Analysis of health budget

2012-2013

ADMINISTRATIVE STAFF COLLEGE OF INDIA, HYDERABAD

WHAT IS BUDGET ?

• It is the detailed plan expressed in quantitative terms, that specifies how resources will be acquired & used during a specified period of time.

• WHAT IS UNION BUDGET ?• The union budget of India, referred to as annual Financial Statement

in Article 112 of constitution of India, is the annual budget of the Republic of India, presented each year on the last working day of February by the Finance Minister of India in Parliament.

• The budget has to be passed by the parliament house before it come into effect on April 1, the start of India's financial year. The Union Budget 2012-13 presented by Mr.Pranab Mukherjee on March 16, the Financial Minister of India on16th March 2012.

• The budget implemented on 1st April 2012.

HEALTH BUDGET

• Allocation for National Rural Health Mission (NRHM) proposed to be increased from ` 181.15 bn in FY12 to ` 208.22 bn in FY13.

• Scope of Accredited Social Health Activist– ‘ASHA’• National Urban Health Mission is being launched.• Pradhan Mantri Swasthya Suraksha Yojana• New integrated vaccine unit to be set up in Chennai.• Budgetary allocation for rural drinking water and sanitation

increased from ` 110 bn to ` 140 bn, representing an increase of over 27%.

• Preventive health checkup deduction up to 5000 Rs. allowed • 5 year extension to the 200 percent R&D tax deduction up to

2017• Fund allocation for the health sector recorded a paltry 14%

increase in 2012-13 to Rs 30,477 from Rs 26,760 crore• duty of 6% on iodine• Basic customs duty on probiotics will be reduced from 10% to

5%.

HEALTH BUDGET FINANCIALS

2010-2011 2011-2012 2011-2012 2012-2013

Actuals Budget estimates Revised estimates

Budget estimates

Ministry of health and family welfare

20726 26760 24315 30477

Department of health and family welfare

19362 23560 21577 27127

Department of AYUSH 849 900 650 990

Department of health research

515 600 588 660

Department of AIDS control

---- 1700 1500 1700

NRHM

NATIONAL RURAL HEALTH MISSION

• Inaugurated on April 12,2005• Correct the deficiencies of the health system.• Focus on 18 states- northern and eastern(Arunachal

Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, J&K, Manipur, Mizoram, Meghalaya, MP, Nagaland, Odisha, Rajasthan, Sikkim, Tripura, Uttaranchal, UP)

• Intended for 2005-2012 now extended to 2017.

AIM

• ASHA(Accredited Social Health Activist) To provide accessible, affordable, accountable, effective

and reliable primary health care through creation of ASHA.Reduction in Infant mortality rate(IMR)Reduction in maternal mortality rate(MMR)Universal access to public health services like women’s

health , child health, water , immunization, sanitation and hygiene and nutrition.

Prevention and control of communicable and non-communicable diseases.

Revitalise local health conditions and main stream AYUSH.

MMR & IMR

INFANT MORTALITY RATE

Components of NRHM

ASHA• Resident of the village• One ASHA per one thousand population• Chosen by Panchayat• Bridge between ANM & village• Receiving performance based compensation.

Responsibilities of ASHA

• To create awareness• Counselling• Encouragement• Accompany the pregnant women

requiring treatment and admission to the nearest PHCs

• Primary medical care • Providers of DOTS

STRENGTHENING SUB-CENTRES• Each sub-centre will have an Untied Fund for local action @ Rs.

10,000 per annum.• Supply of essential drugs, both allopathic and AYUSH, to the Sub-

centers.STRENGTHENING PRIMARY HEALTH CENTRES• Adequate and regular supply of essential quality drugs.• Provision of 24 hour service in 50% PHCs by addressing shortage of doctor.

.

STRENGTHENING CHCs FOR FIRST REFERRAL CARE• Operationalizing 3222 existing Community Health Centers (30-50

beds) as 24 Hour First Referral Units.• It includes medicine doctors, surgeon, gynaecologist, anaesthetist.• Developing standards of services and costs in hospital care.DISTRICT HEALTH PLAN • Health Plans would form the core unit of action proposed in areas

like water supply, sanitation, hygiene and nutrition.• District becomes core unit of planning, budgeting and

implementation.• District Health Mission.

CONVERGING SANITATION AND HYGIENE UNDER NRHM-• Total Sanitation Campaign.

