Public health spend inadequate, falling

It is a matter of concern that government spending on health has fallen despite claims that the health sector would get increasing budgetary support. According to the latest National Health Accounts data, government expenditure on health as a percentage of GDP saw a decline in 2018-19, the latest financial year for which figures are available. After a steady rise for 14 years, it fell to 1.28% of GDP from 1.35 % in the previous year. This shows that even before the pandemic, the country was not on course to achieve the public health spending of 2.5% of GDP by 2025, which was the target set in the National Health Policy of 2017. In comparison, China spends 5-6% of its much larger GDP on health and most other countries spend more than 4-5%, with some going up to even 15-16%.

Some other figures related to public health spending are also not very comforting. The total health spending, which is expenditure by government and non-government agencies, declined from 3.9% of GDP to 3.2% in the five years up to 2018-19. The per capita healthcare expenditure had risen from Rs 3,174 in 2013-14 to Rs 3,503 in 2016-17 but fell to Rs 3,314 in 2018-19. The data also shows that out-of-pocket expenditure on healthcare declined, but this has not been fully explained. It decreased from 62.6% of the total health expenditure in 2014-15 to 48.8% in 2017-18 and to 48.2% in 2018-19. Though this should be considered good, there is a view that this may be because fewer people have been seeking healthcare. Even after the fall in out-of-pocket expenditure, it is still high in comparison to what people in other countries in the region, including Pakistan, pay for healthcare.

Beyond all these percentages of national and individual spending, the clear finding is that the government’s efforts to improve the public health situation are below par and have not progressed much in the last few years. It should be realised that the fractions of percentages of health expenditure and performance affect the lives and wellbeing of millions of people. The fact is that most people do not get the healthcare they need because they have no access to public health facilities, which either do not exist or are inadequate. They can’t afford private medical facilities. Every citizen has the right to healthcare and the government has the duty to provide it. The data shows that public health has not got the priority that it should get.