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Will India achieve the SDGs on health?

The United Nations headquarters in New York.

India’s aim to meet the United Nations Sustainable Development Goals (SDGs) on Health seems likely to be unattainable by 2030, the Comptroller and Auditor General of India (CAG) has said. The main reason it identifies behind this is India’s ability to achieve public health expenditure targets, as the country faces a relative dearth of data to track its progress.

“There is a long way to go before the target of public health expenditure is achieved and the central allocation for health for 2019-20 is far short of target,”  the CAG said in a report titled “Preparedness for the Implementation of Sustainable Goals”.

The National Health Policy has envisaged increasing government public health expenditure to 2.5 percent of GDP by 2025. This figure has remained within a narrow band of between 1.02 and 1.28 percent of GDP for a number of years. This remains quite low compared to the global average.  The World Health Report 2010 noted that “it is difficult to get close to universal health coverage at less than 4–5 percent of GDP.” 

The CAG report indicates that these gaps “represent risks for the achievement of the key objectives of the 2030 Agenda”. Similarly, NITI Aayog’s three-year action agenda (2017-20) projects central allocation for health sector to Rs 1 lakh crore by 2019-20. However,  the allocations have fallen short with only allocating Rs 53,294 crore (US$7.7 billion) in 2017-18; Rs 56,045 crore (US$8.1 billion) in 2018-19; and Rs 65,038 crore (US$9.4 billion) in 2019-20, the report noted. In states, health spending, as a percentage of total states’ expenditure, ranged from 3.29 to 5.32 percent – suggesting this needs considerable augmentation. 

A World Health Organisation report directly relates public health spending to universal health coverage (UHC). It states, “UHC performance improves as countries increase public spending on health; convergence in performance between countries is also observed as spending increases.” This convergence improves once countries spend more than PPP US $40 per capita. 

India’s National Health Policy 2017, designed to meet the SDGs, seeks allocation to increase by more than 8% of their annual budgets by the year 2020. However, the seven states evaluated spent between 3.29% and 5.32% for the period of 2012-2017.

Recently, Health Issues India had reported the stark difference between government spending on defence to health. Despite terrorism deaths only amounting to 0.007 percent of total deaths as compared to ninety percent due to ill health, India spends ten percent of its GDP on defence, whereas a minuscule one percent is spent on public health.

The SDGs aim to achieve UHC by 2030, which can only be attained by systematic planning. This has to start by strengthening the public healthcare system from the primary to the tertiary levels. It requires adequate infrastructure, human resources, medicines and other facilities. This has to be done in a determined way by improving the infrastructure and bringing back trust in the public healthcare and can only be achieved by thought comprehensive innovation and investment in the sector. 

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