Jan Swasthya Abhiyan Rajasthan in a meeting held on 27th February 2018 expressed its deep discontent with the state health budget for the financial year 2018-19 and the government’s increasing inclination towards privatization of public health facilities. The meeting held at Vinobha Gyan Mandir, Jaipur was attended by about 70 civil society representatives, public health experts, academicians, lawyers and PRI members from across the state, who reiterated the concern that public health facilities in the state, and especially preventive and primary health care services, have for long been in a state of neglect and that there is an urgent need for adequate budgets to revamp and expand existing health and nutrition related services. The Abhiyan also expressed concern over increasing dependency of the state on health insurance scheme and PPP of public health facilities and cautioned the state that while this approach to health care may attract patients to seek treatment, but it would do little to reduce out of pocket expenditure on health or improve indicators such as maternal mortality, infant mortality, anemia, malnutrition etc.

Inadequate state health budget:

The Abhiyan highlighted that while the overall state health budget has shown an increase in monetary terms from 10800 crores (RE) in 2017-18 to about 12813 crores in the current budget, yet in terms of state GDP it's not any different from the previous budget. Abhiyan has for long been demanding that the state health budget should be increased to at least 2.5% of the state’s GDP, while it has been hovering at close to 1% since quite some years, which is grossly inadequate to deliver quality health care services to a population of 7 crores. What is astonishing is that this fiscal year the budget for NRHM has seen a steep decline from 2158.62 crores in revised budget estimates of previous year to 1788.61 crores in the current announcements. This would certainly mean that preventive and promotive health care services in rural and deprived areas would evident huge setback.

No increase in budget allocations for free medicines and free diagnostic schemes:

The Abhiyan stated that the focus of the current budget announcements has largely been on augmenting health infrastructure by bringing about new health facilities and upgrading the existing ones, without any thought on how the government is going to meet the mammoth shortfall of human resources including that of doctors, pharmacists, lab technicians etc, which for long has been an issue of grave concern for the state. The budget allocations for free medicines and free diagnostics this year have remained almost the same as last year with an allocation of 557.09 crores for free medicines and 185.39 crores for free diagnostics. The previous year’s budget (RE) was 560.02 crores and 175.51 crores for free medicines and free diagnostics schemes respectively.It indeed is quite amusing to see that while the state has suggested that the number of health care facilities both at primary and tertiary levels will be increased, it has not made any provisions to meet the increase in demand of free medicines and free diagnostics that this would call for.This raises a big question mark on the government's intent to strengthen free medicines and diagnostic services.

Increasing dependence on health insurance and PPP:

It is still not clear as in how much budget has been allocated for Bhamashah Swasthya Bima Yojana, but there's all probability that the budget for the scheme would receive a considerable hike, as was evident last year as well, given the very inclination of the government to expand and sustain its flagship scheme. In 2017-18 the scheme saw an abrupt raise in its budget to around 1500 crores. The current budget also categorically had a mention of establishing medical colleges and other hospitals on PPP mode. This alternately means that there's going to be more private empanelment and more public money would be diverted to private kitty. The state has already handed over more than 100 rural and urban PHCs to private agencies to be run on PPP mode.

Abhiyan demands shifting elementary education of children in the age group 3-6 years from anganwari centres to primary schools:

The Abhiyan also raised concern around malnutrition and anemia among children and women. Anaemia of more than half and lesser body mass index (BMI) of more than quarter of women in reproductive age group of the state is urgently required to be corrected. In one of its major demands Abhiyan stated that elementary education of children aged 3-6 years should be shifted from Anganwari centres to primary schools.All government schools should have nursery section and admit children from age three onwards as is being the practice in most of the privately funded schools. This entails delinking children of 3 – 6 years age group from Aganwadi centre. The reasons for this change as suggested by Abhiyan are:

  • Meals provided in schools are much better in quality and quantity and hence could impact the state of undernutrition in children.
  • Pre-primary education or what is called as Early Childhood Education and development could be better organized if the children are part of formal schooling system.
  • There would be better attendance of children as they could come with their elder siblings and the parents will also find it easy to manage.
  • School health programmes under the National Bal Swasthya Karyakram (NBSK) is better organized and can easily take over the health related functions of the children in the age range of 3 - 6 years.
  • Schools closed down or merged for the reason of not enough number of children can be reopened as the number of children would significantly increase after children of 3 – 6 years join in.

Together with this Abhiyan also emphasized that Aganwadi Centres should be engaged in Infant & Young Child Feeding (IYCF) and for dietary needs of pregnant and lactating mothers. Anganwadi centres could be turned into crèches wherever the need be. Women can leave children while going for work or spend around three hours daily with their more than six months and less than six months old child.