.

In the current Indian context, it is clear that it is NCDs and not infectious diseases that are the major cause of ill-health. Schemes such as the National Cancer Control Programme, the National Tobacco Control Programme, the National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke have been implemented, but these need to be strengthened, as in their current form they have not been able to reduce the burden due to limited scale of implementation, monitoring and awareness.

Since most NCDs are chronic, they are associated with a huge loss of potentially productive years (35-64 years) thereby causing huge economic losses at the individual level, and macroeconomic losses at the national and international levels. More resources need to be provided in order to create awareness and to adopt preventive health initiatives, especially those related to tobacco use and lifestyle changes.

Primary care centres

While the healthcare sector has made impressive strides in recent years in the care and treatment of NCDs, it is critical to strengthen its capacity to tackle NCDs more effectively and efficiently. Leveraging the strengths of the private sector to develop a road map to address NCDs through the network of primary care centres in the government sector could be a potential game changer.

In a unique effort to strengthen the fight against NCDs, the Association of Health Providers -India (AHPI) and the Public Health Foundation of India (PHFI) are organising a national conclave as a first step in a multi-collaborative approach. This will develop into a national think tank to holistically address issues related to health, and more specifically, NCDs. The National Health Conclave 2017 in Delhi will bring together stakeholders including government, research institutions, academia, industry, community and international agencies on one platform.

The underlying determinants of NCDs mainly exist in non-health sectors like agriculture, education, trade etc. Inter-sectoral collaboration to create an environment that promotes a healthy lifestyle is imperative. A nationwide database for NCDs and health interventions and surveillance will be useful in creating this environment. By synergising the efforts of the private and public sectors in the area of NCDs, the white paper resulting from the deliberations during the conclave is expected to have policies and strategies that can be realistically implemented.

It will also result in the formation of a group which will be in a position to actively inform the government on adopting the right policies and allocating funds in a manner that is reflective of the real health needs of the nation, conducive to the optimal utilisation of resources, and ensuring maximum access and affordability of health care for all sections of society.

(The writer is Executive Director, Association of Health Providers, India)