STRENGTHENING DISEASE CONTROL PROGRAMMES-• National Disease Control Program.• New Initiatives would be launched for control of Non Communicable

Diseases.• Supply of generic drugs.• Provision of a mobile medical unit

REORIENTING HEALTH/MEDICAL EDUCATION TO SUPPORT RURAL HEALTH ISSUES-

• While district and tertiary hospitals are necessarily located in urban centres, they form an integral part of the referral care chain serving the needs of the rural people.

• Medical and Para-medical education.• National Institution for Public Health

Management etc.

HIGH FOCUSED STATES

• So, NRHM is the way to provide better healthcare to rural village system.

• It helps to connect sub-centres to PHC’S to CHC’S to District hospital.

NUHM(NATIONAL URBAN HEALTH MISSION)

The Central government has planned to develop a new scheme of National Urban Health Mission (NUHM) in order to highlight the health challenges in towns and cities

Provisional Census 2011 data showed that for the first time since Independence, the absolute increase in population was more in urban areas that in rural areas.

At present, rural population in India is 68.84 per cent (down from 72.19 per cent in 2001 Census) as against 31.16 per cent urban population.

Of the 370 million urban dwellers, over 100 million are estimated to live in slums and face multiple health challenges on the fronts of sanitation, communicable and non communicable diseases.

As per sensus 2011 ,37.7 crore people live in urban areas.Urbanization in India 1951 - 2026

Urb

an P

opul

ation

(in

mill

ion)

Percentage to total population

India has been urbanizing rapidly in recent decades. It is estimated that the urban population will nearly double to reach 534 million by 2026.

Health challenges in urban India

Smaller the city – bigger the problem

NFHS 3(05-06)

Health challenges in urban India (Cont..)

Poor supply of Funds: 77% Public Subsidy for Curative Care Goes to Richest 3 Quintiles

Research and knowledge/information gaps

Poor community awareness and weak community capacity to demand and access health care

Poor family support system

Poor Environmental Conditions

GOAL

Improving the efficiency of public health system in the cities by strengthening, revamping and rationalizing urban primary health structure.

• Provision for a need based contractual human resource, equipment and drugs.

• Partnership with non-government providers for filling up of the health delivery gaps.

• Promotion of access to improved health care at household level through community based groups : Mahila Arogya Samitis.

• Strengthening public health through preventive and promotive action.

• Increased access to health care through risk pooling and community health insurance models.

• All the services delivered under the urban health delivery system are based on identification of the target groups (slum dweller and other vulnerable groups); preferably through distribution of Family/ Individual Health Suraksha Cards.

Scope, Coverage and Duration of the Mission

• The Mission would be covering 430 cities, i.e. all cities with population one lakh and above.

• The duration of the Mission would be for the remaining period of the 11th Plan (2008-2012).

• The initial focus would be on the urban slums then it will be extended to the whole urban population .

INSTITUTIONAL FRAMEWORK

Community Level Urban Social Health Activist (USHA)USHA would remain in charge of each area and serve

as an effective and demand–generating link between the health facility and the urban slum populations.

The USHA would preferably be a woman resident of the slum

Mahila Arogya Samiti (MAS) Act as community based peer education group,

involved in community monitoring and referral. The MAS may consist of 20-100 households (HH) with an elected Chairperson and a Treasurer, supported by an USHA

Budgetary Provisions• The NUHM would commence as a 100% centrally sponsored

Scheme in the first year of its implementation during the XIth Plan period.

PRADHAN MANTRI SWASTHYA SURAKSHA YOJNA

PHASE 1S. NO. AIIMS

1. PATNA, BIHAR

2. RAIPUR, CHATTISGARH

3. BHOPAL, MADHYA PRADESH

4. BHUBANESHWAR, ODISHA

5. JODHPUR, RAJASTHAN

6. RISHIKESH, UTTRANCHAL

6 New AIIMS started by government.

S. N AIIMS

1. LOCATION NOT SELECTED, U.P

2. RAIGANJ, WEST BENGALPHASE 2

decided to strengthen 13 existing Medical College-• An outlay of Rs. 120 crore has been approved for

upgradation of each medical college institution.• the Government of India is investing Rs. 100

crore for each institution and the State Government’s share is Rs. 20 crore.

• The estimated cost for setting up each institute is Rs. 332 crore.

