In fact the usual practice of any
govt is that the exact expenditure(revised estimates) is usually 60% of
the proposed allocations . so out of 15000 crores that is allocated in
this 2022-23 budget, we are going to see only 8000 crores for health.
The figures proposed in the
budget are just estimates of the extent of expenditure the government is
willing to go for. The government later gives a revised estimate of how much is
possible for it to extend to the said sector. The revised estimates and budget
estimates may vary.
It is surprising that no
allocations have been made for establishing and strengthening of start-ups
especially in medical devices, pharma and technology in the health sector
A majority of the budgetary
allocations are for treatment and medical care, Rs 2,462.03 crore for National
Health Missions (Urban and Rural) and Rs 2,000 crore for YSR Aarogyasri Health
Care Trust.
Don't we learn lessons from the pandemic?
One should know the naked truth about the mortality during the covid pandemic-
India had the highest mortality of any country during the pandemic.
As many as 4.07 million people in India are estimated to have died during the COVID-19 pandemic in 2020 and 2021, according to a new analysis. This is eight times more than the number of COVID-19 deaths India has officially registered. Even now, the official toll is only 0.5 million.
official figures for AP is just 20000 deaths due to covid. But as per the study by the Institute for Health Metrics and Evaluation (IHME) published in Lancet ,the real harsh figures are 2lakh pandemic deaths.
An ongoing Supreme Court case has also been testimony to fatality undercounting during the pandemic. Many state governments have admitted, tacitly or otherwise, that they have sanctioned compensation claims for more victims than their respective registration systems have recorded.
not only the AP, the entire country should learn lessons from the pandemic. Whatever be the cause, it shows a huge mishandling of the pandemic. The death of 4 million people a massive mortality impact.
Right to Health ?!
Health is considered as a state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity. Health is one of the vital parameters of a country’s development.Though Right to Health may not be called as a Fundamental Right, however on Liberal interpretation of Article 21 of the Constitution of India, one may attempt to cover Right to Health as an integral part of Article 21; that guarantees Right to Life and Personal Liberty. There are various provisions under the Constitution of India, which deal with the Health of the Public at large.
Insurance Model:
The Andhra Pradesh government, like many other Indian states, has chosen to bank on insurance to uphold public health. The state’s Aarogyasri is among the earliest public health insurance scheme around. But how has it performed in its existence of nearly a decade-and-a-half? Aarogyasri has been lauded for some of the benefits it provides such as for tertiary and secondary care. But it also has a number of shortcomings.
90%of house holds in AP have
minimum one member under AS insurance.
the AP state has 1.44 CRORE white ration cards and 1.4 crore arogyasri cards.
The expansion of AS at the cost of
permanent infrastructure would be costly. simultaneous development of rural health infra is very much needed to provide right treatment at right time by right doctors!
Governance :
1.private Empaneled HOSPITALS have been complaining about the piling up of pending dues from the government.
patients occasionally complain that some hospitals reject the treatment
for some diseases and procedures. The fact is, such hospitals
might not be empaneled for that particular treatment under the scheme.
There are nearly 8,825 private medical care establishments under 11 categories including hospitals, diagnostic labs and others in the state at present. The state-level panel has to regulate them all, from registration to day-to-day functioning to implementation of acts, health schemes and directions from the state government. The panel also will inspect the establishments and recommend penal action including suspension and even their registration based on intensity of violation of norms. The vigilance and enforcement authorities have booked 89 private hospitals and penalised 66 hospitals to the tune of Rs 9.90 crore by June 3. 2021
2. SMALL &MEDIUM SIZE NON-EMPANELED HOSPITALS-stringent implementation of AP
Allopathic Private Medical Care Establishments (Registration and Regulation)
Act, 2002 will add more burden on small and medium size hospitals as they
need to fulfill the norms and procure more facilities that
could raise the charges of treatment which will hurt the pocket of the
patients!.
The government should see these small hospitals as a separate category and extend helping hand in the form of -
- Discounting the electricity and water charges and property taxes under domestic category.
- Remove these small hospitals (below 20beds) from the ambit of all regulatory acts, rules and taxes.
