Finance Minister Ajanta Neog presented the budget for FY 2023–24 in the Assam Assembly on March 16, allocating 5.1 percent of the total budget outlay (Rs 1,39,755 crore) to the health sector. With the announcement that Assam would emerge as the hub of healthcare in NE India by 2026, and infrastructure is being set up accordingly, she allocated Rs 7,130.19 crore for the health sector in the budget, which is Rs 24.38 crore (a 0.34 percent decrease) than the budget estimates of Rs 7154.57 crore for the 2022–23 fiscal year.
The centerpiece of the budget 2023–24 in the health sector is the government’s plan to provide 100 percent health insurance coverage to National Food Security Act beneficiaries through a scheme, Mukhya Mantri Ayushman Asom Yojana, of Rs 5 lakh for 27 lakh additional ration cardholders for cashless treatment on the lines of the Atal Amrit Abhiyan. The scheme will be a supplement to the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana. Rs 135 crore have been allocated for this scheme. While Atal Amrit Abhiyan provided health insurance to individual beneficiaries, the Mukhya Mantri Ayushman Bharat Yojana will cover the entire family. To avoid duplicity, Atal Amrit Abhiyan will be discontinued. Until cashless cards are made available to all the beneficiaries, ration cards will be accepted in the empanelled hospitals to avail the benefits. The scheme is a significant step towards achieving the government’s long-term goal of ensuring affordable and quality health care for every citizen. It will reduce out-of-pocket private expenditure on health that has been pushing many people into poverty. The scheme will be a tremendous help to the people if it is implemented in letter and spirit.
Minister Neog proposed launching the Assam Urban Health Mission (AUHM) to provide affordable, accessible, and quality healthcare for the urban population. AUHM will include mapping of all urban healthcare facilities to identify the existing gaps, along with area-specific and need-based intervention. It will extend primary healthcare services with a strong linkage to secondary and tertiary care services in urban areas. For this, the FM proposed to add around 1000 ASHAs, set up 20 FRUs with special newborn care units, upgrade obstetric facilities at the secondary level, strengthen immunization facilities, and provide free diagnostic facilities and services related to non-communicable diseases in urban areas. The proposed mission will effectively reduce out-of-pocket expenditure for the urban population and prevent them from entering debt traps due to unforeseen health care expenditure if it is implemented properly.
Neog announced that ongoing construction of the Tinsukia Medical College is at an advanced stage. Construction of medical colleges in Charaideo, Biswanath, and the Pragjyotishpur Medical College in Guwahati is advancing smoothly. Further, steps are being taken to construct eight new medical colleges in Karimganj, Goalpara, Tamulpur, Bongaigaon, Dhemaji Morigaon, Goalghat, and Sivasagar. She also announced that the government would establish a new university college of medical sciences on the new campus of the Srimanta Sankaradeva University of Health Sciences (SSUHS) with a teaching hospital and two new dental colleges in Marigaon and Lakhimpur. Currently, nine medical colleges are fully functional in Assam, with 1200 MBBS, 722 PG, and 46 DM/MCh seats. Another three new medical colleges (Nalbari, Nagaon, and Kokrajhar) will start functioning from the current academic year as the National Medical Commission (NMC) has issued a letter of permission for the admission of 100 MBBS students in each college. This will increase MBBS seats to 1500 in Assam. The number of MBBS seats will substantially increase when all the medical colleges start functioning. However, the proposal in the budget for the reservation of some MBBS seats for NRIs and Assamese diaspora on payment of reasonable fees is not acceptable as it will deprive some meritorious unreserved category students of the state. Instead, the government should take the necessary steps to remove the restrictions so that they can compete with the students of the state for admission to the MBBS course in the medical colleges of Assam.
The establishment of new medical colleges plays a vital role in health care initiatives for citizens, providing the latest services and reducing the demand-supply gap. However, there was a need to give priority in the budget to the strengthening of all the existing medical colleges in Assam in terms of infrastructure development, recruitment of expert manpower, and installation of a number of high-end equipment. The proposal for new medical colleges is excellent if the state government can provide sufficient faculty and infrastructure for these new colleges. It is seen that most of the faculties of medical colleges in Assam have opted for either voluntary retirement or resignation. To stop this, the government must adopt some policies for the faculties, like a fair and transparent transfer policy, a higher salary, better accommodations, etc. One hopes the government will take the necessary steps in this regard.
Finance Minister Neog also announced the establishment of nine B.Sc. nursing colleges in the medical colleges in Diphu, Jorhat, Tezpur, Lakhimpur, Nagaon, Nalbari, Barpeta, Kokrajhar, and Dhubri. Investment in establishing nursing colleges is a progressive move in view of the severe shortage of nurses in Assam. This will definitely improve the nurse-patient ratio and help make quality healthcare accessible to a larger population. However, the current state of existing nursing colleges must be evaluated for upgradation and better job opportunities for nurses to be identified to curb international migration. Also, the proposed graduate college for paramedical sciences on the campus of GMCH, at an estimated cost of Rs 53 crore, will reduce the skill gap by producing more skilled paramedics.
Introduction of the Assam Mental Health and Social Care Scheme, establishment of super speciality wing at existing six medical colleges, infrastructure improvement of six district hospitals to upgrade them as super speciality hospital, providing Rs 300 crore for infrastructure improvement of the AMC, upgradation of the existing Regional Institute of Ophthalmology attached to the GMCH as a centre of excellence, introduction of smart classrooms with skill and simulation laboratory facilities in all medical colleges, introduction of master of hospital administration course under the SSUHS, providing 1000 new ambulances to the hospitals in the state, increasing wage compensation for pregnant women of tea garden areas of Assam to Rs 15,000 from the existing Rs 12,000, development of state-of-the-art health and wellness centres on the premises of the Assam Homeopathic Medical College, development of state-of-the-art Ayush health care centres on the premises of the Jibakanta Saikia Homeopathic Medical College and establishment of Swasthya Bhawan in Guwahati are excellent proposals in the budget if government can complete and implement them fruitfully.
The budget is promising in the health sector and expected to provide enhanced coverage of preventive, promotive, curative, and quality health care services to the people of Assam. However, there was a dire need to increase the health budget allocation. The government should focus more on primary healthcare investment and increasing public spending in the health sector.