Generating resources for health care: A discussion

Brig R Borthakur (Veteran)

(The writer can be reached at ranshre03@yahoo.com)

The deadly disease COVID -19 has clearly brought out that no country in the world is prepared to deal with health issues of such a magnitude. The speed at which the virus spreads has demonstrated that the highly mobile, inter-connected world provides myriad opportunities for the rapid spread of such infectious diseases. India by following strict lockdown measures has been meeting this challenge by waging a fairly successful war against COVID-19 though currently it is far from over.

Besides COVID-19, every year thousands of lives are lost in India and in many other countries due to communicable diseases as well as non-communicable ones. Moreover, new diseases like SARS, Nipah, Ebola, Avian Influenza etc have led to the loss of lives in many countries.

Thus, it is clear that in order to meet similar challenges in the future, the countries have to create adequate infrastructure in terms of hospitals, doctors, nurses, paramedics and others. While developed countries spend substantial amounts on healthcare, India's public health expenditure is amongst the lowest. India's budget for health and family welfare for the year 2020-2021 is Rs 67,112 crore. This is extremely low for a population of 130 billion. It is about 1.17% of the GDP. India has one doctor per 1,700 patients, 1 nurse per 1,000 patients.

But where can the nation raise adequate funds for health care (education and other social sectors)? Countries all over the world, including India, spends huge amount on defence. There is no doubt that national security is of prime importance. However, in the name of national security (real or imaginary) millions of dollars are used to acquire weapons which in all likelihood will never be used. Yet these are 'deterrent' which every country would like to acquire.

With the establishment of UNO in 1945 at the end of World War II, it was hoped that peace and security would prevail in the world. The organization (UNO) can be given credit that during the last seventy five years no global war has taken place. But a number of conflicts, localized wars, limited war, terrorism etc continue in many parts of the world, many instigated and engineered by countries like the USA mainly to help their defence Industries. Then there are looming threats of global war, nuclear war, chemical and biological war etc.

Thus, the defence budget continues to rise in almost all countries. The defence budget of the USA in 2019 was 717 billion dollars, followed by China 177 and India 61 billion dollars. The USA and its allies justify that it has the responsibility and the mandate to maintain International peace and security; it has to support global order and deter other countries from waging war. This has rippling effects on many other countries. But strong and powerful countries like the USA, with nuclear weapons which could finish the world many times over have found that they are short of ventilator, medicine, health care workers to fight COVID-19. The most lethal weapons have been nullified by coronavirus.

There is no doubt that India should definitely spend more on healthcare. Moreover, India's healthcare is urban centric. There are a number of reasons why doctors do not want to serve in rural areas namely professional isolations, disparity in living conditions, security etc. India has substantive Research and Development capabilities, large pool of skilled workers and established role of "pharmacy of the world" which has been acknowledged by the world.

How can we generate resources for healthcare? Can we reduce our defence budget and allot adequate funds for health sector? But unfortunately we have two neighbours who always look to create troubles for us. Pakistan, where healthcare scenario is absolutely worst spends crores of rupees (Pakistan ranks 20th in the world)) on defence. Besides Pakistan gets huge defense aid primarily from China (as well as the USA). Even at this juncture while the entire world is fighting the pandemic, Pakistan is continuing with its proxy war in Jammu & Kashmir. They have been trying to push in militants into Kashmir valley as evident by the increase in encounters with our Security Forces. Pakistan and India, both nuclear powers which deter a conventional war breaking out, continue to acquiring fighter aircrafts, missiles and a host of other hardware and in many cases from the same countries. Thus, it is obvious that military industrial complex (particularly in the USA) are benefitting from such huge acquisitions.

Similarly, how can one trust China, especially after the way it suppressed information on coronavirus. We have also seen how in 1962, China betrayed India by talking "Hindi -Chini Bhai Bhai" and at the same time, attacking India. Now they have been again aggressive carrying out incursions in numbers of locations of the Eastern Ladakh. Therefore, at this stage India cannot be caught off guard as far as defense preparation is concerned.

Though India's defence budget looks big on paper but in reality this year's budget allocations is only 1.8% of the GDP, lowest since 1962. Moreover, 70% of the budgeted amount is spent for pay and pension of soldiers and civilian defence employees. Only 30% is earmarked for capital expenditure (procuring aircrafts, ships and other defence hardware). Can India consider diverting a portion of this year's defense budget earmarked for acquisitions of military hardware towards health sector?

Another way the Government can think of generating fund is by reducing subsidies. In the budget 2020-21, Rs 2,62,109 crore has been earmarked for different subsidies which include Rs 1,15,570 crore on food subsidies, Rs 40,915 crore on petroleum subsidy and Rs 71,309 crore on fertilizer subsidy. Every state doles out huge subsidies, especially when the election time approaches. Moreover, it is seen that subsidies tend to reduce efficiency and hampers work culture. While the government may not be able to reduce subsidies, it can institute strong measures to plug leakages on the subsidy chain and encourage people to give up subsidies. The government can also plan to close down all the loss making public sector enterprises such as Air India and can divert the resources to healthcare.

Another big issue which is impacting healthcare is population growth. A strong population policy needs to be conceived and implemented. Another important matter that needs addressing is health education. Probably, the spread of corona could have been reduced had we strictly followed basic health hygiene.

Thus India needs to initiate multi-pronged measures which include the introduction of strict austerity drive to generate resources to face health and economic challenges in the future.