3. DOCTORS IN GOVT SERVICE: Govt has failed its doctors
in govt service. The UGC pay scales were due to them from 2016. But
the doctors did not get this benefit until March 1, 2021, that too without
being paid the arrears. This, has halved the pension of doctors who retired
before this date as PRC was delayed and pension is paid based on basic pay.
This being the scene, governments found it difficult in getting just 120
specialists to work in its CHCs.
4. INTERNS&JUNIOR DOCTORS: STIPEND ISSUES and WORK HOURS- IMA AP demands one nation-one stipend. uniform stipend on par with the stipend paid by govt institutions.
5. APPSC – Mid Level Health Provider – MLHP Recruitment SINCE 2019 Mid Level Healthcare Provider(MLHP) on Contract basis / purely temporary in nature from the eligible candidates against the vacancies available in the Health Sub-Centre – Health and Wellness Centers(HWC-HSCs).
They are authorized to work autonomously to diagnose, manage and treat illness, disease and impairments, as well as engage in preventive and promotive care. this is why the IMA is aphrensive and concerned about the discrimination the rural people experience in their health care.
The minimum educational qualification for psc.ap.gov.in recruitment 2022 is BSC Nursing, however, candidates with higher education also eligible for apply for Mid Level Health Provider – MLHP vacancy but age limit is mandatory.
B.Sc. (Nursing) and registered in the AP Nursing Council.
Must have studied Certificate Programme for Community Health (CPCH) as integrated Certificate Programme in the B.Sc. (N).
State govt didn't bother to consult the IMA and other stakeholders. The authorities executing purely arbitrary decisions. for example see the GOs - GO NO148, GO NO 57, GO NO 64 and so many!
Andhra Pradesh government set up
a16-member state-level advisory committee with special chief
secretary/principal secretary, health, as the ex-officio chairman. It
comprises 10 nominated members from stakeholder associations like
IMA, Consumer Forum and others in the state. But it never invite the IMA members
and still didn't constitute the district level advisory committees.
The state government intends to set
up district-level advisory committees shortly, with District Collector as
its ex-officio chairman and the district medical and health officer as
member-convener. It will have 10 members including two each from IMA and
AP Private Nursing Homes Association, two each from reputed NGOs dealing
with health care, two from Zilla Samakhya and two from legal professionals
and consumer organisations. The panels will have the same responsibilities as
the state-level panel but at district level.
Reforms in AS :
The
Govt revamped YSR Aarogyasri since 2019 by expanding the number of
network hospitals from 919 to 1,757( out of this total, 1400 are private) ,
increasing the procedures covered from 1,059 to 2,446, and enhancing the
ceiling limit to Rs 5 lakh income per annum per family.
“All
procedures costing more than Rs 1,000 are covered under the programme. About
1.4 crore YSR Aarogyasri Smart Health Cards with QR codes were distributed. As
per the National Family Health Survey – Round 4, the percentage of households
in AP with a member covered by a health scheme or health insurance, has
increased from 74.6% in 2019-20 to 91.27% in 2021-22,.
For the proposed 16 new
medical colleges minimum 15000 crores is necessary. if the govt plans to
complete the colleges in 5years ,per anum allocation should be 3000 crores
exclusively for new colleges. But in this budget the allocation is just 250
crores! THIS IS ONE GLARING EXAMPLE!
In conclusion
one can say,if the government want to complete the proposed 16 medical
colleges, 12000 rural family clinics, 600 urban clinics and 5 super-specialty
hospitals in tribal areas with in a decade, the govt must spend
minimum 25000 crores annually.
అనుకొన్న వన్నీ వచ్చే 10 ఏళ్లలో సాకార మవ్వాలంటే కనీసం ఏడాదికి 25000 కోట్లు ఆరోగ్యరంగం పై ఖర్చుపెట్టాలి. ఇప్పుడు ఖర్చుపెడుతున్నట్లు ఏడాదికి 10000కోట్లు ఖర్చుపెడుతూ ఉంటె, అనుకున్నవి పూర్తవ్వడానికి 30 ఏళ్ళు పడుతుంది.
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