The Maharashtra government is in the firing line for its performance on health indicator by experts, who claim that the outward appearance of progress belies the truth of the government’s performance.
“The last five years tell the story of lost opportunities as far as the health sector is concerned,” said Jan Swasthya Abhiyan (People’s Health Movement) co-convener Dr Abhijit More ahead of forthcoming Legislative Assembly elections in the state, in which the BJP-led government led by Chief Minister Devendra Fadnavis is seeking a second term.
During the state government’s term in office, Dr More says, “there was no leadership [on health]. There has been no appreciable budget increase. They has been no expansion of healthcare infrastructure or human resources. There has been no significant legislation in this five-year period.” Indeed, there is pressure from policymakers as well as health experts for state governments to raise health expenditure. Union Health Minister Dr Harsh Vardhan has recently called on state governments to raise their spending to five percent of their income.
In its manifesto, the BJP has pledged to free the state from drought and provide free health testing to all state denizens aged thirty or more, for conditions including diabetes, hypertension, leprosy, tuberculosis, and dental and mental healthcare issues. Yet whilst the state, which ranks among the most-developed in India, has made strides, experts say the Fadnavis government could have achieved more – particularly concerning health spending.“Health expenditure has been stagnant or even lower than before,” opines health economist Ravi Duggal. Indeed, per capita health spending in the state is a mere Rs 975 – higher only than that of Bihar (Rs 898) and Uttar Pradesh (Rs 892). “Maharashtra spends only 0.5% of the state income on health, while other states spend much more,” Duggal adds. By comparison, in the 1985-86 period, the Maharashtra government spent one percent of the state’s income on health. Its allocation in the 2017-18 fiscal year marked a 5.4 percent reduction in its allocation the previous fiscal year.
In addition, the Maharashtra government government has also cut funding for the Integrated Child Development Scheme in recent years despite a high burden of malnourishment – one which cuts to nutritional schemes has exacerbated. Indeed, on malnutrition and health more broadly, Maharashtra fares poorly compared to national averages on a number of indicators. Data collated by The Wire showed that the state had levels of wasting, anaemia, immunisation coverage, and out-of-pocket spending on health similar to or higher than the national average.
This is despite, as observers have noted, Maharashtra being among India’s wealthiest states. To be clear, Maharashtra has made progress on a number of indicators – effecting declines in its infant and maternal mortality rates, reaching increased numbers of citizens with free ambulance services, and reducing doctor vacancies. Yet there is a consensus that health spending is sorely needed to build on these achievements.
“With rising healthcare inflation, year-on-year the health budget should increase rather than decrease,” said Dr D. K. Mangal, a Research Dean at the Indian Institute of Health Management. “Maharashtra’s health indicators may be better than the national average but they are certainly not commensurate to its economic development. If the state has to maintain its achievements in infant mortality rate (IMR), maternal mortality rate (MMR) and further reduce them and move towards the sustainable development goals (SDG), it needs to allocate more budget towards health in [the] next five to ten years.”