S. No. State Name Of Institution1st Phase

1. Andhra Pradesh (1) Nizam Institute Of Medical Sciences,hyderabad.(2) Sri Venkatshwara Institute Of Medical Sciences,tirupati

2. Gujrat B .J.Medical College, Ahmedabad

3. Jammu –Kashmir (1) Govt. Medical College, Jammu(2) Govt. Medical College,srinagar

4. Jharakhand (1) Rajendra Institute Of Medical Sciences,ranchi

5 Karnataka (1) Govt. Medical College ,Banglore

6. Kerala Govt. Medical College,thiruvananthpuram

7. Maharashtra Grants Medical College,mumbai

8. Tamil Nadu Govt. Mohan Kumarmangalam Medical College,salem

9. Uttar Pradesh (1) Sanjay Gandhi Postgraduate Institue Of Medical Science, Lucknow(2) Institute Of Medical Sciences, Banaras Hindu University, Varanasi

10. West Bengal Kolkata Medical College,kolkata

Upgradation of 13 medical institutes under PMSSY

2ND PHASE

1 HARYANA PANDIT B.D. SHARMA POST GRADUATE INSTITUTE OF MEDICAL , ROHTAK

2 HIMACHAL PRADESH

DR. RAJENDRA PRASAD GOVT. MEDICAL COLLEGE, TANDA

3 MAHARASHTRA GOVT. MEDICAL COLLEGE,NAGPUR

4 PUNJAB GOVT. MEDICAL COLLEGE,AMRITSAR

5 TAMIL Nadu GOVT. MEDICAL COLLEGE,AMRITSAR

6 Uttar pardesh JAWAHARLAL NEHRUGOVT. MEDICAL COLLEGE OF AMU,ALIGARH.

NEW INTEGRATED VACCINE UNIT

• India will up a state-owned unit to build a 5.9 billion rupees integrated vaccine complex project in the southern state of Tamil Nadu.

• HLL Biotech Limited.• build in the Kanchipuram district.• produce vaccines for DPT, hepatitis B,

BCG, measles, Rabies, Japanese encephalitis and haemophilus influenza B, known as Hib.

IMPACTS OF HEALTH BUDGET• The Budget has focused towards improving healthcare services at the

rural as well as urban region. • The increased NRHM outlay is expected to further improve access to

healthcare in the rural areas. • Under the PMSSY scheme, the Government aims at setting up eight

AIIMS-like institutions and up gradation of existing Government medical colleges.

• Drug prices may rise due to excise duty hike • Undergoing a preventive health check-up will help a consumer save tax

up to Rs 5,000• Boost for probiotics product industry• The healthcare service in the urban region is also expected to increase

with the launch of NUHM. Enhanced rate of deduction linked to capital expenditure is expected to increase investments in hospitals in the coming years.

• These measures are expected to have a marginally positive impact on the healthcare sector.

Current status of schemes

•NAGPUR: Though there was a delay in work in the initial phase, the GMCand Hospital (GMCH), which is being upgraded as the state-of-the-art medical college under the PMSSY, now seems to be moving at the right pace. The project is about to enter the second phase.(rajaram powar, TIMES 7sep2012)

•National Vaccine Policy: For industry, not people's healthThe new National Vaccine Policy Draft 2011openly favours industry. It provides for advance market commitments for new vaccines.(Jacob Puliye is a member of the National Technical Advisory Group on Immunisation and of the Working Group on Food and Drug Regulation in the 12th Five-Year Plan. inEPW November 5, 2011)

RELATED ARTICLES

REFRENCES • BUDGET-

indiabudget.nic.in/health.india.com › Diseases & Conditionsarticles.economictimes.indiatimes.com indiabudget.nic.in/ub2012-13/bh/bh1.pdfwww.grantthornton.in/.../budget/2012-13/.../Budget_2012-13 india.blogs.nytimes.com/.../budget-2012-13-populist-measures• NRHM- www.mohfw.nic.in/NRHM.htm• NUHM-www.uhrc.in/downloads/Reports/NUHM-Draft.pdfmohfw.nic.in/NRHM/Documents/.../UH_Framework_Final.pdfhttp://articles.economictimes.indiatimes.com/2012-06-30/

news/32484215_1_health-sector-nrhm-public-health-systems

• PMSSY-mohfw.nic.in/index4.php?lang=1&level=0&linkid=96&lid.india.gov.in/citizen/health/health.php?id=41• INTEGRATED VACCINES COMPLEX-articles.timesofindia.indiatimes.com › Collections › Hibpib.nic.in/newsite/erelease.aspx?relid=82683http://www.upiasia.com/Health/2012/05/03/New-Indian-unit

-to-build-113m-vaccine-project/CVB-1336017818537/

ADMINISTRATIVE STAFF COLLEGE OF INDIA, HYDERABAD